lecture 8: energy balance and healthy body weight

Question 1

BMI

Answer 1

(Weight in KG) / (Height in M)^2; ex., 63.5kg / (1.66m)^2 = 23 BMI
Inherently only reflects height and weight, not body composition
Tends to have a correlation with body fatness unless you’re a bodybuilder
Exceptions*: People who are lean and healthy, very muscular people, people who are <18 and still growing, pregnant women/lactating women, those who are 65+ (27-32 could be okay)

Question 2

underwight

Answer 2

less than 18.5

Question 3

healthy BMI

Answer 3

18.5-24.9

Question 4

overweight

Answer 4

BMI 25-29

Question 5

obese

Answer 5

BMI 30+
class 1: 30-34
class 2: 35-39.9
class 3: 40+

Question 6

an epidemic those who are overweight/obese

Answer 6

61.8% men, 46.2% women*****

Question 7

problems w obesity***

Answer 7

Type 2 Diabetes
Dyslipidemia (abnormal cholesterol; high LDL, low HDL)
HTN, Coronary heart disease
Gallbladder disease
Sleep Apnea
Certain cancers

Question 8

central obesity

Answer 8

Central Obesity: Fat collecting deep within central abdominal area (visceral fat); ex., people with big stomachs but rock hard abs: it’s because it’s mixed around under the organs vs. subcutaneous pooch
Generally can be determined if you measure waist circumference as well
Increased risk of diabetes, stroke, HTN, CVD, death
apple vs pear shaped

Question 9

apple shape obesity

Answer 9

Greater risk in men, postmenopausal women, smokers, alcoholics (beer belly)
Keynote feature of central obesity; Can be reduced with physical exercise

Question 10

pear shape

Answer 10

Women in reproductive years with hips and thighs

Question 11

waist circumference**

Answer 11

Reflects degree of visceral fatness, most practical indicator* of fat distribution
Where you take it depends on organization; pretty much the same
Take a deep breath then let it out (can’t suck in)
Health Canada: 102cm for men, 88cm for women = increased risk*
Heart and Stroke:
Men: 94cm+ = increased, 102cm+ = substantially increased risk*
Women: 80cm+ = increased, 88cm+ = substantially increased risk*

Question 12

waist-hip ratio?

Answer 12

gives no more information, benefit, rism than just waist***, useless xtra work

Question 13

ideal fatness range

Answer 13

12-20 for men, 20-30% for women

Question 14

Edmonton Obesity Staging System*

Answer 14

This assumes they’re already obese (30+ BMI)
Stage 0: Obese but no risk factors like BP, dyslipidemia, fasting glucose, symptoms
Stage 1: Subclinical, borderline risk factors
Stage 2: Established Diseases related to obesity: HTN, Type 2 Diabetes, Sleep apnea…
Stage 3: Organ damage related to obesity: Heart attacks, strokes…
Stage 4: Severe end-stage disabilities related to obesity; debilitation, impairment, limitations
Know the basics of each of these (none -> signs -> disease -> damage -> 2x damage)

Question 15

Energy In:

Answer 15

Foods and drinks that you intake; the calories taken in
Any extra calories taken in are stored as Fat; roughly 3500kcal/lb of fat

Question 16

Energy Out:

Answer 16

Lifestyle and metabolism; percents vary day to day
Basal Metabolism: Sum total of energy expended on all involuntary activities needed to sustain life except for digestion - heartbeat, breathing, skin maintenance
Physical Activities: All voluntary activities and variable element of energy output
Thermic Effect of Food: 5-10% of a meal’s energy is expended while digesting food
Protein has the highest thermic effect of food

Question 17

Hunger:

Answer 17

Unpleasant/painful sensations that signal a need for food
Roughly 4-6 hours after eating a meal when stomach, SI empties and stomach hormone ghrelin is released but there are MANY more factors
Bloodstream nutrients, meal composition, weather, exercise, hormones, illness

Question 18

appetite

Answer 18

no hunger, but desire to eat

Question 19

Leptin

Answer 19

Appetite-suppressing hormone made by adipose that contributes to satiety
If we gain fat = more leptin, less eating; opposite is true

Question 20

most practical indicator for health

Answer 20

waist circumference

Question 21

Fasting:

Answer 21

Glycogen stores are exhausted in a day
Protein is broken down to meet brain’s glucose needs; eventually breaks down heart/liver
Ketone bodies are converted from fat as well, most after 10 days of fasting
Healthy person could live 6-8 weeks without eating based on body’s reserves

Question 22

ketosis

Answer 22

leads to acid-base imbalance

Question 23

cleanses?

Answer 23

total bs

Question 24

Low Carb Diets:

Answer 24

Glycogen holds a lot of water: You may just be losing water weight; gained back after eating carbs, desserts tend to be high in carbs as well
Less variety = less interest/appetite, high protein foods also tend to be slow to prepare
Note that minimum carb intake is 130g/day to prevent ketosis, AMDR for carbs is 45-65% kcal

Question 25

Realistic Calorie Intakes:

Answer 25

Very Low Calorie Diets: <800 kcal/day, generally medically supervised (Dr. B Diet) Calories are less important than eating a healthy, balanced diet

Question 26

Spot-reduction*

Answer 26

YOU CANNOT REMOVE FAT AROUND ONE PARTICULAR AREA

Question 27

surgeries for obesity

Answer 27

It depends and requires extreme obesity BMI >40 alone or BMI >35 with coexisting disease Person needs to be fit for surgery; not a cure and requires strict diet, control

Question 28

Gastric Banding: “Lap-Band”

Answer 28

Silicone donut is put around top of stomach and you can control how tight the band is Restrictive* method of weight loss; you feel full by restricting how much can be put in stomach

Question 29

Gastric Bypass (Roux-en-y): Major surgery

Answer 29

Staples are placed to make a smaller, mini stomach; place on SI is cut, placed onto mini stomach so it goes straight to the jejunum (bypasses most of the stomach, duodenum) It is a restrictive and malabsorptive* method of weight loss Need to take vitamin supplements since you’re absorbing less

Question 30

Gastric Sleeve:

Answer 30

You remove most of the stomach except for a banana-width portion of the stomach, both sphincters are left intact however Restrictive* method of weight loss; can lead to complications, depends on compliance Vitamin and Mineral deficiencies can occur

Question 31

Sibutramine

Answer 31

Suppresses appetite; is a serotonin reuptake inhibitor

Question 32

Orlistat

Answer 32

Inhibits pancreatic, gastric lipase; reduces fat absorbed by the body but in turn may lead to fatty shits

Question 32

Orlistat

Answer 32

Inhibits pancreatic, gastric lipase; reduces fat absorbed by the body but in turn may lead to fatty shits

Question 33

Saxenda

Answer 33

Makes you feel less hungry and more full sooner; GLP-1 hormone analog

Question 34

Saxenda

Answer 34

Makes you feel less hungry and more full sooner; GLP-1 hormone analog

Question 35

Off-Label Use Drugs

Answer 35

Drugs used for secondary effects; ex., epilepsy medications for weight loss

Question 36

Ephedrine

Answer 36

Not allowed in Canada for weight loss, energy, bodybuilding, euphoria

Question 37

eating disorders

Answer 37

- psychological (not a choice) HIGHER IN WOMEN THAN MEN**

Question 38

Female Athlete Triad

Answer 38

Combination of disordered eating, amenorrhea, osteoporosis Disordered Eating: Inadequate nutrition/restrictive dieting + overexercising, weight loss, lack of fat, and extreme bodily stress Amenorrhea: Absence of periods, caused by the extreme stress, disordered eating, leads to diminished hormones Osteoporosis: Lowered bone mass and density caused by malnutrition, lack of hormones

Question 39

Male Athletes

Answer 39

Dancers, figure skaters - aesthetic appeal of being thin, weight classes in sports “Make weight” practices compromise abilities and can be dangerous; ex., dropping water weight in order to make a weight class Muscle Dysmorphia: Psychiatric disorder; obsession with building body mass

Question 40

Anorexia Nervosa

Answer 40

Distorted body image leading to severe low weight, self-starvation Persistent energy restriction Fear of weight gain Disturbance in body image Can be restriction type or bingeing/purging type least prevalent

Question 41

anorexia nervosa diagnostic criteria**

Answer 41

Persistent restriction of energy and significantly low body weight Intense fear of weight gain Disturbance in way one’s body image is tied to self worth, achievements

Question 42

bulimia nervosa

Answer 42

Characterized by binge eating and purging Episodes where you binge eat and lose self control After binge, you compensate with purging: vomiting, laxatives, diuretics, exercise, etc. Episodes happen once a week for 3 months

Question 43

bulimia nervosa diagnostic criteria***

Answer 43

Recurrent episodes of binge eating; larger than normal in a small period of time, lack of control Recurrent inappropriate compensatory behaviours to prevent weight gain Not just vomiting; also laxatives, diuretics, enemas, fasting, excessive exercise Binge eating/Compensation occurs on average at least once a week for 3 months Self-evaluation is influenced by body shape/weight

Question 44

binge eating disorder

Answer 44

Characterized only by binge eating Episodes where you binge eat and lose self control Episodes may lead to psychological stress Episodes happen once a week for 3 months Not associated with any compensatory behaviours most prevalent

Question 45

binge eating disorder diagnostic criteria

Answer 45

Recurrent episodes of binge eating; way more food than normal and lack of control Episodes may lead to fasting, fullness, eating alone due to disgust/depression Distressful episodes occur at least once a week for 3 months Not associated with purging, fasting, AN, BN