Lecture 4 Adult Obesity Flashcards
Define obesity
Obesity is a chronic, progressive disease
characterized by abnormal or excessive body fat
(adiposity) that impairs health and decreases life
span.
Main messages from 2020 CPGs for obesity
The ’obesity’ field is starting to apologize for the stigma/bias it has caused. Everyone deserves to be treated with respect, dignity and care
* Not all people with higher weights, BMIs or larger body sizes have obesity
* NEW: Obesity is a chronic, progressive disease characterized by abnormal or excessive body fat (adiposity) that impairs health
* BMI should NOT be used at the individual level to diagnose obesity
* Emerging evidence is shifting our understanding and treatment options. Move away from weight, body size or shape to focus on
improving health outcomes. Research community to shift the focus from BMI and weight towards health based outcomes (regardless of weight change)
CPG recommendation
Adults living with obesity should receive
individualized medical nutrition therapy
provided by a registered dietitian (when
available) to improve weight outcomes
(body weight, BMI), waist circumference,
glycemic control, established lipid and
blood pressure targets.
* Level 1A, grade A.
5 key steps from CPG
- Ask permission to offer advice and help treat this disease in an unbiased manner recognizing obesity as a chronic disease.
- Assessment of an individual living with obesity, using appropriate measurements, and identifying the root causes, complications and barriers to obesity treatment.
- Discussion of the core treatment options (medical nutrition therapy and physical activity) and adjunctive therapies that may be required, including psychological, pharmacologic and surgical interventions.
- Agreement with the person living with obesity regarding goals of therapy, focusing mainly on the value that the person derives from health-based interventions.
- Engagement by health care providers with the person with obesity in continued follow-up and reassessments, and encouragement of advocacy to improve care for this chronic disease.
What is the 5 As framework for obesity management in adults?
- Ask
- Assess
- advise
- agree
- assist
Where is nutrition information gathered from?
- 80% online
- 70% social media or health celebs
- <5% nutrition professionals
What are typical expectations from people wanting to lose weight?
- Expect body weight and shape can be changed to what is desired
- Evidence-based outcomes for weight loss are lower than what is desired
- Want permanent weight loss when regain is normal
- Effort and outcome are mismatched
What is weight bias?
Weight bias is the inclination to form unreasonable judgments, negative attitudes and views about obesity and about people based on a person’s weight.
What is weight stigma?
Stigma is the social sign (stereotypes and
misconceptions) that is carried by a person who is a victim of prejudice and weight bias
What leads to weight discrimination?
weight bias and weight stigma
Consequences of weight bias
- Poor body image & body dissatisfaction
- Low self-esteem
- Low self-confidence
- Loneliness
- Sense of worthlessness
- Depression, anxiety and other psychological disorders
- Suicidal thoughts & acts
leading to…
* maladaptive eating disorders
* avoidance of activity
* stress induced pathohpysiology
* avoidance of medical care
Recommendations regarding weight bias for health professionals
Healthcare providers should
1. Assess their own attitudes and beliefs regarding obesity and consider how their attitudes and beliefs may influence care delivery
2. Recognize that internalized weight bias (bias towards oneself) in people living with obesity can affect behavioural and health outcomes
3. Avoid using judgmental words, images and practices when working with patients living with obesity.
4. Avoid making assumptions that an ailment or complaint a patient presents with is related to their body weight.
How to set the tone when working with someone living with obesity.
- Be positive
- Be understanding
- Be aware of non-verbal communication
- Be helpful and supportive
- Be collaborative
- Be environmentally aware
What is the preferred term to describe obesity?
Weight (for both makes and females)
* excess weight was next followed by BMI for both
* weight problems for men (although very small) but not for women
Undesirable terms to describe obesity
- weight problem (for females)
- unhealthy body weight
- unhealthy BMI
- heaviness
- large size
- excess fat
- obesity
- fatness
Person first language
patient with obesity
* instead of obese patient
Good versus bad language to use
Seek to not be
* Authoritarian “You must not eat these foods”
* Disapproving “You shouldn’t eat that” (red circle on records)
* Demanding “Before you come and see me, fill out this food chart so I can see what’s going wrong”
* Threatening “If you don’t lose weight, you’ll get diabetes”
Seek to be more
* Encouraging “I can see the effort you’re putting in…”
* Empowering “What changes do you feel are needed?”
* Collaborative “Let’s talk together about the different options and see what you think would suit you best”
* “How can I help you achieve your goals? “
Criteria for a disease
- Impairment of normal functioning of some
aspect of the body; - Characteristic signs or symptoms;
- Harm or morbidity
Therapeutic interventions reduce morbidity
and mortality
Obesity as a chronic relapsing progressive disease process
Clinical component of the medical diagnosis of obesity
candidates for weight-loss therapy can present with either excess adiposity (i.e. anthropometric component) or weight-related complications (i.e. the clinical component)
Iceberg of obesity
The root causes lie below the surface and need to do more digging to find changes
Measuring BMI
recommended classifications of BMI
Mortality Risk Ratio by BMI Category
Language with BMI
Describe waist circumference
Waist circumference is a modifiable risk factor that can indicate cardiometabolic risk, morbidity and mortality.
* Benefits associated with reductions in waist circumference might be observed with or without a change in BMI
