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HLTH 230 > Energy Balance and Body Weight > Flashcards

Energy Balance and Body Weight Flashcards

1
Q

What is body composition?

A

Proportions of muscle, bone, fat & other tissue that make up a person’s total body weight
Body composition is more important than controlling body weight

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1
Q

In 2019, what percentage of Canadian adults (18 to 79) were considered overweight or obese?

A

59.8%

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2
Q

What can be said about how many people struggle with too little body fat vs obesity?

A

Too little body fat is not a widespread problem
Obesity is an escalating epidemic

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3
Q

People who are underweight are at risk when?

A

During famine
When hospitalized
When fighting a wasting disease (cancer) may die from starvation, not the disease

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4
Q

What problems are associated with underweight?

A

Undernutrition, osteoporosis, infertility, impaired immunocompetence

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5
Q

Some people who are underweight may benefit from gaining weight. What are two of these?

A

Energy reserve
Reserves of nutrients that can be stored

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6
Q

What are the problems associated with overweight/obesity?

A

Type 2 diabetes
Dyslipidemia
Hypertension
Coronary heart disease (CHD)
Gallbladder disease
Sleep apnea
Certain cancers

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7
Q

Body weight is not the only disease risk factor of being overweight/obese. What are some of the things that play a role in determining who stays healthy?

A

Genetics
Not smoking
Cardiovascular fitness

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8
Q

Central obesity correlates with the amount of visceral fat someone has. What is that?

A

The fat that collects deep within the central abdominal area of the body.

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9
Q

Central obesity may increase the risk of death from all causes as compared to fat accumulations elsewhere in the body. Visceral fat leads to an increased risk of what?

A

Diabetes, stroke, hypertension, and coronary artery disease.
Hypothesized it is because visceral fat is readily released into the bloodstream

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10
Q

What is subcutaneous fat?

A

Fat just below the skin – ex., abdomen, thigh, hips, legs.

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11
Q

Who is most likely to develop an apple shape and who is least likely?

A

Males and females who are postmenopausal
Smokers (despite a lower body weight)
Moderate-to-high alcohol intake

Physical activity correlates negatively with central obesity

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12
Q

Who is more likely to have a pear shape?

A

Females (around hips and thighs) prior to menopause

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13
Q

How is bodyweight/body fat assessed?

A

BMI (body mass index): kg/m^2
Generally correlates with degree of body fatness & disease risk

Waist circumference (visceral fatness)

Disease risk profile (hypertension, diabetes, high cholesterol, etc.)

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14
Q

What can be said about the need to control body fatness?

A

The more risk factors and the greater the obesity, the more important controlling body fat becomes.

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15
Q

What are some limitations of the body mass index (kg/m^2)?*

A

No indication about how much of the weight is fat

No indication of location of body fat

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16
Q

What are the different BMI categories?

A

<18.5 Underweight (inc risk)
18.5-24.9 Normal weight
25-29.9 Overweight (inc risk)
30+ Obese
30-34.9 Obese Class I (high)
35-39.9 Obese Class II (v high)
>= 40 Obese Class III (ex high)

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17
Q

Who is the BMI generally not appropriate or effective for?*

A

<18 yo
Athletes
Pregnant and lactating women
Adults over 65
(Need more research on cutoffs for different races and ethnic groups; BMI values originally based on people under 65 who were primarily white Europeans and Americans).

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18
Q

What is important to remember about BMI and composition?

A

BMI reflects height and weight, not body composition

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19
Q

Waist circumference is the most practical indicator of fat distribution and abdominal fat. According to Health Canada, an increased risk of developing health problems such as diabetes, heart disease and high blood pressure is associated with a waist circumference at or above what?

A

102 cm for males
88 cm for females

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20
Q

What are the risks from overweight?

A

Cardiovascular fitness improves health & longevity, independent of BMI

Fitness may be a greater determinant of the risk of death for those who are obese, than the body fat

The lowest risk of death from chronic diseases is seen in normal weight fit people

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21
Q

What are some of the social & economic costs of excess adiposity?

A

People who have elevated BMIs:
- are sometimes judged on their appearance
- less often hired
- pay higher insurance premiums
- less often admitted to college or universities

Our society places enormous value on thinness

Unjust stereotypes of those with excess weight

Prejudices and hostility can have an emotional toll

Need to draw attention to weight bias and obesity stigma

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22
Q

What is weight bias?

A

Refers to negative attitudes and views about
obesity and about people with obesity

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23
Q

What is weight stigma?

A

refers to social stereotypes and
misconceptions about obesity. These social stereotypes and
misconceptions include beliefs that people with obesity are
lazy, awkward, sloppy, non-compliant, unintelligent,
unsuccessful and lacking self-discipline or self-control

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24
Q

What is weight discrimination?

A

Weight bias and stigma can lead to weight
discrimination. This is when we enact our personal biases and
the social stereotypes about obesity and treat people with
obesity unfairly

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25
Q

How is obesity operationally defined?

A

A BMI exceeding 30kg/m^2 and is subclassified into class 1 (30-34.9), class 2 (35-39.9) and class 3 (>= 40)

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26
Q

What is the edmonton obesity staging system (EOSS)?

A

A five-stage system of obesity classification

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27
Q

What does EOSS consider?

A

The metabolic, physical, and psychological parameters in order to determine the optimal obesity treatment

EOSS has been reported to be a better predictor of mortality than BMI

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28
Q

What is stage 0 of the EOSS?

A

No apparent risk factors (e.g., blood pressure, serum lipid
and fasting glucose levels within normal range), physical
symptoms, psychopathology, functional limitations and/or
impairment of well-being related to obesity

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29
Q

What is stage 1 of EOSS?

A

Presence of obesity-related subclinical risk factors (e.g.,
borderline hypertension, impaired fasting glucose levels,
elevated levels of liver enzymes), mild physical symptoms
(e.g. dyspnea on moderate exertion, occasional aches and
pains, fatigue), mild psychopathology, mild functional
limitations and/or mild impairment of well-being

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30
Q

What is EOSS stage 2?

A

Presence of established obesity-related chronic disease
(e.g., hypertension, type 2 diabetes, sleep apnea,
osteoarthritis), moderate limitations in activities of daily
living and/or well-being

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31
Q

What is EOSS stage 3?

A

Established end-organ damage such as myocardial
infarction, heart failure, stroke, significant psychopathology,
significant functional limitations and/or impairment of well-
being

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32
Q

What is EOSS stage 4?

A

Severe (potentially end-stage) disabilities from obesity-
related chronic diseases, severe disabling psychopathology,
severe functional limitations and/or severe impairment of well-being

33
Q

What are some recommendations of the first chapter of Clinical Practice Guidelines dedicated to weight bias?

A
  1. Healthcare providers should assess their own attitudes
    and beliefs regarding obesity and consider how their
    attitudes and beliefs may influence care delivery
  2. Healthcare providers should recognize that internalized
    weight bias (bias towards oneself) in people living with
    obesity can affect behavioural and health outcomes
  3. Healthcare providers should avoid using judgmental
    words, images and practices when working with patients
    living with obesity.
  4. We recommend that healthcare providers avoid making
    assumptions that an ailment or complaint a patient
    presents with is related to their body weigh
34
Q

What are some recommendations for the clinical practice guidelines for obesity management and indigenous peoples?

A
  • Engage with patient social realities.
  • Validate the patient’s experiences of stress and systemic disadvantage
    influencing poor health and obesity, exploring elements of their environment
    where reduced stress could shift behaviours
  • Advocate for access to obesity management resources within publicly funded
    healthcare systems, recognizing that resources beyond may be unaffordable and
    unattainable for many
  • Help patients recognize that good health is attainable, and they are entitled to it
  • Self-reflect on anti-Indigenous sentiment common within healthcare systems,
    exploring patient motivations and mental health (e.g., trauma, grief) as
    alternative understandings of causes and solutions to their health problems.
    Explore one’s own potential for bias influenced by systemic racism
35
Q

When more food energy is consumed than needed, excess fat accumulates in the fat cells of the body’s tissue. How many kcal equals 1 pound of body fat?

A

3500 kcal

36
Q

When energy supplies run low, stored fat is used for energy. What is the daily energy balance?

A

Change in energy stores = energy in - energy out

37
Q

What can be said about energy in vs energy out?

A

Foods and beverages contribute to the “energy in” side of the energy balance equation

The “energy out” side of the equation requires knowing about a person’s lifestyle & metabolism

38
Q

Energy in foods & beverages contribute to the “energy in” side of the energy equation. What are the conversions from grams to kcals?

A

1g carb = 4kcal
1g protein = 4 kcal
1 g fat = 9 kcal
1 g alcohol = 7 kcal

39
Q

What is basal metabolism?

A

Sum of total of energy expended on all of the involuntary activities needed to sustain life
Excludes digestion and voluntary activities
It is usually the largest category of expenditure of energy

40
Q

What are the voluntary activities (physical activity)?

A

Intentional activities

*Most variable element of energy output (day to day and person to person) (marathon vs rest day)

Very changeable

41
Q

What is thermic effect of food?

A

5%-10% of a meal’s energy is expended in stepped-up metabolism following a meal (which may last up to 5 hours)

42
Q

What is the thermic effect of food? Specifically eating?

A

GI tract muscles speed up their activity, enzymes produced, etc - produces heat

43
Q

What is the thermic effect of food?

A

The total amount of energy needed to digest, absorb, metabolize and store the food you eat
– Influenced by:
– Meal size
– Meal frequency
– Meal composition
– Generally the TEF is not counted

44
Q

What is the thermic effect of different types of foods?

A
  • Fat 0-5%
  • Carbohydrate 5-10%
  • Protein 20-30% *(largest)
  • Alcohol 15-20%
45
Q

What is the basal metabolic rate (BMR)?

A

The rate at which the
body uses energy to support its basal metabolism”
* Varies from person to person
* Varies with activity level
* Lowest during sleep

46
Q

What can be said about physical activity and BMR?

A
  • In the short term, physical activity will not increase BMR
  • Long term, increasing physical activity will increase BMR
  • Lean tissue has a higher BMR than fat tissue
47
Q

In who is the basal metabolic rate higher?

A

Younger people -lean body mass declines with age

Taller people – have a larger surface area

People who are growing (children, pregnancy)

People with more lean muscle mass (physically fit
people)
– Lean body mass: the weight of the body minus fat
– Generally, males have a higher BMR than females

Fever

During stress

Environmental temperature – adjusting to heat and
cold

Hyperthyroidism

48
Q

In who is basal metabolic rate lower?

A

Older people-lean body mass declines with age

Fasting – body slows to preserve energy

Malnutrition

Hypothyroidism

49
Q

How can we compare BMR (basal metabolic rate) vs RMR (resting metabolic rate)?

A

BMR (Basal metabolic rate): The rate of energy use for metabolism under specific conditions
- After a 12 hour fast and restful sleep
- Without physical activity or emotional excitement
- In a comfortable temperature/setting

RMR (Resting metabolic rate): Similar to BMR, a measure of energy use of a person at rest in a comfortable setting but with less stringent criteria for food intake and
physical activity

50
Q

Energy estimating equations often include what?

A

Sex: Females generally have less lean body mass than males

Age: BMR declines by an average of 5% per decade

Physical activity: generally cluster activities according to their
typical intensity

Body size & weight: The higher BMRs of taller & heavier people need to be factored in when estimating EER

51
Q

What are some ways of measuring body composition and fat distribution?

A

Anthropometry: fatfold measures - caliper

Density: underwater weighing or air displacement plethysmography (lean tissue is denser than fat tissue)

Conductivity: bioelectrical impedance

Radiological techniques: DEXA

52
Q

How much body fat is ideal for health?

A

Varies with sex, age, lifestyle, stage of life
Percent body fat should generally be:
- Male of normal weight: 12-20% (18-39 years old)
- Female of normal weight: 20% -30% (18-39 years old)

But it also depends on lifestyle/life stage:
- These numbers increase after 40
- Endurance athletes need fat for energy and insulation but do not want to be weighed down
- Fishing in the arctic: more fat for warmth/insulation
- To become pregnant
- The elderly may benefit from higher body fat

53
Q

When do around 85% of eating disorders start?

A

During adolescence

54
Q

Who is more likely to develop an eating disorder?

A

Athletes and dancers

54
Q

What is the female athlete triad?

A

Disordered eating/eating disorder
Amenorrhea (absence of menstruation)
Osteoporosis

An ultra-slim appearance has long been considered desirable in some activities/sports

55
Q

Amenorrhea affects how many people in the US (women, athletes)?

A

2-5% of women in US
May be as high as 66% in athletes

56
Q

What can be said about misconceptions about amenorrhea?

A

Not an adaptation to strenuous physical training

Weight-bearing exercise: usually increases bone mass, can endanger the bone for those with anorexia nervosa

57
Q

What is the Relative Energy Deficiency in Sport (RED-S)?

A

The syndrome of RED-S refers to impaired physiological function including, but
not limited to, metabolic rate, menstrual function, bone health, immunity, protein
synthesis, cardiovascular health caused by relative energy deficiency

The International Olympic Committee (IOC) Consensus group has come up a
broader term: Relative Energy Deficiency in Sport (RED-S) because evidence
shows it is not simply a triad, but rather a syndrome with many effects caused by
inadequate energy

58
Q

What is muscle dysmorphia?

A

A psychiatric disorder concerning obsession with building body mass.
Athletes with well-muscled bodies can see themselves as underweight and weak

59
Q

What are some characteristics of anorexia nervosa?

A

Often come from middle or upper-class families

Men account for around 5 to 10% of cases

Central to its diagnosis is a distorted body image that overestimates body fatness. Malnutrition is known to affect brain functioning & judgment

May be a way of gaining control

Self-starvation

60
Q

What are some physical perils of anorexia nervosa?

A
  • Brings the same damage as classic protein-energy
    undernutrition
  • Body tissues are depleted of needed fat & protein
  • Youth - growth ceases & normal development falters, BMR slows
  • The heart pumps inefficiently & irregularly – muscle thin and
    weak
  • Low blood pressure
  • Imbalance of electrolytes that help to regulate heartbeat go out
    of balance
  • Deaths are often due to heart failure
  • The brain loses significant amounts of tissue
  • Nerves function abnormally also affecting brain function
    The lining of the intestinal tract shrinks
  • Pancreatic production of digestive enzymes slows
  • Food is not adequately digested
  • Diarrhea
  • Anemia
  • Impaired immune response
  • Altered blood lipids
  • Dry skin
  • Low body temperature
  • The development of fine body hair
  • Loss of sex drive in adults, regardless of sex
61
Q

What are the criteria for diagnosis of anorexia nervosa - DSM V?

A

A. Restriction of energy intake relative to requirements, leading to a significantly low
body weight in the context of age, sex, developmental trajectory, and physical
health. Significantly low weight is defined as a weight that is less than the minimally
normal.

  • B. Intense fear of gaining weight or becoming fat, or persistent behavior that
    interferes with weight gain, even though at a significantly low weight.
  • C. Disturbance in the way in which one’s body weight or shape is experienced,
    undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.
62
Q

What are the two types of anorexia nervosa?

A

Restricting type
Binge eating/purging type

63
Q

What is the restricting type of anorexia nervosa?

A

During the last 3 months, the individual has not engaged in
recurrent episodes of binge eating or purging behaviour (i.e., self-induced vomiting
or the misuse of laxatives, diuretics, or enemas). This subtype describes
presentations in which weight loss is accomplished primarily through dieting,
fasting, and/or excessive exercise

64
Q

What is the binge eating/purging type of anorexia nervosa?

A

During the last 3 months, the individual has engaged in
recurrent episodes of binge eating or purging behaviour (i.e., self-induced vomiting
or the misuse of laxatives, diuretics, or enemas)

65
Q

What does the treatment of anorexia nervosa entail?

A

Requires a many different health care professionals
and supports working together
- Approaches relating to relationships, to food & to
weight as well as to oneself and others

Supplemental formulas – tubefeedings may be
needed

Denial makes treatment difficult

Many relapse into abnormal eating behaviours

66
Q

What are some of the characteristics of bulimia nervosa?

A

Much more prevalent than anorexia nervosa

Often secret and may deny the behaviours

More men have bulimia nervosa than anorexia nervosa but
bulimia nervosa is still most common in women

Bulimia Nervosa: Binge Eating & Purging

  • Food is not consumed for its nutritional value
  • Binge is a compulsion
  • During a binge, eating is often accelerated by hunger from
    previous caloric restriction
  • Binges are very large – often exceed 1000 kcal
  • Typical foods are easy-to-eat, low-fibre, smooth, high-fat and
    high-carb
  • There may be several binges in a day
67
Q

What is the binge/purge cycle?

A

Negative self perceptions
Dieting/severe energy restriction
Binge
Purge

68
Q

After a binge, to purge the food, what may be used?

A
  • Cathartic – strong laxative
  • Emetic- an agent that causes vomiting
69
Q

After the binge and purge, what can be said about the person’s physical state?

A
  • Hands may be scraped and cut from the teeth
    during induced vomiting
  • Swollen neck glands & reddened eyes from straining
    to vomit
  • Bloating, fatigue, headache, nausea, pain
70
Q

What are some of the physical and physiological perils of bullimia nervosa?

A

Fluid and electrolyte imbalances caused by vomiting or diarrhea (abnormal heart rhythms and injury to the kidneys)

Vomiting causes
- Irritation & infection of the pharynx, esophagus, salivary
glands
- Erosion of the teeth & dental caries
- The esophagus or stomach may rupture or tear
- Overuse of emetics can lead to death by heart failure
- Remember not everyone with bulimia nervosa vomits (other
compensatory mechanisms)

71
Q

What can be said about recovery from bullimia vs anorexia?

A

Those with bulimia are less likely to be in denial &
more likely to recover than those with anorexia

72
Q

What is the DSM V criteria for diagnosis of bulimia nervosa?

A

A. Recurrent episodes of binge eating. An episode of binge eating is
characterized by both of the following:
1. Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances.
2. A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).

B. Recurrent inappropriate compensatory behaviours in order to prevent weight gain, such as self-induced vomiting; misuse of
laxatives, diuretics, or other medications; fasting; or excessive exercise.

C. The binge eating and inappropriate compensatory behaviours both occur, on average, at least once a week for 3 months.

D. Self-evaluation is unduly influenced by body shape and weight.

73
Q

What is the treatment of bulimia nervosa?

A
  • A multidisciplinary team/supports working together
  • To regain control over food & establish regular eating
    patterns requires adherence to a structured eating plan
  • Regular exercise may be of benefit
  • Restrictive dieting is forbidden
74
Q

What are the goals of recovery of bulimia nervosa?

A

Steady maintenance of weight

Learning to consistently eat enough food to satisfy hunger is a major step towards recovery

Medications, such as antidepressants, may be used in treatment

75
Q

What is binge eating disorder?

A
  • Obesity is not an eating disorder
  • BED is a mental illness like AN and BN
  • Characterized by recurrent episodes of eating large
    quantities of food then experiencing shame, distress or
    guilt afterwards.
  • Compared to bulimia nervosa those with BEN generally:
  • consume less during a binge
  • rarely purge
  • exert less restraint during times of dieting
  • Responds more readily to treatment than other disorders
76
Q

A person with binge eating disorder demonstrates the following (DSM)

A

A. Recurrent episodes of binge eating. An episode of binge eating is
characterized by both of the following:
1. Eating, in a discrete period of time (e.g., within any 2-hour
period), an amount of food that is definitely larger than what
most individuals would eat in a similar period of time under
similar circumstances.
2. A sense of lack of control over eating during the episode (e.g.,
a feeling that one cannot stop eating or control what or how
much one is eating).

B. Binge eating episodes are associated with at least 3 (or more) of
the following
1. Eating much more rapidly than normal
2. Eating until feeling uncomfortably full
3. Eating large amounts of food when not feeling physically hungry
4. Eating alone because one is embarrassed by how much they are

C. Marked distress regarding binge eating is present

D. The binge eating occurs, on average at least once a week for 3
months

E. The binge is not associated with the recurrent use of inappropriate
compensatory behaviours as in bulimia nervosa and does not
occur exclusively during the course of bulimia nervosa or anorexia
nervosa

77
Q

What is EDNOS?

A

Eating disorder not otherwise specified

78
Q

What is Orthorexia?

A

Not a diagnosable eating disorder included in the DSM.

A colloquial term referring to problematic eating behaviours that can
seriously impact someone’s life

Warning sign

79
Q

Orthorexia is a cluster of food- and weight-related symptoms, including:

A

“Eating only foods regarded as healthy.”

“Relying only on “natural” products to treat an illness.”

“Finding more pleasure in eating “correctly” rather than enjoying the
tastes and textures of a variety of foods.”

“Although orthorexia is not a recognized diagnosis, it does - like other
forms of disordered eating - lead to an obsessive focus on food. People
with orthorexia experience emotional satisfaction when they stick to
their goals, but intense despair when they fail to do so. Weight is
commonly used as a measure of their success. Their behaviours and
beliefs can lead to social isolation and ill health. If weight loss
compromises health and body dissatisfaction plays a part, orthorexia
may become anorexia nervosa.

80
Q

Eating disorders in society may have many causes/contributing factors, such as:

A

Sociocultural
- Known only in developed nations
- Become more prevalent as wealth increases and food becomes plentiful

Psychological

Heredity

Probably neurochemical

HLTH 230 (7 decks)

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