Nutrition Module 7: Obesity - Basic and Clinical Flashcards
(121 cards)
1
Q
What % of adults are overweight?
A
66%
2
Q
What % of adults are obese?
A
35%
3
Q
What % of children are obese?
A
17%
4
Q
By how much has obesity prevalence increased since 1960?
A
Tripled
5
Q
How has the obesity of kids in difference age groups increased?
A
- 2-11 yo: 5 to almost 20%
- 12-19: 5 to 12%
6
Q
How many obese adults worldwide?
A
1.4 billion
7
Q
Is the rapid increase in obesity only seen in developed countries?
A
NOPE but rate of increase is faster
8
Q
What is causing the global obesity epidemic?
A
- Rising incomes
- Urbanization
- Globalization of food supply
- Decreased physical activity because of technology
9
Q
BMI for overweight?
A
25 or above
10
Q
BMI for obese?
A
30 or above
11
Q
How is obesity defined for kids?
A
BMI for age above 95th percentile
12
Q
What are the 8 health risks of obesity?
A
- CV disease
- Hypertension
- Type 2 DM
- Cancer (breast, endometrium, prostate, and colon)
- Gallstone disease
- Hyperuricemia (gout)
- Joint degeneration
- Mental health problems
13
Q
What is central obesity?
A
Excess fat in abdomen and upper body (apple shape): abdomen, back, arms, and chest
14
Q
What can increase the health risks of obesity? Why?
A
Central obesity because:
- Impaired lipoprotein metabolism
- Impaired glucose handling
- Higher CVD risks
- Higher DM risks
- Higher cancer risks
15
Q
What kind of weight loss can reduce the health risks of obesity?
A
Modest
16
Q
What are the 10 leading causes of death in the US from most prevalent to least? Note those that obesity (*) and nutrition (#) contribute to.
A
- Heart disease*#
- Malignant neoplasms*#
- Chronic lower respiratory diseases
- Cerebrovascular diseases*#
- Accidents
- Alzheimer’s
- DM*#
- Nephritis, nephrotic syndrome, and nephrosis#
- Pneumonia and the flu
- Suicine
17
Q
What determines body fat distribution?
A
Genetic variation
18
Q
How can we determine body fatness in patients?
A
- Underwater weighing = hydrodensitometry
- Imaging techniques: CT scan, MRI, DEXA
- Bioelectrical impedance analysis (using differences in electroconductivity)
- Air-displacement plethysmography
- Doubly-labeled water method (radioactive water is ingested)
19
Q
Which are more dangerous: intra-abdominal fats or subcutaneous fats?
A
Intra-abdominal fats
20
Q
What are the 6 cancers that obese people are more at risk for?
A
- Breast (postmenaopausal)
- Endometrium
- Prostate
- Colon
- Kidney
- Esophagus
21
Q
What are indirect measures of body fat?
A
- Weight
- BMI
- Waist circumference or waist-to-hip ratio
- Skinfold thickness measurements
- Others
22
Q
Does W-T-H ratio apply equally to all pops?
A
NOPE
23
Q
What are the units of BMI?
A
wt/ht^2= kg/m^2
24
Q
In what 5 situations is BMI not appropriate to use?
A
- Pregnancy/lactation
- Competitive athletes and body builders
- Children under 2 yo
- Old people who are frail and sedentary
- Patients with conditions precluding accurate height measurement (kyphosis, scoliosis)
25
What is waist circumference an indicator of?
Intra-abdominal fat
26
What waist circumference suggests central obesity in males and females?
Males: 40 inches or above
Females: 35 inches or above
27
How to measure waist circumference?
1. Locate uppermost border of iliac crest and draw a horizontal line
2. Plane of the tape should be parallel to the floor and snug but should not compress the skin
3. Measurement is made during normal minimal respiration
28
What is another way of saying central obesity?
People with mainly intra-abdominal fat
29
Do humans have a limited capacity to store fat?
NOPE
30
How can body weight stay constant?
Energy intake = energy expenditure
31
What is the equation to calculate energy expenditure?
Energy expenditure = resting metabolic rate (60-75%) + activity (15-30%) + thermic effect of food (5-10%)
32
Why is the rate of weight gain is often less than expected for the amount of excess calories? How can anyone gain weight then?
Because the higher body weight requires more energy
We gain weight because there is a regulatory response to excess intake that leads to metabolic ineffeciency
33
What are the 6 factors that lead to the development of obesity?
1. Genetics
2. Environment
3. Physiology
4. Metabolism
5. Psychology
6. Culture
34
Will individuals with a strong genetic obesity disposition lose weight when their energy expenditure exceeds intake?
YUP
35
What is one reason for increased CVD risk in obese people?
Obesity commonly elevates serum lipids.
36
Why is gallstone a risk for obese peeps?
Excess synthesized cholesterol is eventually excreted with bile and raises the risk of gallstone formation
37
What is gout?
Rich man's disease
| Uric acid crystallizes and causes joint inflammation in feet and toes
38
What are the 3 keys for a diet for weight management?
1. Moderation
2. Variety
3. Balance
39
What are the consequences of following restricted and unbalanced diets?
Range from short-term dehydration and diarrhea to more serious problems like malnutrition, loss of muscle mass, and electrolyte imbalance
40
What are the 3 steps to successful weight management?
1. Assess: BMI, co-morbidities, willingness to change, present intake and exercise, social support
2. Provide: intervention, encouragement, therapeutic HW
3. Plan: for long term follow up and possible relapse
41
What are the 4 benefits of physical activity in obese peeps?
1. Maintains greater muscle mass
2. Avoid excess body fat
3. Improve mental health
4. Avoid weight gain
42
What 6 health risks are reduced with regular physical activity?
1. Cancer
2. T2DM
3. Metabolic syndrome
4. CVD
5. Hypertension
6. Osteoporosis
43
What explains the importance of exercise for weight loss maintenance?
1. Stimulates HSL
2. Strengthens muscles
3. Increases glycogen storage capacity of muscles
4. Increases # of mito in muscle cells
=> muscles have greater peak metabolism
44
For what patients can the slighest over intake compared to expenditure cause weight gain?
Children
45
What ultimately results in weight gain?
Consistent intake that exceeds expenditure
46
What are the 6 components of TEE and their %? (Total Energy Expenditure)
1. Physical Activity (15-30%)
2. Basal energy expenditure (50-75%)
3. Thermic effect of food (increase in energy expenditure due to digestion) - (5-10%)
4. Growth (childhood, adolescence, or pregnancy) (less than 2%)
5. Thermoregulation (only contributing to TEE under extreme environmental conditions)
6. Lactation
47
Which is the most variable component of TEE in healthy people?
Physical activity
48
What is NEAT?
Nonexercise activity thermogenesis: component of physical activity which includes fidgeting, reading, typing,
49
What can determine NEAT?
Genes
50
By how much will the TEE be increased with walking (mild-moderate speed)?
~1.1 kcal/mile/kg
51
What % of BEE is the is the energy expenditure from PA for a sedentary person?
Less than 50%
52
What % of BEE is the is the energy expenditure from PA for a very active person?
200%
53
What is BEE? What is it closely correlated with?
Basal energy expenditure = closely correlated with size of fat-free mass (FFM)
54
What % of TTE is thermic effect of food?
10%
55
What foes the thermic effect of food depend on?
Depends on macronutrient consumed: protein has a higher one than carbs which are higher than fat
56
Can a diet low in carbs and high in protein increase the TEE by increasing the thermic effect of food?
NOPE
57
How many more calories a day are needed during growth (1-18 yo)? What % of total daily energy requirements is that? What does this illustrate?
~8-34- kcal/day depending on age and sex = Less than 2% total daily energy requirements
Shows that small amounts add up to normal tissue deposition and small excesses can lead to excess fat gain
58
Why can the actual effect of a small intake/activity change over 6 months be actually smaller than expected?
Regulation mechanisms to maintain homeostatis
59
What can explain the difficulties people can have when trying to lose weight? How to overcome this?
Regulation mechanisms to maintain homeostatis
| Time, persistence, and maintaining lifestyle changes can overcome this
60
Describe the short term regulation of appetite (list all hormones involved too).
1. Hormones secreted by stomach to hypo induce hunger: ghrelin
2. Hormones secreted by small/large intestines and pancreas to hypo signal satiety:
- Duodenum => Cholescystokinin (CKK)
- Jejunum + fat = apolipoprotein AIV + GLP-1
- Jejunum/Ileum + fibers = peptide YY
- Pancreas + carbs = amylin released with insulin
61
Describe the long-term regulation of appetite
Adipose tissue: when fat stores decrease, appetite increases
62
Describe the adipose-brain axis.
Adipose tissue signals to the brain when fat contents fall by decreasing leptin secretion, which increases appetite
63
Does the rise of leptin with fat gain have a big effect on appetite?
NOPE because the energy requirements are higher
64
Explain how the functioning of leptin affects weight gain/loss.
It's easy to gain weight and it's hard to lose it
65
Describe central appetite regulation.
2 types of neurons in the paraventricular and arcuate nuclei of the hypo regulate appetite:
1. Orexigenic neurons are
- Activated by ghrelin and release NPY and agouti-related protein (AgRP) which bind to Y1 and Y5 receptors on secondary neurons
- Inhibited by leptin, insulin, GLP-1, and PYY
2. Anorectic neurons are activated by leptin and release POMC, and cocaine-and-amphetamine-stimulated transcript (CART) which bind to MC3 and MC4 (melanocortin) on secondary neurons
66
On what nerve does CKK act?
The vagus nerve: the nerve that leads to and from the brain to the pancreas
67
How can the stomach signal satiety to the brain?
Stretching
68
What are the 5 determinants of individual TEE?
1. Age
2. Weight
3. Height
4. Gender
5. Physical Activity
69
How do TTEs fluctuate with age?
They decrease after 30
70
What is the info you want to collect during a dietary habits assessment?
1. Food choices
2. Calories
3. Variety
4. Adequacy
5. Portion sizes
6. Excesses/deficiencies
7. Supplements
71
What factors determine which diet assessment method you should use?
1. Age
2. Primary caregiver presence or not
3. Reading/writing ability
4. Purpose
72
When are more precise dietary assessment methods used and what are they?
During research or used by dietician:
1. Food frequency questionnaire
2. Food record
3. 24h recall
73
What are 2 characteristics of good dietary screening tools?
1. Easy to administer
| 2. Scored for interpretation
74
What are 3 examples of dietary screening tools? Can these be self-administered?
1. Family Eating Habits Quiz
2. Food Group Assessment Tool
3. Fate Your Plate (Dietary fat screening tool)
YUP!
75
What are the 6 basic food groups?
1. Grains
2. Vegetables
3. Fruits
4. Oils
5. Dairy
6. Protein
76
What are discretionary calories?
Small amount of calories that remain in a person's energy allowance after meeting nutrient intakes (assuming they are low in fat and do not contain added sugars)
77
What is the standard serving size for fruit?
1/2 of cut-up fruit, juice, large fruit OR 1/4 cup of dried fruit
78
What is the standard serving size for vegetables?
1/2 cup of cut-up raw or cooked veggies, juice OR 1 cup of leafy salad greens
79
What is the standard serving size for grains?
1/2 cup of cooked rice, pasta, cereal OR 1 oz of dry pasta/rice OR 1 slide of break OR 1 cup of cereal or 1/2 an 8'' tortilla
80
What is the standard serving size for protein?
1 oz cooked lean meat, poultry or fish OR 1 egg OR 1/4 cup of beans/tofu OR 1/2 oz nuts/seeds
81
What is the standard serving size for dairy?
1 cup of milk/yogurt OR 1.5 oz natural cheese or 2 oz processed cheese
82
How much does 1/2 cup of solid food weigh?
100 g
83
1 oz in grams?
30 g
84
How many oz in 1 cup of liquid? How much is that in mL?
8 oz = 240 mL
85
How have portion sizes evolved over time? 3 examples?
```
Increased dramatically over past few decreased:
1. Bagel: 140 kcal to 350
2. Burger: 333 to 590
3. Spaghetti and meatballs: 500 to 1025
Soda: 140 to 280
Fries: 210 to 610
```
86
How many kcal does raking leaves for almost an hour use up for a 130 lbs person?
210 kcal
87
How many kcal does lifting weight for an hour and a half use up for a 130 lbs person?
260 kcal
88
How many kcal does leisurely walking for a little over an hour use up for a 160 pound person?
400 kcal
89
How many kcal does cleaning for two and a half hours use up for a 130 lbs person?
500 kcal
90
What types of food are the foundation for a healthy diet that favors energy balance?
Nutrient dense foods
91
What do nutrients dense foods often contain?
1. Fiber
| 2. Phytochemicals
92
What are phytochemicals? Where are they found?
Non-nutrient plant constituents that may contribute to lower risk of cancer or heart disease found in fruits, veggies, tea, carotenoids, flavonoids, whole grains, soy
93
When are energy dense food recommended?
To meet very high kcal requirements due to surgery/trauma or for an athlete or for those who have trouble eating (old people or cancer patients)
94
Do energy-dense foods provide a lot of nutrients?
Depends
95
What 4 factors describe physical activity?
1. Frequency
2. Intensity
3. Type
4. Time
= FITT
96
Other than FITT, what other info do you need to assess physical activity?
1. Personal characteristics (disabilities, age, etc)
2. Physical circumstances (SES, environment, access)
3. Motivation (for kids: how much their parents exercise)
97
What to ask preschoolers to determine PA?
Ask parent about outdoor playtime, TV, computer, or video game time
98
What to ask youth/adolescents to determine PA?
Ask about organized sports, PE, leisure time PA, preferences, screen time
99
When are direct measures of PA appropriate? Examples?
When monitoring overweight kids or those who are motivated/interested
Eg: step counters, pedometers, activity diaries
100
How much exercise is enough for adults? Type?
1. For some health benefits: At least 30 min
2. To reduce weight: 1 hour
Mix of cardio and resistance is ideal
101
How much exercise is enough for kids?
1 hour
102
How can you tell intervention is needed on a kid with regards to his/her PA?
Spends less than an hour being active OR spends more than 2 hours on screen time
103
What is motivational interviewing?
PC approach to effect behavior change utilizing understand and reflective listening techniques and relies on the patient to identify personal strategies and areas of change
104
What are the 4 principles of motivational interviewing?
1. Express empathy
2. Develop discrepancy
3. Roll with resistance
4. Support self-efficacy in the patient
105
What are the 6 common elements of motivational interviewing?
1. Feedback
2. Responsibility
3. Advice
4. Menu (give options)
5. Empathy
6. Self-Efficacy
= FRAMES
106
Is there a set-point for body weight? Why does this homestatic process sometimes fail?
There is but there are many pathologies associated with this set-point
107
What are the 2 implications of leptin resistance?
1. Decrease in norepinephrine secretion from hypo = decrease in TAG breakdown and FA beta oxidation
2. Increase in body weight set-point by opposing satiety and adipose storage
108
How is the body weight set-point established? How can the set-point be overweight or obese?
Surges of leptin occur in utero, pre-puberty, conception establishing the set-point
If you have an inappropriately sized or timed surge, your set-point could be higher than it should be
109
What could cause hypothalamic leptin resistance in utero?
Over-consumptive under-nutrition
during pregnancy might promote a premature leptin surge that establishes in utero leptin
resistance in the fetus. This hypothesis argues that these children and adults have an artificially
high leptin set point, leading to obesity
110
How can patients with a genetic leptin deficiency be treated? How does it work?
Exogenous leptin which will rewire the arcuate nucleus to regain the inhibitory input in the orexigenic neurons and regain the stimulatory input on the anorexigenic neurons
111
How does the gut microbiome contribute to obesity?
Obese have a different bacteria population than lean people: they have more efficient harvester types of bacteria which produce higher amounts of calories
112
What % of our calories come from our microbiome?
10%
113
How can antibiotics lead to obesity? Which ones are worse?
Antibiotics against
adenovirus-36 (Ad-36), a virus more commonly associated with respiratory and eye infections, in the first 6 mos of age have shown to increase obesity risks by impacting the gut microbiome and selecting for these efficient energy harvesting bacteria
Broad range antiobiotics are worse
114
Where is the largest use of antibiotics in the US?
Within farms, with low doses fed to large numbers of a production to increase weight gain by as much as 15%
115
What are the 3 main homestatic regulatory mechanisms that gover body weight?
1. Satiety signals
2. Glucostatic signals
3. Lipostatic signals
116
What is the prevalence of homozygous mutations in leptin or the leptin receptor in humans?
EXTREMELY low
117
What 6 other drugs (on top of antibiotics) are prescribed that seem to have a weight gain issue?
1. Medications for Type Diabetes Mellitus
2. Medications for Hypertension
3. Antihistamines
4. Steroid Hormones
5. Anticonvulsants
6. Psychoactive medications
118
Why can T2DM meds cause weight gain?
Hyperglycemic drugs force cells to take up glucose sometimes when they do not need to, which leads to fat storage
119
What % of body weight is due to genetics?
30-70%
120
Why can breastfeeding be good for normal weight gain?
when breastfeeding, a baby can stop suckling when the
| baby is full
121
What are the 3 components of BEE? Include %
1. Ion pumping: 40%
2. Protein synthesis: 20%
3. Homeostatic functions (breathing, circulation, nutrient processing): 40%
