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What is the difference between fat shaming and body confidence?

Fat shaming- Definition: judging/discriminating against because of their size. Celebrating weight loss and disapprove weight gain.
Body Confidence- accepting yourself for what it is


What is an IAS?

Implicit Association test- people are presented with words and pictures they are asked to hit the buzzer on the left if the word is positive or a thin person and hit the buzzer on the left if it is a negative word or an overweight person. Then switching so positive words and overweight are the left side and thin & negative words are on the right side. The results showed if there was a faster time for thin & positive you have a weight bias.


How do obesity stereotypes affect workplace, medical, educational and interpersonal settings?

hypothetical hiring (same credentials the thinner person will get hired)
Gender differences (females 16 times more likely to be discriminated against because of weight)
Income gap (women who are overweight make less than their counterparts)
Fewer hiring recommendations (lower salary assignments, more disciplinary decisions, worse placement decisions, more negative personality ratings)
Negative belief about obese people (their fault/lack discipline and psychological problems)
Belief that obesity is caused and controlled by person’s behaviour
PE teacher generally more bias
Effects overweight children (drop out of PE)
Strangers, peers, family & friends all judge
Stereotypes (less sexually desirable)


What are interpersonal, psychosocial, health-related, and academic/socioeconomic consequences of weight bias?

Lack of relationships and social isolation
Physical and emotional abuse
Poor body image, low self-esteem, greater psychological distress
Mediated by experience being overweight does not mean you have psychosocial disturbances
Impaired quality of life
Academic and socioeconomic
Misperception of lower cognitive ability
Relationship with income


What are the coping strategies for weight discrimination?

Internalizing social stereotypes
Attempting to lose weight (personal control/ self-blame)
Turn to food/refuse to diet (unhealthy eating behaviours/eating your feelings)
Assertive coping
Confronting perpetrator
Formal complaints (employment setting)
Public social groups (identify with others/ strength in numbers. Ex. NAFFA)
Asserting body acceptance
Confirmation and compensation strategies
Behaviour consistent with negative stereotypes
Compensating through other means (ex. intelligence or humour)
Self-protection strategies
Placing less value on bias
Avoiding social interactions


What are the 3 causes of weight bias?

Cultural transmission
Belief in controllability of weight
Belief in a “just world” and “beautiful=good”


What are 3 ways to change weight bias?

Changing blame attributions
Evoking empathy
Changing perceived social consensus


What are micro-analysis, macro-analysis, and intermediate-analysis?

Personal choice (taste)
Government regulations, food industry incentives, school lunch programs and campaigns
Big picture reasons
Eating environment (atmosphere, effort time, social interaction and distractions)
Food environment (5 S’s)


Explain the 5 S’s of the food environment

Memories & psychological connections
Structure and perceived variety
Greater variety= greater consumption
Arrangement of food (perception of variety)
Increased visibility and salience
Bulk foods
Serving containers
Drinking glasses (vertical-horizontal illusion)
Plates and bowls (Delbouef illusion)


What are four components of the eating environment?

Eating atmosphere (temp, lighting odour, noise)
Eating effort (ease, location of food, stopping points)
Eating with others (familiar vs unfamiliar)
Eating distractions (initiate, obscure or extend consumption/ script-related eating)


What is the most effective diet?

Any diet will work if you stick to it.


How are resting metabolic rate and total energy expenditure estimated?

Estimating resting metabolic rate (RMR)
○ Harris-Benedict equation and Mifflin-St. Jeor equation
○ Indirect calorimetry - Can use handheld machines to give a clearer estimation of our calorie needs
To measure total energy expenditure, multiply the RMR by your activity factor.


Describe the following:
Low calorie diet

• Less expensive, similar efficacy to VLCD
• 1200-1500kcal/day
○ 500-600kcal fewer/day
○ Weight loss of 0.5kg/week is a healthy rate (1-2lbs/week is healthy)
• Replace high calorie foods with less energy-dense foods


describe a very low calorie diet

Less than or equal to 800kcal/day
• Supervised (medically)
• BMI greater than or equal to 30 are the people who are targeted
• Not individualized
○ Regardless of what your calorie needs are (depending on weight, height, age, activity level), people normally start the diet at around 800 calories


describe a meal replacement

• Nutrition and portion control
• 180-300kcal/serving
• 2 meal replacements, 1 meal
• Pre-packaged, portion-controlled, calorie-labelled food
• Taste and price should be considered


What is a fad diet?

no real scientific evidence
A catchy name
Key words are used to draw people in: “100% effective”
Sometimes presented in phases. Eg. Phase 1, you eat only 1 food. Phase 2, you eat that food and introduce one more food.


What is the AMDR for fats, proteins, and carbohydrates?

○ Protein = 10-35%
○ Fats = 20-35%
○ Carbohydrates = 45-65%


What are glycemic index and glycemic load?

GI: Reference point of how much glucose is in a food, and this is important because we want to know how much the food will raise our blood sugar. GI is controversial because it's effected by many things. If everyone ate the same thing, all of our blood sugars will not spike to the exact same point. It also matters what we eat our foods with. If I ate a plate of potatoes with a steak and a salad, it will be different than if we just ate a plate of potatoes. Glycemic load is more useful!

GL: Taking GI one step further. We take the glycemic index number and multiply it by the serving size. GI is based on 50g of food regardless of what the food is. Glycemic load compares GI to how much we are eating.


Describe the following diets and provide an example:
Very low fat

• Less than 10% calories coming from fat
• Low vitamin E, B12, calcium, and zinc is common in low fat diets
• "Low-fat" and "non-fat"
• Eg Pritikin Diet


describe the following diet and provide an example: very low carbohydrates

• Consume less than 20% of calories in our diet
• Don't differentiate fats
• Limited nutrient content and balance
• E.g Atkins Diet


describe the following diet and provide an example: moderate fat/moderate carbohydrates

• 40-50% carbs
○ Emphasis =high fire
• 20-30% fat
• Very broad category
• Eg. Zone diet and South Beach Diet
The majority of diets fall into this category. These diets have some sort of “key” or “twist” to them (as compared to science-based diets)


describe the following diet and provide an example:Science-based moderate carbohydrate/moderate fat

Mostly high-fiber, high unsaturated fat diets. High unsaturated fat works because it is balanced with fiber. Involves a lot of plant-based foods.


What is the difference between physical activity and exercise?

• Physical activity
○ Any movement that results in skeletal muscle contraction and noticeable increases in energy expenditure
• Exercise
○ Planned, structured, repetitive bodily movement
○ Goal is to improve or maintain physical fitness


What is NEAT?

Non-Exercise Activity Thermogenesis (NEAT)
• NEAT often overlooked
• Accounts for 15-50% of total energy expenditure
• Moderate lifestyle activities provide same benefit as vigorous exercise


What role does physical activity play regarding weight loss and maintenance?

Effects of Physical Activity on Weight:
• Prevention of Weight Gain
○ Modest activity prevents weight gain
○ 15-30 minutes/day = 1-1.5 miles = 200-3000steps
• Initial weight loss
○ Physical activity and calorie restriction
Burn 500-1000 calories, walk 1 1/2 to 2 1/2 hour walk

Weight Loss Maintenance
• Prevent weight regain
• Maintains lean muscle
• Added benefits


Provide an example of each of the following measures of physical activity:
Criterion methods

○ Gold standard most accurate measures - most expensive, most inaccessible
○ Doubly labeled water - drink water that has some isotopes in it. Measure output through urine or saliva, and use that as a measurement for basal metabolic rate and energy expenditure
○ Indirect calorimetry - air. Person expires are from the lungs into a machine. This measures oxygen and CO2 output. Those will be used to measure physical activity levels


Provide an example of each of the following measures of physical activity:
objective measures

Objective measures - things we will most often use. They are fairly simple
○ Pedometers
○ Accelerometers - more expensive. Measures changes in motion
○ Heart rate monitors


Provide an example of each of the following measures of physical activity:
subjective measures

• Diaries
• Interviews
• Questionnaires
• 7-day PAR (physical activity recall), PACE, SQUASH.
• For seniors - CHAMPS, PASE, YPAS


Describe the transtheoretical model

○ Pre-contemplation
○ Contemplation
○ Preparation
○ Action
○ Maintenance
It is a non-linear model to explain the different stages a person can be in relating to behaviour change.


Briefly explain the following:
Social cognitive theory

Psychosocial, environmental, behavioural
• Self-efficacy
The theory posits that learning occurs in a social context with a dynamic and reciprocal interaction of the person, environment, and behavior.


Briefly explain the following:
health belief model

Physically activity if sedentary behaviour is viewed as a risk


Briefly explain the following:
theory of planned action

• Behaviours are function of health beliefs, attitude, perception of social norms, self-efficacy, and locus of control


How is weight loss maintenance defined?

No clear definition (depending on which organization, which study, etc)
One definition says:
• You must keep the weight off for a minimum of 1 year
• Weight regain of less than 3kg over two years
○ Sustained reduction of waist circumferences of 4cm
• Prevalence ~20% (20% of people who lose weight keep the weight off)


What is the Diabetes Prevention Program and why is it significant?

Diabetes prevention program
○ Lifestyle intervention - low-fat, low-calorie diet, increased physical activity, behavioural strategies
○ Goal = 7% initial weight and 150 minutes PA/week
○ Goal achieved by 49% of participants
The program is important because it showed that the lifestyle intervention program was more effective than the drug in preventing diabetes/seeing positive health outcomes


Describe the behavioural, biological, and environmental factors that influence weight loss maintenance.

Biological Changes
• Total energy requirement decreases with reduced body mass
• Possibly lower capacity for fat oxidation and increased work efficiency
• Increased drive to eat, reduced RMR, carbohydrate preference, increased insulin sensitivity, leptin signals

Behavioural Factors
• Maintaining lifestyle changes (it is hard to maintain a diet)
• Motivation - Motivation is typically very high at the beginning of a diet. Motivation decreases with time.
• Positive reinforcement - Once you hit your goal and you're in maintenance, these cues of positive reinforcement aren't there anymore.

Environmental Factors
• Our environment isn't very conducive to weight loss and weight loss maintenance
• Promotes overeating and discourages PA
• High-calorie, high-fat, convenient foods
• Sedentary environment


What is the NWCR?

The National Weight Control Registry - a database of people who have lost weight and kept it off. They are asked questions that help determine popular and effective methods of weight loss maintenance. Criteria for someone to be part of the registry:
• Minimum weight loss of 13.5kg
• Maintenance for at least 1 year


What are the keys to weight loss maintenance?

Successful weight loss maintenance (as shown in the NWCR):
• High physical activity
• Low calorie, moderate fat diet
• Regular breakfast consumption
• Daily self-weighing
• Conscious control over eating (what they eat, when they eat, how much they eat, etc.)
People who successfully maintain weight loss also have a lack of variety of food and watch less tv per week than the average population.


What are some strategies to encourage weight loss maintenance?

As the client:
• Continue to track physical activity and food consumption
• Don't buy junk food, or don't buy food that I don't have a plan for
• Keep a schedule (so I know when I will exercise, etc.)
• Participate in social physical activity (positive peer pressure)
• Pre-plan and pre-organize meals. (Portion control, fresh options, won't get fast food)
• Make short-term and long-term goals (to keep active now and later)
• Do physically active things that you like (with people you like!)

As the professional:
• Encourage small changes
• Check in (to keep them on-track or intervene if they fall off track)
• Provide information on ways they can stay on track
• Give praises to the client for keeping the weight off
Develop or make changes to existing exercise routines to continue to see change


How is childhood obesity defined using BMI?

85th-94th percentile is overweight
95th+ is obese


What is the adiposity rebound?

A children’s BMI chart does not follow a linear pattern. It starts high followed by a dip then a “adiposity rebound” where the child puts on weight quickly.


What is acanthus is nigricans

Skin condition (raised, discoloured, dermal hyperplasia) common sites include: armpits, elbow and back of the neck. Associated with obesity and insulin resistance.


What is CVD?

Cardiovascular Disease: hypertension, left ventricular hypertrophy and atherosclerosis. The most concerning for children is the hardening of the arteries.


What is PCOS?

Polycystic ovary syndrome. Female hormonal disorder. Need 2 of the following: oligomenorrhea (8 or less periods a year), clinical manifestations of excess androgen and/or elevated levels of circulatory androgens (total or free testosterone), polycystic ovaries on ultrasound.


What respiratory problems affect obese children?

Sleep Apnea & asthma


What orthopedic problems affect obese children?

Bowed legs, increased incidence of slipped capital femoral epiphysis (hip dislocation), injury to growth plates, scoliosis, spondylolisthesis, damage to weight bearing joints may lead to osteoarthritis, flat feet & flat knee cap


Briefly explain each of the conditions associated with obesity(5)

Diabetes Mellitus- type 2 diabetes
Metabolic syndrome


What is Anthropometry

Physical measures of stature (weight & regional dimensions)
Noninvasive and inexpensive
Direct (Measurements ie. skinfold) or indirect (equations)


What are circumference measures and norms?

Based on the principle that circumference reflects FM and FFM differences, measures fat distribution


Briefly explain each of the following body composition measures
Ski folds

Body dar percentage estimate based on anatomical sites, then placed into the Siri equation


Briefly explain each of the following body composition measures

Bioimpedance analysis- resistance and reactance of electrical current (assumptions: ambient temperature, hydration, position, electrode placement, equations, eating & drinking)


Briefly explain each of the following body composition measures
Hydrostatic weighing

Gold standard. Weighing under water. (archimedes principle- fat floats)


Briefly explain each of the following body composition measures
Air plethysmography

BOD POD 35-200kg - poisson’s law (volume varies inversely with pressure at a constant temperature)
PEA POD- for children mx 8kg


Briefly explain each of the following body composition measures

High speed digital cameras and math used to detect position of laser-light points projected into a surface of the body


Briefly explain each of the following body composition measures
dilution techniques

Total body water changes affect body composition and alter estimate of body composition. Volume measured using a dilution tracer technique


Briefly explain each of the following body composition measures

Dual energy X-Ray absorptiometry- whole body and regional estimates of bone mineral, bone free FFM & fat.


Briefly explain each of the following body composition measures
imaging techniques

Imaging(MRI-magnetic) used to estimate adipose tissue, skeletal muscle etc.


Briefly explain each of the following body composition measures

Magnetic Resonance Spectroscopy- chemical composition of tissue


How would psychodynamic theorists explain obesity and sex differences?

Historically- women are inferior, childbearing; men- bodies did not matter if they were good providers
Psychology & gender differences - harder for daughters to separate from mothers therefore overweight mothers often result in other weight daughters


Briefly explain psychodynamic approach

Behaviour is determined by several unconscious changing factors that often conflict with one another (ego, ID & superego)
ego- more rooted; society/social norms
Id- develops first, most primal (pleasure principle)
Superego- mediator between the two (moral standards)


Briefly explain the key components of the following - contemporary Freudian approach, relational/interpersonal approach, self-psychological orientation

Contemporary Freudian
transference - client unknowingly projects their experience on the counsellor
neutrality - counsellor completely neutral, no judgments
Self-awareness and interpretation- client can discover where the conflict comes from
and why is results in weight gain
Relational/interpersonal model
Interpersonal relationships- deprived of social needs (I eat because my dad & I have a bad relationship)
Self-psychological/ deficit model
Emphasizes developmental deficits, empathy and attunement (the idea is to give the
client what they need, love support, control, empathy..)
The key to this model is acceptance
Therapist is a reflector/listener


What is neutrality?

Remaining neutral, do not celebrate or punish behaviours. No judgements


What are transference and countetransference

The client projects their experiences/emotions on the counsellor. Getting upset at the counsellor for an unrelated issue. In COUNTERtransference the counsellor is allowed to react.


What is classical conditioning?

When stimuli are linked together example eating chips & watching a particular tv show. The goal is to un-pair the behaviours (watch tv at different times, sub healthier option)


What is operant conditioning?

Behaviours are rewarded; work hard you get good grades.


What is functional analysis?

Chain behaviours (woke up late, didn’t have time to eat breakfast, didn’t have time to pack a lunch, had a late work meeting, lunch break didn’t happen until 2:30, went out a picked up food fast because you were so hungry, plus you had to go home and let the dog out since you forgot in the morning, cutting you lunch break in half..) identifying the event associated with eating & exercise patterns.


Describe a hypothetical behavioural weight loss program

10-15 people support groups, 60-90 min sessions, 16-26 weeks, then biweekly for maintenance. General methods: individual weight measurements, give homework, group addresses barriers, presentation of new material and homework/goals reviewed.


Explain the following:

Most important component. Record food & physical activity, read labels, measure food and create visual graphs for weight


Explain the following:
stimulus control

Classical and operant conditioning. Ex. Environmental influences (food/environment factors)


Explain the following:
problem solving

1. Identify issue
2. Brainstorm solutions
3. Pros & cons of solutions
4. Choose and plan solution
5. Evaluate effectiveness


Explain the following:
cognitive destructing

Thoughts determine someone’s behaviours (replace negative thoughts with positive, eliminate the all or nothing thinking)


Explain the following:

Strategy developed for high risk situations. Plan ahead for risky situations (set limits, have goals)


What are the 3 assumptions of the anti-dieting trend?

1. Dieting is ineffective
2. Dieting is harmful
3. Long-standing beliefs about causes consequences of overweight are incorrect


What are the goals of a non-dieting program?

- increase awareness of dieting ill effects
- educate about biological basis about body weight
- use internal cues rather than external cues to guide
- improving psychological well-being
- increasing physical activity
- empirical support


Is non-dieting an effective approach to obesity?

Non-dieting is effective in regards to boosting self-worth, mood & body image however does little to no change of body weight