Lecture 6 - Part 2 Flashcards
(47 cards)
What is the difference between wt bias, stigma and discrimination?
Bias: personal beliefs
Stigma: social stereotypes
Discrimination: acting on those beliefs
What is obesity?
A complex chronic disease in which abnormal or excess body fat (adiposity) impairs health, increases the risk of long-term medical complications and reduces lifespan.
What are some of the complex contributing factors to obesity?
◦ Intake
◦ Physical activity
◦ Obesogenic environment ◦ Portion sizes, energy density
◦ Genes - >140 genetic regions
◦ Emotional health
◦ Disordered eating patterns ◦ Gut microbiota
◦ Lack of sleep
◦ Stress
◦ Medical conditions
◦ Some medications
◦ Some medical disorders: Cushing’s syndrome, hypothyroidism, Pradar-Willi syndrome
What % of adults and kids have obesity?
64% of adults are overweight/ obese
31% children are overweight/ obese
What are the different ways fat can be distributed in obesity?
Abdominal
-Android: excess subcutaneous
truncal-abdominal fat = health risk
Gluteal-thigh
-Gynoid: excess gluteofemoral fat
Waist circumference
◦ increase health risk if > or = 88 cm in women or > or = 102 cm in men (Caucasians)
What are the different BMI classification of obesity?
- 0 – 29.9 kg/m2 Overweight
- 0 – 34.9 Obesity Class I
- 0 – 39.9 Obesity Class II (severe obesity)
> or = 40.0 Obesity Class III (severe obesity)
What is the EOSS?
Edmonton obesity staging system stages
0: no apparent risk factors ◦ 1: preclinical risk factors ◦ 2: established co-morbidity ◦ 3: end-organ damage ◦ 4: end-stage
How does one develop insulin resistance?
Accumulate more fat there more production of chemicals from the adipose cells and are realised into body. The chemicals are pro inflammatory and endothelial calls are impacted.
What is MetS?
Metabolic syndrome
Health disorder resulting from insulin resistance
What do you have to have to be considered to have MetS?
High blood pressure - ≥ 130/85 mm Hg*
High blood glucose levels - ≥ 5.6 mmol/L*
High triglycerides - ≥ 1.7 mmol/L*
Low HDL-Cholesterol - < 1.0 mmol/L in men or < 1.3 mmol/L in women
Large waist circumference - ≥ 102 cm in men, 88 cm in women
◦ Ethnicity-specific ranges
*or receiving treatment for
What is the core treatment for obesity?
medical nutrition therapy (MN) and physical activity (PA)
What are the adjunctive therapies for obesity management?
psychological, pharmacologic and surgical interventions ◦ Highly individualized
What is the best wt for obese people?
weight at which the body stabilizes when engaging in healthy behaviours
◦ Focus on healthy, enjoyable life
◦ May not be ‘ideal weight’ on BMI scale
What are the 3 A’s of obesity?
A set of practical tools to guide primary care practitioners in
obesity counseling and management
- Ask for permission to discuss weight and explore readiness for change
- Assess obesity related health risk and potential “root causes” of weight gain
- Advise on obesity risks, discuss benefits treatment options
- Agree on realistic weight-loss expectations and on a SMART plan to achieve behavioral goals
- Assist in addressing drivers and barriers, offer education and resources, refer to provider, and arrange follow-up
What is the medical nutrition therapy for obesity?
◦ Long-term adherence to a personalized healthy eating pattern that meets individual values and preferences, while fulfilling nutritional needs and treatment goals
◦ Not to be used in isolation: maintaining wt loss difficult long-term d/t compensatory mechanisms affecting neurobiological pathways that control appetite, hunger, cravings and body weight regulation that may result in increased food intake and weight gain
◦ Combine with psychological, pharmacologic, and/or surgical interventions to meet individual health- or weight-related outcomes
What do we want to emphasize with nutrition management for obesity?
Gradual integration of physical activity
◦ Encourage NEAT (non exercise activity thermogenesis)
What is the importance of self management?
Importance of self-management
◦ increase confidence, motivation, self-efficacy, coping skills
◦ Including goal-setting, problem solving, self-monitoring
◦ Difficulty in maintaining wt loss
◦ Progressively more difficult
◦ Body wants to maintain highest weight
◦ Defends fat stores
What is the metabolic adaptations to wt loss?
After wt loss theere is a larger energy gap
• Decrease in energy expenditure and increase in hunger work at the same time
• Drives the person to take in more and burn less calories
Why are fad diets bad?
Promise a “miracle cure”
Lack of nutritional balance
Potential health risk
No improvement of eating behaviours
See PEN handout
What is pharmacotherapy used for obesity?
BMI ≥ 30.0 or ≥ 27.0 kg/m2 c co-morbidities
◦ Consider cost, side effects, and rebound weight gain
What are the 3 main drugs for longterm obesity management ?
◦ Orlistat (Xenical®)
◦ Liraglutide (Saxenda®)
◦ Naltrexone/bupropion (Contrave®)
What is rebound?
wt gain when you stop takiing the meds
What can liraglutide be used for aside from obesity?
for diabetes management and also obesity managmeent benefits as well
What does Orlistat (Xenical®) do?
Lipase inhibitor
Prevents fat absorption -30% of ingested fat is excreted
-prevent lipase from breaks down of fat (truglycerides) in the SI
Does not target appetite or satiety mechanisms
Side effects: flatulence, urgent BMs, oily stools, inability to control stools
