Obesity Treatment: Diet and Physical Activity

Question 1

body adaptations to calorie restriction

Answer 1

initial: negative energy balance

Long term: the body lowers energy expenditure

-most weight loss is achieved in first 3-6mths

Question 2

energy gap

Answer 2

• created by initial weight loss
• filled by lower calorie intake/ physical activity
• usual range: 700 calories/ day

Question 3

fact that indicates the body defends higher weight

Answer 3

24hour energy expenditure goes down more than would be expected by weight loss alone

Question 4

moderate calorie restriction

Answer 4

• deficit of 500-1000 calories/day
• 20-40% of calorie requirement for person consuming 2500 calories/ day
• achievable for several months without great difficulty

Question 5

component that is predictive of success in weight loss

Answer 5

self-monitoring of food

Question 6

recommended daily calorie deficit

Answer 6

500-1000 calories

1-2 pounds/ week at first

Question 7

calorie target for weight

250

Answer 7

1200-1500

Question 8

very low calorie diets

Answer 8

• less than 800-1000 or less than 50% of daily requirement
• more effective short term, same long term
• require medical monitoring

Question 9

how to determine if provider has successfully overcome weight bias

Answer 9

if patient feels empowered after the encounter

Question 10

considerations 4 diet plan for adult patient

Answer 10

• goal setting to produce small but continuous improvement in eating patterns
• goals that are specific, concrete, measurable, achievable

Question 11

5 Dietary plan first steps

Answer 11

1. cut out sugary drinks
2. increase fruit and veg.
3. avoid skipping meals but if you do skip dinner
4. reduce portion size by 25-33%
5. slow pace of eating to at least 20min/ meal

Question 12

Aggressive dietary plan

Answer 12

1. self help diet book
2. structured meal plan like meal replacement
3. commercial weight loss program
4. recommended high intensity programs: >14 visits over 6 mths
5. dietary logs with budget for calories and fat

Question 13

macronutrient balanced diet

Answer 13

• recommended by most organizations in US

- low fat, less than 30% calories from fat

Question 14

low carbohydrate diets

Answer 14

• short term weight loss greater than low fat

- possible greater long term weight loss after 2 years

Question 15

mediterranean diet

Answer 15

• maybe greater weight loss than low fat diet

- difficult to follow in US

Question 16

diets high and low in protein and fat

Answer 16

did not make a difference wrt weight loss

Question 17

most important predictor of weight loss after 2 years

Answer 17

self monitoring

attendance with group sessions

Question 18

energy density

Answer 18

• calories/ weight

- independent effect beyond macronutrient content

Question 19

meal replacement

Answer 19

-additional weight loss above and beyond meal plans with same number of calories recommended

Question 20

3 reasons physical activity is important for weight loss and maintenance

Answer 20

1. fill energy gap from initial weight loss
2. maintaining fat free mass/ muscle mass: determinant of 24 hour energy expenditure
3. regulate appetite

Question 21

regular exercise and the risk for diabetes, and coronary heart disease

Answer 21

-independently reduces risk beyond what is attributable to weight loss alone

Question 22

lifestyle activity

Answer 22

• expending energy throughout energy of daily living: stairs instead of elevator
• reduce sedentary activity

-same calorie expenditure through lifestyle activity possible as with exercise

Question 23

2 factors that impact weight

Answer 23

Sleep: adequate duration and quality of sleep –> prevent weight gain

Social environment: higher income ev ~ lower rates of severe obesity

Question 24

how obstructive sleep apnea effects weight loss

Answer 24

• appropriate sleep helps people lose weight

- undiagnosed OSA = harder time losing weight

Question 25

5 facts that support predisposition to weight gain

Answer 25

1. reduction in 24hour energy expenditure beyond what is expected from weight loss and loss of lean body mass alone
2. Increased subjective hunger
3. increase in Gherlin (hunger)
4. Decrease Leptin (fullness)
5. fMRI: increased neural activation when shown photos of food in weight reduced individuals

Question 26

why is physical activity without calorie reduction not enough for weight loss?

Answer 26

• activity required to burn 500-1000 calories is several hours
• but activity is a strong predictor of success in maintaining weight loss regardless of method

Question 27

threshold level of exercise to maintain weight loss

Answer 27

about 30 min vigorous activity

60 min moderate activity

Question 28

formula for calories to prevent weight gain

Answer 28

47kcal per (kg body weight X 0.1) -1

for 70 kg person= 328kcal

Question 29

two strategies for exercise plans

Answer 29

1. FITT: frequency- intensity- time-type

2. pedometer

Question 30

FITT method

Answer 30

Frequency

Intensity: Moderate (60% max predicted HR)

Time

Activities: large muscle groups and are continuous

Question 31

Proper use of pedometer

Answer 31

1. baseline #steps/week
2. step goal: increase by 500 steps/ day higher than baseline
3. slowly increase step by 3500 steps per week/ 500 per day

To maintain long term weight loss: 10,000-12,000 steps/day

Question 32

5 predictors of success in weight loss maintenance

Answer 32

1. use of moderately low fat, high carb diets
2. frequent self monitoring
3. eating breakfast
4. large amount of physical activity
5. limited tv viewing

Question 33

average energy expenditure for physical activity in successful weight loss maintenance

Answer 33

2800 kcal/week ~1hour of moderate intensity physical activity

-pedometer average steps/day 11,000 vs 5000 in sedentary person

Question 34

tv viewing in weight loss maintenance

Answer 34

american average: 28hrs/week

63% 21hours/week

Question 35

calorie target for weight over 250

Answer 35

1500-1800