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SR-334 > OBESITY > Flashcards

OBESITY Flashcards

1
Q

Current Obesity Statistics in Wales

A
  • 58% classified as overweight (25-29.9kg/m2) or obese
  • 22% classified as obese (>30kg/m2)
  • 36% of men and 23% of women have PA levels to convey good health
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2
Q

CMO Guidelines, 2012 - Benefits of PA for Adults and Older Adults

A
  • benefits health
  • improves sleep
  • maintains health weight
  • manages stress
  • improves quality of life
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3
Q

Following CMO Guideline Reduces

A
  • T2D - 40%
  • CVD - 35%
  • Falls, depression and dementia - 30%
  • joint and back pain - 25%
  • Cancers (colon and breast) - 20%
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4
Q

Morton et al., 2010 - Walking and Lipid Burning

A
  • walking improves lipid burning
  • 19% lipid contribution pre-train, 26% post-train
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5
Q

Sources of Lipids in the Body

A
  • plasma; NEFA ~0.4g; TG ~4g
  • intramuscular TG; IMTG ~300g
  • adipose tissue
  • humans have a fuel reserve to complete between 43 (female elite) - 195 (female obese) marathons on lipids alone
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6
Q

Goodpaster et al., 2000 - Athlete Paradox

A
  • lipid accumulation within muscle fibres is significantly increased in obesity and is reduced by weight loss
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7
Q

Goodpaster et al., 2001 - Athlete Paradox

A
  • skeletal muscle of trained endurance athletes is markedly insulin sensitive and has a high oxidative capacity, despite having an elevated lipid content
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8
Q

Coen et al., 2015 - Lipid Metabolites Interfere with GLUT-4 Mobilisation

A
  • Fat/CD36 is increased in human IR skeletal muscles
  • existing skeletal muscle can decrease intramuscular ceramides and sphingolipids
  • ceramide content in muscle decreases with RYGB surgery - induced weight loss
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9
Q

Bariatric Surgery

A
  • derived from Greek words baros = weight and iatrokos = medicine
  • currently referred to as metabolic surgery
  • results in weight loss
  • improves metabolic consequences of obesity
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10
Q

All Wales Obesity Pathway: PA Component

A
  • tier 1 - community based prevention early intervention
  • tier 2 - community and primary weight management service
  • tier 3 - specialist, multi-disciplinary weight management services; specialist dietary, PA and behavioural elements delivered through primary and secondary care; sometimes w drug therapy
  • tier 4 - specialist medical and surgical services
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11
Q

NICE (National Institute for Health Care and Excellence) Guidelines State

A
  • BMI of 40kg/m2 or more
  • all appropriate non-surgical measures have been tried but the person has not achieved or maintained adequate, clinically beneficial weight loss
  • person has been or will be receiving intensive managements in a tier 3 service
  • person is generally fit for anaesthesia and surgery
  • person commits to the need for the long-term follow-up
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12
Q

Types of Bariatric Surgery

A
  • laparoscopic adjustable gastric bonding (LAGB)
  • laparoscopic biliopancreatic diversion with duodenal switch
  • laparoscopic sleeve gastrectomy (LSG)
  • laparoscopic roux-en-Y gastric bypass (LRYGB)
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13
Q

Wu et al., 2016 - Bariatric Surgery vs Exercise

A
  • bariatric surgery results in significantly greater percentage loss of excessive fat deposits except for epicardial adipose tissue (EAT)
  • EAT but not paracardial adipose tissue (PAT) was relatively preserved despite weight reduction in both groups
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14
Q

ASMBS, 2012 - Pre-Surgical PA

A
  • evidence of pre-surgical PA markers is poor but advocated
  • mild ex for 20mins/day on 3/4days/week before surgery
  • pre-surgery PA engagement may improve cardiorespiratory fitness, reduce risk of surgical complications, facilitate healing and enhance post-operative recovery
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15
Q

Marcon et al., 2016 - Pre-Surgical PA

A
  • pre-surgery ex programme significantly improved functional capacity and cardio-metabolic parameters in intervention group and worsened in control
  • exercise adherence above 78%
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16
Q

ASMBS, 2012 - Post-Operative Exercise

A
  • exercise after surgery is imperative, and may be the most important factor that can achieve long-standing and successful weight loss
  • start walking from day 1
  • increase walking each day; add other aerobic activities as surgeon permits
  • start light weight training and sit ups as surgeon allows
  • consider using a PT to educate about exercise, improve motivation and ensure correct techniques
17
Q

Mechanick et al., 2009 - Post-Surgery PA

A
  • increase their PA to a minimum of 30 min per day as well as increase PA throughout the day as tolerated
18
Q

Peacock and Zizzi, 2012 - Post-Surgery PA

A
  • only 22% of patients in American college of surgeons bariatric surgery centre network accredited bariatric centres received post-surgery exercise counselling
19
Q

Effects of PA Following Bariatric Surgery

A
  • weight; loss vs regain
  • metabolic control (glucose, lipids)
  • functional capacity: VO2, PA, CVD risk
  • psychological changes: QoL, readiness to exercise
20
Q

Weight Loss

A
  • bariatric surgery induces weight loss but isn’t and infallible treatment
  • 10-30% of bariatric patients experience sub-optimal weight loss and long-term effectiveness is less clear
  • exercise may be an important adjunct therapy
21
Q

Coen et al., 2015 - Weight Loss

A
  • walking (2h/week over 6month period) didn’t impact RYGB surgery induced weight loss or fat mass
22
Q

Rothwell et al., 2015 - Weight Loss

A
  • excess weight loss was improved at 12months but not 36 post-op by attending semi-structures exercise education classes
23
Q

Chaston et al., 2007 - Weight Loss

A
  • loss of FFM accounted for 31.3% of weight loss with RYGB surgery
24
Q

Janssen et al., 2002 - Weight Loss

A
  • RE excellent way to maintain muscle mass
  • supervised ex reduced loss of FFM in patients undergoing 16 weeks of weight loss on low calorie diet
25
Q

Wing, 2002 - Weight Regain

A
  • 12-18 months after weight loss, 33-50% of initial weight loss may be regained
26
Q

National Weight Control Registry (NWCR), 2001 - Weight Regain

A
  • moderate intensity-ex critical for maintaining weight loss
  • addition of 275min/week in combination with a reduction in energy intake was necessary for maintenance of 10% weight loss in obese women
27
Q

Campos et al., 2010 - Metabolic Control

A
  • caloric restriction improves hepatic insulin sensitivity after RYGB surgery
28
Q

Dunn et al., 2012 - Metabolic Control

A
  • peripheral tissue insulin sensitivity 1 month after RYGB surgery and 11% weight loss didn’t change
29
Q

Olbers et al., 2006 - Metabolic Control

A
  • long-term improvements in peripheral tissue insulin sensitivity after bariatric surgery do occur after ~50% reduced whole body fat mass and a ~60% decrease in visceral adipose tissue after a year
30
Q

Camastra et al., 2011 - Metabolic Control

A
  • peripheral insulin sensitivity remains low compared with that in lean, metabolically healthy individuals
31
Q

Best et al., 1996 - Metabolic Control

A
  • exercise may be beneficial to improve peripheral tissue insulin sensitivity after surgery induced weight loss
32
Q

Coen et al., 2015 - Functional Capacity

A
  • 6 months walking improved fitness in obese patients without diabetes who underwent bariatric surgery
33
Q

Stegen et al., 2011 - Functional Capacity

A
  • 4 months strength/endurance programme improved cardio-respiratory fitness and physical function
34
Q

Huck, 2015 - Functional Capacity

A
  • Resistance training can improve cardiorespiratory fitness and muscle strength in patients who have undergone bariatric surgery
35
Q

Directions for Clinical Practice

A
  • implement pre-surgery diet and exercise programmes
  • post-surgery PA programme; begin day 1progressively increasing to CMO guidelines and beyond
  • introduce pedometers/trackers and characterise baseline activity, then increase week by week
  • upskill more practice HCPs involved in tier 3 and 4 provision using number of exercise in medicine initiatives
  • empower patient to exercise and lead to a change in behaviour for life

SR-334 (7 decks)

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