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NUTR 344: Clinical Nutrition 1 > 3. Obesity Pt 1- Introduction > Flashcards

3. Obesity Pt 1- Introduction Flashcards

1
Q
  • What is the current and most important definition of overweight/obesity classifications?
  • Why is this definition used versus the older definitions (“overweight” = excess body weight, incl. fat, muscle, bone and water; and “obesity” = excess body adiposity, men >25%, women >30%)?
A
  • A progressive chronic disease characterized by excess or abnormal body fat that can impair health.
  • Excess body adiposity levels can exist without the presence of health problems.
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2
Q

Which body shape is more often associated with health consequences; pear or apple?

A

Apple-shaped

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3
Q

Beige or brown adipose deposits can be found in what areas of the body?

A
  • Retro-orbital
  • Periarticular regions
  • Bone marrow
  • Cervical
  • Supraclavicular
  • Paravertebral
  • Abdominal (subcutaneous)
  • Gluteal (subcutaneous)
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4
Q

White adipose depots are considered more of a health risk than brown/beige depots, because of their locations in what body areas?

A
  • Subcutaneous: cranial and facial
  • Intra-abdominal: omental, retroperitoneal, and visceral
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5
Q

________ is when there is an increase in the total number of adipose cells. This leads to smaller amounts of lipid accumulation over all, and is considered a “healthy expansion”.

  • When does this occur?
  • When does insulin resistance typically occur?
A

Hyperplasia

  • Occurs by De novo adipocyte differentiation and angiogenesis
  • Occurs after a long time; no immediate insulin resistance
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6
Q

________ is when the adipose cells increase in size, leading to large amounts of ectopic lipid accumulation and lipotoxicity. It is considered to be a pathologic expansion.

  • What is this typically caused by?
  • When does insulin resistance begin to occur?
A

Hypertrophy

  • Inflammation, hypoxia, fibrosis
  • Insulin resistance occurs immediately and increases with size
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7
Q

What is the danger of ectopic lipid accumulation?

A

When fat grows in areas other than the expected subcutaneous areas, like around visceral organs, this can interfere with the proper functions of vital organs.

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8
Q

What are the risks of health problems based on BMI and waist circumference?

A
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9
Q

What BMI and waist circumference has the least risk for health problems? What combo has a very high risk level for health problems?

A
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10
Q

According to the WHO, the prevalence of obesity has increased by how much from 1980-2011?

A

The prevalence has more than doubled (~500 million obese individuals, incl. 43 million children under 5)

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11
Q

Despite the increase in obesity prevalence being referred to as an “epidemic”, why isn’t this term appropriate?

A

Obesity is not transmissible.

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12
Q

The prevalence of obesity has been shown to have a relationship with what factor in populations?

A

Obesity prevalence has a relationship with the economic development of countries.

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13
Q

What could account for lower-than-actual obesity prevalence levels (measured from BMI) in Canada?

A

BMI measurements are self-reported; there exists the tendency to overreport height and underreport weight. This leads to a lower-than-actual BMI calculation.

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14
Q

In Canada, which gender was found to have more prevalence of obesity in 2015?

A

Males were found to be more obese compared to females.

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15
Q

In Canada, the prevalence of obesity was found to be lower in groups that (2):

A
  • had higher education levels
  • were landed immigrants
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16
Q

What factors are typically associated with obesity?

A

Socio-economic status: race, gender/sex, education

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17
Q

Obesity increases all-cause mortality. What is obesity itself considered in relation to health?

A

Obesity is considered to be associated with illnesses and not a cause of illness.

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18
Q

What are the potential cardiometabolic risks associated with obesity?

A
  • CV diseases
  • Hypertension
  • Diabetes
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19
Q

What are possible health consequences associated with obesity?

A
  • CV diseases
  • Hypertension
  • Diabetes
  • Cancer
  • Breathing problems (apnea, asthma)
  • Arthritis
  • Hepatobiliary disorders (liver, gallbladder, bile ducts)
  • Reproductive and obstetrical complications
  • Surgical risk and complications
  • Psychosocial and emotional consequences
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20
Q

Obesity is associated with many health consequences that leads to higher health care costs. What is a theory that explains the prevalence of health issues in these individuals?

A

The tendency to avoid criticism on weight from health-care professionals by simply avoiding going to clinics or hospitals for health issues.

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21
Q

How can you read this graph?

What can you ascertain from this info?

A
  1. Anything touching the 1.0 dotted line indicates no increased risk for all-cause mortality.
  2. Bigger boxes indicate more individuals in the sample.
  3. Largest sample size falls at a BMI of around 26-27
  4. There is a linear relationship between increase in BMI and increased risk for all-cause mortality

What we can say from this graph:

  • BMI of 26-27 shows very little increase in risk to all-cause mortality; despite being considered overweight for women, and obese for men; increases more realistic weight recommendations for goal weights based on health
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22
Q

What can be expressed from the following graphs?

A

That even small increases in BMI can show increases in risk for CHD (coronary heart disease) and Type 2 Diabetes.

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23
Q

What can be used as an independent predictor of all-cause mortality in men?

A

Intra-abdominal (visceral) fat

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24
Q

Intra-abdominal fat in premenopausal women has been shown to increase the risk of Type 2 Diabetes. Why?

A

Testing of obese individuals with high intra-abdominal fat levels have depicted much higher insulin responses and blood glucose levels to the same glucose challenges given to both non-obese controls and obese individuals with low intra-abdominal fat, indicating insulin resistance in those with more visceral fat.

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25
Q

In females, obesity increases the risk of which types of cancers?

A
  • endometrium
  • ovary
  • cervix
  • breast (post-menopausal)
  • colon, gallbladder, kidney, liver
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26
Q

In males, obesity increases the risk of which kinds of cancers?

A
  • prostate
  • pancreas
  • esophagus
  • colon, gallbladder, kidney, liver
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27
Q

The prevalence of what hepatobiliary disorder is increased 3x in individuals with a BMI >30, abdominal obesity, and with rapid weight loss?

A

Gallstones

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28
Q

The risk for NAFLD (non-alcoholic fatty liver disease) is increased amongst obese individuals. What event can start the chain of events that may eventually lead to cirrhosis and liver failure?

A

Steatosis, or the accumulation of fat in the liver. This can lead to steatohepatitis, which is a liver disease characterized by inflammation of a fatty liver.

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29
Q

What kind of reproductive disorders are obese men at risk of developing?

A
  • Reduced testosterone and increased estrogen levels
  • Gynecomastia (swelling of breast tissue)
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30
Q

What kinds of reproductive disorders are obese women more at risk of developing?

A
  • PCOS (acne, irregular cycles, infertility, excess body hair)
  • During pregnancy= higher risk for gestational diabetes, preeclampsia, labor/delivery complications, fetal or maternal death
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31
Q

What etiological factors can be associated with obesity?

A
  • Energy balance
  • Appetite and body weight regulation
  • Genes
  • Environmental factors
  • Medical conditions and medications
  • …
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32
Q

What factors can have an influence on obesity?

A
  • Nutrition
  • Culture
  • Psychology
  • Inactivity
  • Heredity
  • Education
  • Socioeconomic status
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33
Q

Under what context did our genes and metabolism evolve?

Why is this important now?

A
  • Starvation
  • It was critical to survival to conserve and store energy before, though now there is a mismatch between our physiology and our modern, more sedentary environment.
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34
Q

Energy balance is based on which ONLY law applied in nutritional sciences?

A

1st law of thermodynamics (conservation of energy)

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35
Q

What is an obesogenic environment?

In an obesogenic environment, the body tends to do what?

A
  • High energy intake (high fat, energy dense foods; palatable, low-cost, available foods; large portion sizes) and low energy expenditure (sedentary lifestyle)
  • Store energy in the form of fat mass.
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36
Q

Where does the energy balance equation lose some viability?

A

The other factors involved in weight gain/loss make it more complicated than the simplicity of the Energy In/Out equation.

37
Q

What are the components of energy expenditure?

A
38
Q

The Total Energy Expenditure (TEE) is higher than usual in which type of individual? Why?

A
  • Higher in sedentary, obese individuals
  • The REE is more elevated due to higher quantities of fat-free mass (lean, metabolically active mass)
39
Q

What is different about energy expenditure between light/moderately active individuals and active individuals?

A

There is a greater TEE, with more of a proportion allotted to PAE.

40
Q

What component of the TEE is the same across all types of individuals, regardless of size or activity level?

A

TEF: the Thermic Effect of Feeding (5-10% of kcal/day)

41
Q

How do the proportions of TEE components differ amongst individuals of different weights and activity levels?

A
42
Q

Define hunger.

A

A physical sensation indicating the need or intense desire for food.

43
Q

Define satiety.

A

Feeling of fullness after eating.

44
Q

Define satiation.

A

State of being satisfactorily full associated with length of time between meals.

45
Q

Define appetite.

A

The desire to eat

“Orexis”

46
Q

What factors influence appetite?

A
  • Homeostatic control
  • Hedonic control: environmental, emotional and social factors
47
Q

What hormone secreted by the stomach induces feelings of hunger?

A

Ghrelin

48
Q

CCK, Oxynto-modulin, GLP-1, and PYY3-36 are produced by the gut to….

A

Inhibit hunger

49
Q

What hormone, produced by adipose tissues, inhibits the feeling of hunger?

A

Leptin

50
Q

The pancreas excretes insulin, amylin, and PP. Why are these known as some of the “Signals of Satiety”?

A

Due to their inhibitory effect on feelings of hunger

51
Q

When you drink water, what causes a signal of satiety to be sent through the vagus nerve?

A

Stomach distension by volume of water

52
Q

What organs/tissues are only involved in anorexigenic effects in appetite regulation?

A

The pancreas and adipose tissues

53
Q

The polygenetic effects on obesity influence primarily…

A
  • The distribution of body fat
  • Regulation of appetite
  • Metabolism
54
Q

Genetic and epigenetically determined factors determine an individuals’ _________ to obesity.

A

susceptibility

55
Q

What is an example of a rare congenital cause for obesity?

A

Down Syndrome

56
Q

Family studies, candidate genes, GWAS (genome wide association studies), and overfeeding of identical twins are examples of the types of studies done on genetic influence on obesity.

What have these studies tended to show?

A

That BMI of offspring tends to be similar to those of their biological parents.

57
Q

What is a common neuroendocrine disorder commonly associated with increased weight gain?

A

Hypothyroidism

58
Q

What type of steroid hormone is often associated with increased weight gain?

A

Corticosteroids (anti-inflammatories) have been linked to increases of 5-10 kg.

59
Q

Obesogenic environments have…

A

Physical, social, cultural and economic factors that promote weight gain and are barriers to weight loss

60
Q

In young children and young adults, obesity can often be associated with what other non-nutrition related factor?

A

Sleep deprivation

61
Q

Some children have shown more prevalence for obesity due to pre-natal exposures. List a few of these exposures.

Name something that may be protective against obesity prevalence for infants.

A
  • Low birth weight (body will tend to pack on more weight later)
  • High maternal BMI and pregnancy weight gain
  • Breast-feeding
62
Q

How does quitting smoking associate with obesity?

A

Nicotine increases metabolism so when somebody quits, the metabolism slows down.

63
Q

________ is an endocrine disrupting chemical (toxin) that is associated with obesity.

A

Bisphenol A (used in synthesis of plastics)

64
Q

True or false:

Viruses (like AD-36) and microbiota have been associated with obesity.

A

True

65
Q

Complete this position statement on obesity from The Obesity Society 2018:

“Obesity is a multi-causal _____ ________ recognized across the lifespan resulting from long term _______ energy balance with the development of excess _______ that over time leads to structural abnormalities, physiological derangements, and functional impairments.

The disease of obesity increases the _____ of developing other ______ ________ and is associated with premature _________.

As with other chronic diseases, obesity is distinguished by multiple _______, clinical presentations, and treatment responses.”

A
  • chronic disease
  • positive
  • adiposity
  • risk
  • chronic diseases
  • mortality
  • phenotypes
66
Q

What are the benefits to individuals by considering obesity as a disease?

A
  • Opportunity for standardized treatments
  • Insurance opportunities
67
Q

Obesity Canada 2020 considers obesity as a ________ chronic disease characterized by excessive body fat that ________ health.

A
  • relapsing
  • impairs
68
Q

What does the obese community face that contributes to increased morbidity and mortality independent of weight or BMI, according to Obesity Canada 2020?

A

Substantial bias and stigma

69
Q

A holistic approach to assessments of obesity prevalence should include looking into:

A
  • dietary history and habits
  • physical activity
  • medical, psychosocial, and cultural aspects
  • behavioral aspects
70
Q

Weight history, previous diets, food intake, patterns of meals, cooking ability, food budget, allergies, beliefs about food, use of supplements, medications, emotional and mindless eating are all things looked into when assessing ____ ________.

A

Dietary history

71
Q

How can PA be assessed?

A
  • Interviews
  • Questionnaires
  • Filling log sheets
72
Q

What is considered when PA is assessed?

A
  • Daily activities: type of work, mode of transportation, household chores, leisure activities…
  • Time spent: standing, sitting, sleeping
  • Formal exercise: walking, running, cycling, sports, weights…
73
Q

What do PA assessments usually not account for?

A
  • Intensity of the PA (brisk walk vs casual, ….)
  • Fidgeting (while standing, sitting….)
74
Q

What are some tools that can be used to begin to become aware of PA?

A
  • Pedometers
  • Accelerometers (estimate REE and total energy spent for the day)
  • Cell phone apps
75
Q

How is physical activity (PA) defined?

A

ALL leisure and non-leisure body movement resulting in a substantial increase in energy expenditure

76
Q

How is exercise defined?

A

A form of leisure time PA that is planned, structured and repetitive with the main objective of improving or maintaining physical fitness.

77
Q

How is physical fitness described?

A
  • Set of attributes that are either health or performance/skill related
  • Ability to carry out daily tasks with vigor and alertness without undue fatigue
  • The ability to meet unforeseen emergencies and enjoy leisure time pursuits with ample energy
78
Q

How is active living defined?

A

When PAs are an integral part of daily living

79
Q

What are the level numbers for low, moderate, and high PAL?

A
80
Q

Examples of Moderate PAs (energy expenditure)

A
81
Q

What are METs?

A

Metabolic equivalent tasks: the energy cost of physical activities

82
Q

1 MET =….

A

1 kcal/kg BW/hour (sitting or lying quietly)

or

3.5 mL O2 uptake/kg BW/minute

83
Q

METs can be converted to calories burned. Vacuuming has a MET # of 3.5. How would we calculate the MET of this activity for an individual?

A

3.5 x body weight (kg) x hours done

84
Q

Mild leisure activities have METs between _____ and _____.
Moderate leisure activities have METs between ____ and _____.
Vigorous leisure activities have METs > ________.

***#s are approximative****

A

Mild: 2.0-2.9

Moderate: 3.0 - 4.5

Vigorous: > 4.9

85
Q

What are some medical aspects associated with treating obesity?

A
  • Physical examinations
  • Blood pressure
  • Lab tests
  • Presence of uncommon causal disease (ex: hypothyroidism)
  • obesity complications
  • Age <16, pregnancy, lactation
86
Q

What are some psychosocial and cultural aspects associated with treating obesity?

A
  • Psychological disorders (ESPECIALLY eating disorders, anxiety, depression)
  • Sociocultural practices and beliefs
  • Previous approaches to weight control (help assess persons judgement)
  • Patient’s readiness (State of Change model)
87
Q

From the behavioral standpoint, the readiness to change lifestyles has a huge impact on managing obesity. What are the things to consider concerning readiness to change?

A
  • ****** Assess readiness to long-term commitment
  • family, friends, or social support
  • right timing
  • identification of barriers to long-term changes
88
Q

What are the steps in the Stages of Change model?

A

NUTR 344: Clinical Nutrition 1 (15 decks)

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