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Clinical Nutrition 1 > Management of Obesity > Flashcards

Management of Obesity Flashcards

1
Q

What are the 5 As of obesity management?

A 
ASK for permission
ASSESS obesity risks/causes
ADVISE on health risks/treatment
AGREE health outcomes, behaviour goals
ASSITS in accessing resources
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2
Q

There are health benefits associated with ____ weight loss

A

5-10%

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3
Q

What are the therapeutic objectives in weight loss?

A
  • Changes in eating behaviours
  • Weight-loss/stabilization
  • Prevention of weight re-gain
  • Reduction in risk factors
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4
Q

Name some improvement in diabetes control with weight loss

A
  • Increased glucose tolerance
  • Increase insulin sensitivity
  • Decreased medication
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5
Q

Name some improvement in cardiovascular health with weight loss

A
  • Normalize TG levels
  • Increase HDL, decrease LDL
  • Improve CHD risk profile
  • Decreased medication
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6
Q

Name some improvement in hypertension with weight loss

A
  • Decreases systolic BP, blood volume, cardiac output
  • Decreased sympathetic activity
  • Decreased need for anti-hypertensive medication
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7
Q

Benefits of a 10 kg weight loss in mortality?

A

-Decrease total mortality, diabetes deaths, obesity related cancers

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8
Q

Benefits of a 10 kg weight loss in BP?

A

Decrease 10 mmHg systolic

Decrease 20 mmHg diastolic

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9
Q

Benefits of a 10 kg weight loss in angina?

A

91% decrease in symptoms

33% increase in exercise tolerance

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10
Q

Benefits of a 10 kg weight loss in lipids?

A

Decrease total cholesterol, LDL cholesterol, TGs

-8% increase in HDL

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11
Q

Benefits of a 10 kg weight loss in diabetes?

A

> 50% reduction in developing diabetes
30-50% decrease in fasting blood glucose
Decrease HmgA1C

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12
Q

Main difference between weight loss and weight maintenance diets?

A

Weight loss = hypocaloric

Weight maintenance = isocaloric

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13
Q

What is in common between weight loss and weight maintenance diets?

A
  • Adequate nutrients
  • Behavioural modification
  • Physical acitivities
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14
Q

What is to consider about the isocaloric diet ?

A

Will be adjusted the the persons CURRENT weight, after the weight-loss, and therefore may be similar or the same amount of calories as the hypocaloric diet

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15
Q

How do we determine an appropriate energy intake for weight loss in obese patients?

A

1) Calculate TEE (with IOM or MFSJ)

2) Subtract 500 kcal

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16
Q

500 kcal will lead to a 1 lb or 0.5 kg loss per week. Explain the principle behind this

A

One pound is equal to 454 g of adipose tissues, where 87% of adipose tissue is fat.
0.87 x 454 g = 395 g of fat
395 g x 9kcal/g = 3500 kcal
3500 kcal/7 days= 500 kcal/day to induce 1 lb weight loss in one week

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17
Q

What is important to consider when adjusting for an energy deficit?

A

We want to induce an hypo-caloric diet that has a large enough energy deficit to induce weight loss without inducing the physiological adaptations to starvation (under hormonal/hedonic control)

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18
Q

In obese patients, we should aim for a modest weight loss of ___

A

5-10% of CBW

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19
Q

How could we estimate target weight?

A

Use simple quick method (if we know kcal, and if we know total calories with deficit, we can know the weight)

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20
Q

How could we recommend weight loss?

A

Using stepwise approach (loss–>stabalize –> loss)

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21
Q

What will the stepwise approach allow?

A

Allow the patient to adjust to behavioural modifications, readjust energy expenditure and energy metabolism.

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22
Q

Pro, CHO, Fat and vitamin supplementation on severely low energy diets ? (<600kcal/day)?

A

Pro: 1.5 g/kg/day
CHO: >50 g/day (prevent ketosis)
Fat: 3.6 g/day linoeic acid
Vit Supplements: Yes

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23
Q

Pro, CHO, Fat and vitamin supplementation on very low energy diets ? (600-1200 kcal/day)?

A

Pro: 1.1-1.2 g/kg/day
CHO: 45-65% (normal)
Fat: <30% (normal)
Vit Supplements: yes

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24
Q

Pro, CHO, Fat and vitamin supplementation on low energy diets ? (1200-1500 kcal/day)?

A

Pro: 1.0-1.2 g/kg/day
CHO: 45-65% (normal)
Fat: <30% (normal)
Vit Supplements: Optional, but recommended

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25
Q

Diets at and below ____ is difficult to reach nutrient requirements

A

1500 kcal

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26
Q

What are the priorities in dietary intervention for people with obeity? (CAPP)

A
  • Creating and energy deficit
  • Avoid nutritional deficiencies
  • Preserve lean mass
  • Promote long-term adherence
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27
Q

In weight management for obesity we want to __

A

Change behavioural and dietary habits for life

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28
Q

What were some key results in high protein diets for weight-loss (study)

A
  • REDUCTION in body weight, fat mass and serum TGs
  • LESS reduction in fat-free mass (LBM)
  • NO CHANGE in cholesterol, fasting glucose, BP, insulin
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29
Q

In the high-protein diet for weight-loss, there was less reduction if fat-free mass - what does this mean?

A

That the diet spared endogenous protein breakdown, meaning that the individual will not experience a decrease in REE which will facilitate weight-loss

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30
Q

What where the 4 diets tested after individuals followed the very low cal diet for 8 weeks?

A

High protein high glycemic
High protein low glycemic
Low protein low glycemic
Low protein high glycemic

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31
Q

Which diet resulted in the greatest weight-regain vs control?

A

LPHG>LPLG>HPHG?HPLG

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32
Q

Which diet resulted in virtually NO weight-regain?

A

High protein, low glycemic diet

33
Q

Low protein =

A

13% AMDR

34
Q

High protein =

A

25% AMDR

35
Q

High protein and low glycemic diets also experienced what?

A

Lower dropout, no changes in satiety, less weight regain. More realistic to follow, and protein was not unrealistically high (22-25%)

36
Q

What is the criteria to register at the National Weight Registry?

A

Lost more than 30 lbs and have kept off for >1 year

37
Q

How did 89% of National Weight Registrants succeed?

A

Through diet and physical activity modifications

38
Q

What are the common factors of successful registrants of the National Weight Registry?

A
  • Low-energy, low-fat w/ little varied diets
  • Exercise 90% 1 hour/day
  • Less than 10hrs/week of TV
  • Eat breakfast
  • Self-weight and monitor weight
39
Q

What are the two KEY messages in management of obesity?

A
  • A modest weight loss of 5-10% is beneficial

- Weight-maintenance and weight loss should be long-term/life-long goals

40
Q

Protein AMDR

A

10-35%

41
Q

Protein AMDR for weight-loss

A

25-30%

42
Q

Protein AMDR for weight-maintenance

A

15-20%

43
Q

CHO AMDR

A

45-65%

44
Q

CHO AMDR for weight-loss

A

45-65% (UNLESS on severely restricted energy diet)

45
Q

CHO AMDR for weight-maintenance

A

45-45%

46
Q

CHO recommendation for weight-loss/maintenance?

A

High fibre, low GI, whole grain CHOs

47
Q

Fat AMDR

A

20-35%

48
Q

Fat AMDR weight-loss & maintenance

A

<30%, enough essential FA, low trans/saturated fats

49
Q

Name some stats about PA

A
  • 50% Canadians inactive
  • More females than males inactive
  • PA decreases with age
50
Q

Active adults have ____ decreased risk of premature mortality

A

20-35%

51
Q

What is encouraging about PA for sedentary individuals?

A

A modest increase in PA has been associated with LAGE improvements in health status, especially in risk of mortality (taper off as aerobic fitness increases - more significant in men)

52
Q

Which diseases drastically decrease in risk, then stabilize as PA increases (curvi-linear relationship?) CODS

A
  • CHD
  • Osteoporosis
  • Diabetes
  • Stroke
53
Q

What linearly decreases as activity increases?

A

Weight gain

54
Q

What increases as physical activity increases?

A

Muscoskeletal injury

55
Q

In someone who is usually sedentary, what is an encouraging message about disease risk and PA?

A

A small increase in PA can have large health benefits in reducing risks of diseases (CODS) and weight gain

56
Q

PA and E to prevent weight gain? Preventative of what % of weight gain?

A

PA: 150-250 min/week
E: 1200-2000 kcal/day
Prevent weight gain of greater than 3% in most adults

57
Q

PA for minimal weight loss?

A

<150 mins/week

58
Q

PA for moderate weight loss?

A

> 150 mins/week

59
Q

PA for greater weight loss? Approx how many kg?

A

> 225-420 mins/week

~5-7.5 kg of weight loss

60
Q

PA for weight maintenance?

A

~200-300 kcal

“more is better?”

61
Q

What is lifestyle PA protective of?

A

May counter the small energy balances found in obese adults

62
Q

What is the paradox in increases PA and energy restiction

A

If the energy restriction is too severe, it will hinder weight loss. (

63
Q

Does resistance training support weight loss? How about with diet restriction?

A

NO for either

64
Q

What may resistance training improve?

A

Chronic disease risk factors, osteoporosis

65
Q

If used, pharmacological treatments must not be ___

A

the sole treatment and MUST be used i conjunction with dietary, activity and behavioural modifications

66
Q

What is orlistat?

A

lipase inhibitor

67
Q

Describe the mechanism of action of orlistat (lipase inhibitor)

A

Acts in the GI (must be take with food), and acts as a non-absorbed inhibitor of lipase which produces a malabsorption of 30% of fat, and will become excreted.

68
Q

What are the results of using orlistat?

A

~50% effective individuals, resulting in a 4kg weight loss and improved co-morbidities

69
Q

What side-effects are associated with orlistat?

A

AFFECT DAILY LIVING ACTIVITIES

  • fecal and urinary urgency
  • fatty stool
  • Vit ADEK deficiencies
70
Q

What is the mechanism of action for appetite suppressants?

A

Acts on the CNS in the central regulation area of appetite to decrease appetite and increase satiety.

71
Q

What are appetite suppressants?

A
  • Seretonin agonist (seretonin = anorexigenic)

- Amphetamine inhibitor

72
Q

What are risks associated with appetite suppresants?

A
  • May cause addiction, nausea, dizziness, CVD ris
73
Q

What are the 3 factors of readiness assessment? (BPE)

A
  • Behavioural
  • Pyschological
  • Environmental
74
Q

What are some behavioural aspects of RA?

A
  • Ability to increase PA
  • Success of previous weight loss
  • Self-control
75
Q

What are some psychological aspects of RA?

A
  • Attitudes about weight loss

- Confidence in ability to lose weight

76
Q

What are some environmental aspects of RA?

A
  • Social support

- Life circumstance

77
Q

Selection criteria for weight management program is based on what? CFN

A
  • Composition
  • Food plans
  • Nutrition counselling
78
Q

What is intricately related in management of obesity? How is it sustained?

A

Diet, physical activity and behavioural modifications

Sustained by maintenance.

79
Q

Overall, what are some key recommendations you would make to a person living with obesity?

A
  • Assess readiness to change, state-of-change model ..
  • Diet high in protein (25-30%), <30% fat, normal range of carbohydrates that are low GI
  • Increase physical activity (pedometer, walking, low amounts of effort - increase lifestyle PA)
  • NO starvation/extremely low kcal diets, fad diets etc.

Clinical Nutrition 1 (30 decks)

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