Obesity

Question 1

What is obesity

Answer 1

Accumulation of fat stores to the extent that it compromises health

Question 2

NHS England impact of obesity

Answer 2

It rose from about 15% in the early 90’s to 27% in 2015

Question 3

NHS atlas of risk

Answer 3

It is the 4th commonest contributor to death in the UK

Question 4

Why is it important to tackle obesity?

Answer 4

The 5 year NHS forward view plan of 2011 highlighted that prevention of obesity in both adult and children is one of the things contributing to the health and wellbeing gap, and if the nation fails to get serious about prevention, then there will be reductions in the quality of care and money available for the treatment of other conditions. Put bluntly, as the nation’s waistline keeps piling on the pounds, we’re piling on billions of pounds in future taxes just to pay for preventable illnesses.

Question 5

What is the current financial cost of obesity to the NHS

Answer 5

Currenlty about 5 billion. This is estimated to double if prevention is not taken seriously, and in 2011 they DOH released a document, A call to action on obesity to identify measures for primary, secondary prevention of obesity

Question 6

What does DOH want

Answer 6

They want to see a downward trend in obesity by 2020 in both adults and kids

Question 7

Genetics of obesity

Answer 7

Twin studies have examined the weight of identical twins reared apart. For example, Skunkard et al 1990 (3 years before Michael was born) examined the differences in weight in 93 pairs of identical twins reared apart. Their study showed a strong link between genetics factors and variance in body weight in these kids by about 66-70%. It should be noted however that this variance is stronger in lighter kids than in obese kids

Adoptee studies: The same group had also looked at the role of genetics to compare the weight of adoptees to the weight of their adoptive parents and their biological parents 4 years earlier. In about 500 adoptees in Denmark, there was a strong relationship between the weight of the adoptee and their biological parents, but no relationship to the adoptive parents. In addition, the mother’s weight had a greater influence on the weight than the fathers.

This research thus suggests a strong role for genetics in predicting weight, but the genetic predisposition expression is unclear. Like it could mean that things like metabolic rate and appetite regulation are the factors influenced by genetics.

Question 8

Obesogenic environment

Answer 8

As genetic models can give us a basic framework for understanding the onset of obesity, they cannot, however, explain why the prevalence of obesity in the last couple of years has suddenly increased. As mentioned in the introduction the prevalence of obesity in the 90s was about 15% but in 2015, 27%.

The term ‘obesogenic environment’ refers to the role environmental factors can play in determining both nutrition and physical activity. Environmental factors like the increasing availability of takeaway, and fast food restaurants, reduction in manual labour, the presence of cars, the presence of lift and escalator. Bezzara et al 2012- overall, food prepared out-of-home tends to be less healthful than food prepared in the home and is associated with fat intake and body fatness. Less active travel to school by children.

Tyrell et al 2017, up to 120 000 adults from the UK Biobank study to test the hypothesis that high-risk obesogenic environments and behaviours accentuate genetic susceptibility to obesity. Findings suggest that the obesogenic environment accentuates the risk of obesity in genetically susceptible adults and relative social deprivation best captures the aspects of the obesogenic environment responsible.

Question 9

Physical consequences of obesity

Answer 9

In about 50,000 women, Moore et al 2008 assessed the impact of BMI 10 years prior to baseline. Their finding showed increased risk for mortality across the range of overweight and obesity, regardless of disease and smoking history. Both overweight and obesity were associated with increased mortality among younger and older women, among women with and without a history of chronic illness and among women who never smoked

Question 10

Physical consequences of obesity

Answer 10

Increased risk of diabetes, atherosclerosis, joint trauma, CVD, (mainly heart disease and stroke), musculoskeletal disorders like osteoarthritis, and some cancers (endometrial, breast and colon).

Question 11

Psychological consequences of obesity

Answer 11

With the ECJ ruling obesity to be a disability if it impairs ability to work to the same level of functionality as person without, in a study by Crossland employment 2015, obese people less likely to be invited past the interview phase

Question 12

Luppino et al 2010

Answer 12

Obesity and depression

Question 13

Obesity and depression

Answer 13

Lupino et al 2010 conducted a systematic review and meta-analysis on the longitudinal relationship between depression, overweight, and obesity in 15 studies. The findings confirmed a reciprocal link between depression and obesity. Obesity was found to increase the risk of depression by about 55% and depression was found to be predictive of developing obesity by 58% as ate more

Question 14

How many studies did Luppino et al 2010 use for the meta-analysis between obesity and depression

Answer 14

15

Question 15

How many women did moore et al 2008 assess for the link between obesity and mortality

Answer 15

A HUGE number. About 50,000

Question 16

Who suggested that none-home cooked meals could increase obesity?

Answer 16

Bezzara et al 2012

Food prepared out-of-home tends to be less healthful than food prepared in the home and is associated with fat intake and body fatness

Question 17

The biobank genetic study how many people and who was the lead?

Answer 17

Tyrell et al 2017, up to 120 000

Question 18

Why do fat trolls suck

Answer 18

In 2017, Pearl et al studied about 150 patients seeking treatment for obesity. If people were mean and they internalise, they are 3x more likely to have metabolic syndrome and 6x more likely to have high TG

Question 19

What are the 3 models of eating

Answer 19

C DA WEIGHT
Cognitive
Developmental
Weight concern

Question 20

What is cognitive model of eating

Answer 20

This involves the TBP and TRA
It involves using intentions to consume specific foods. It

PAS

In 2010 Helmer et al looked at the association between health control beliefs and healthy nutrition in about 3,000 patients. Their study showed that the patients were more likely to engage in healthy eating behaviour if they felt they were in control of their own health

Past behaviour also has an effect on eating behaviour. Wong et al 2009. In about 90 patients, findings showed that the TPB significantly predicted intentions and prospective behaviour of breakfast consumption, however, past behaviour was found to be the strongest predictor of future behaviour.

Question 21

TBP in health, who suggested control played a role?

Answer 21

In 2010 Helmer et al looked at the association between health control beliefs and healthy nutrition in about 3,000 patients. Their study showed that the patients were more likely to engage in healthy eating behaviour if they felt they were in control of their own health

Question 22

Helmer et al 2010

Answer 22

3,000 patients were more likely to engage in healthy eating behaviour if they felt they were in control of their own health

Question 23

Wong et al 2009

Answer 23

Wong and Mullan conducted a prospective study of
determinants of breakfast consumption in 96 undergraduate students, to examine the link between intention and behaviour. Components of intention to eat breakfast (attitudes, subjective norms and perceived
behaviour control) were measured using a behavioural questionnaire, and information on past breakfast behaviour was collected. Results showed that
breakfast eating was strongly correlated to the intention to eat breakfast. However, the strongest correlation
was past breakfast behaviour. The authors concluded
that although the intention to eat breakfast is important, past breakfast behaviour (habit) more strongly predicts the likeliness of eating breakfast in the future.

Similar findings have been reported by Merten and colleagues 2009 in their study showing past breakfast behaviour in adolescents (age 12-19yr) was a strong predictor of breakfast at age 26

Question 24

Problems with cognitive

Answer 24

It ignores the role of affect, things like ‘fear of weight gain’, pleasure, guilt,

It also ignores the influences others might have on eating such as social eating

Intent does not always mean action

Question 25

Developmental model

Answer 25

It emphasises the importance of learning and experience and focuses on the development of food preferences in childhood.

It involves a SEA of factors

Question 26

Social learning by observing others

Answer 26

The food dudes 2004 LOWE et al

By observing others, behavioural norms like breakfast habits that people have learned to be appropriate or desirable in their social have been shown to influence eating behaviour.

Pearson et al 2009 in a systematic review of 24 studies on breakfast and the role of the family. Examining several family correlates (including the availability of breakfast items, parental education, level, family income, parental presence at home and family communication),
the authors concluded that parental breakfast eating and living in two-parent families had the greatest correlation to adolescent breakfast consumption.

Question 27

Exposure

Answer 27

Humans show fear and avoidance of novel foodstuffs called neophobia. This has been called the ‘omnivore’s paradox’. Young children will, therefore, show neophobic
responses to food but must come to accept and eat foods which may originally appear as threatening. Research has shown that mere exposure to novel foods can change children’s preferences. Birch et al 1982 gave 2-year-old children novel foods over a six-week period. A minimum of about 8 to 10 exposures was necessary before preferences began to shift significantly. One hypothesised explanation for the impact of exposure is the ‘learned safety’ view which suggests that preference increases because eating the food has not resulted in any negative consequences. This suggestion has been supported by studies by Birch which exposed children either to just the sight of food or to both the sight and
taste of food. The results showed that looking at novel foods was not sufficient to increase preference and that tasting was necessary

Question 28

Associative eating

Answer 28

Associative learning refers to the impact of contingent factors on behaviour. Some research has examined the effect of rewarding eating behaviour as in ‘if you eat your vegetables I will be pleased with you’. For example, Birch et al. (1980) gave children food in association with positive adult attention compared with more neutral situations. This was shown to increase food preference.

Food as the reward

Barker et al 2017

Researchers at the Norwegian University of Science and Technology, King’s College London, University College London, and the University of Leeds. They appear in the journal Child Development.

Researchers examined emotional feeding and eating in a representative group of 801 Norwegian 4-year-olds, looking at these issues again at ages 6, 8, and 10. They sought to determine whether parents involved in the study (mostly mothers) shaped their children’s later behavior by offering food to make them feel better when they were upset (emotional feeding), and whether parents whose children were easily soothed by food (those who calmed when given food) were more likely to offer them more food for comfort at a subsequent time. The study found that young children whose parents offered them food for comfort at ages 4 and 6 had more emotional eating at ages 8 and 10. But the reverse was also true: Parents whose children were more easily comforted with food were more likely to offer them food to soothe them (i.e., to engage in emotional feeding). Thus, emotional feeding increased emotional eating, and emotional eating increased emotional feeding. The findings held even after accounting for children’s body-mass index and initial levels of feeding and eating.

Question 29

Problems with the developmental model

Answer 29

Food can have a much more diverse set of meanings which are not incorporated into this model. For example, food can mean power, sexuality, religion and culture.
Such complex meanings are not incorporated into a developmental perspective

Also, once eaten food is incorporated into the body and can change body size. This is also loaded with a complex set of meanings such as attractiveness, control, lethargy and success as the child grows up. A developmental model does not address the meanings of the body.

Question 30

Weight concern model

Answer 30

Once eaten food is incorporated into the body and can change body size. This is also loaded with a complex set of meanings such as attractiveness, control, lethargy and success thus the weight concern model helps to further understand the implications of these on eating behaviour

Question 31

Body distortion

Thompson and Thompson 1968

Answer 31

30 men and women were selected from a general college population by Thompson and Thompson 1968. On the average, all subjects overestimated their body sizes. Females had significantly higher body distortion scores than males, but significantly lower self-esteem scores. These findings could explain why females are more prone to eating disorders.

Question 32

Much research has looked at the role of social factors in causing body dissatisfaction
in terms of the media, ethnicity, social class and the family environment.

Answer 32

One of the most commonly held belief in both the lay and academic communities is probably that body dissatisfaction is a response to representations of thin women in magazines, newspapers, television, films.

We are therefore led to believe that thinness is not only the desired norm but also the actual norm.

When on those rare occasions a fatter woman appears she is usually there making a statement about being fat (fat comedians make jokes about chocolate cake and fat actresses are either evil or unhappy) not simply as a normal woman.

Question 33

Family and culture

Hall and Brown 1982

Curtis et al 2014 NEW ZEALAND

Answer 33

Mothers who are dissatisfied with their own bodies communicate this to their daughters which results in the daughters’ own body dissatisfaction. For example, Hall and Brown (1982) reported that mothers of girls with anorexia show greater body dissatisfaction than mothers of non-disordered girls.

Question 34

Treatment for obesity

Answer 34

The therapy for obesity is that obese people have maladaptive eating patterns which need to be corrected and modified with specific interventions which will lead to correction of the behaviour.

Behavioural therapy GEL
Goal setting
Education
Lifestyle interventions

Question 35

Galani et al 2007

Answer 35

Lifestyle interventions which include exercise, diet plus another component like counselling were more likely to be successful. This other component could include things like stress management, smoking cessation as well. In a meta-analysis of 17 studies, compared to obese patients receiving standard care, these patients had more significant weight loss by about 3 kg and this was a sustained weight loss

Question 36

Health promotion for weight loss

Answer 36

Health promotion involves HAS

I HAS passed my exam

Question 37

Three components of health promotion

Answer 37

Health education
Advocacy
Service Improvement

Question 38

Health Education

Answer 38

This could involve creating increased educational awareness about the importance of good eating behaviour, although in a Westernised culture like the UK we would assume everyone is aware of this. However,t the findings from most studies indicate that those with lower socioeconomic status are more likely to be affected and there is this inequality. What could be done is things like the change 4 life traffic light system, which allows people see the food and know what is high in saturates and all that

Question 39

Advocacy

Answer 39

This involves identifying those most at risk in the community for developing obesity and other conditions and representing them. This involves studies and presenting the findings to the appropriate local body and hopefully raising money to be able to cater to their needs. This could involve things like setting up LEAP programmes

There could also be breakfast clubs and handing out of food vouchers. The healthy start scheme last year provided about £60 million pounds worth of vouchers to those who needed it most. These vouchers can be exchanged for things like fresh fruit, vegetables, milk

Question 40

Service improvement

Answer 40

Sugar tax. Introducing a soft drinks tax and the proceeds from that can then be used to invest more into the development of programmes to encourage physical activity. According to PH England, by September 2017 all primary schools should have proper sports facility. There could also be a doubling of the PE and sport premium. The money made from the tax, can be allocated using the BARNETT FORMULA and can help re-allocate funds to places that need it including healthy breakfast clubs.

Question 41

Green spaces

Answer 41

The influence of green spaces, such as urban parks, has also been a focus of interest. High-quality parks near home lead to people being more active during recreational periods. In one study, parks were associated with recreational walking at levels that deliver health benefits. Overall, however, studies associating green spaces and physical activity have produced contradictory results. In some reviews, for example, park accessibility has been associated with use and physical activity and inversely associated with BMI. This is not necessarily surprising as none of the papers used the same definition of this metric. The review provides a good example of the problem of the multiple approaches, metrics, and definitions employed in obesogenic environment research since its inception.

Question 42

Tackling obesity

Answer 42

Introducing a soft drinks tax and the proceeds from that can then be used to invest more into the development of programmes to encourage physical activity. According to PH England, by September 2017 all primary schools should have proper sports facility. There could also be a doubling of the PE and sport premium. The money made from the tax, can be allocated using the BARNETT FORMULA and can help re-allocate funds to places that need it including healthy breakfast clubs.

Question 43

The food Dudes, lowe and horne 2004

Answer 43

In 400 children, Lowe and Horne in 2004 used the peer modelling intervention ‘the food dudes’ over 2 weeks to try and encourage children to eat their fruits and vegetables by watching a series of videos about ‘the food dudes’ who enjoyed eating their vegetables and fruits, and whenever they did so, they got rewards for them. By the end of the programme what their study showed was that following the intervention, children had increased liking for food and vegetables and even consumed more of it.

Question 44

Pearson et al 2009

Answer 44

Systematic review of 24 studies on breakfast and the role of the family Examining several family correlates (including the availability of breakfast items, parental education, level, family income, parental presence at home and family communication),
the authors concluded that parental breakfast eating and living in two-parent families had the greatest correlation to adolescent breakfast consumption.

Question 45

Breakfast and the family affect social learning?

Answer 45

Pearson et al 2009 24 studies systematic review

Question 46

What is omnivores paradox?

Answer 46

Humans show fear and avoidance of novel foodstuffs called neophobia

Question 47

How does omnivores paradox play out?

Answer 47

Young children will show neophobic responses to food but must come to accept and eat foods which may originally appear as threatening. Research has shown that mere exposure to novel foods can change children’s preferences.

Question 48

Who described and explained neophobia in kids in 1982

Answer 48

Birch et al 1982 gave 2-year-old children novel foods over a six-week period. A minimum of about 8 to 10 exposures was necessary before preferences began to shift significantly. One hypothesised explanation for the impact of exposure is the ‘learned safety’ view which suggests that preference increases because eating the food has not resulted in any negative consequences. This suggestion has been supported by studies by Birch which exposed children either to just the sight of food or to both the sight and taste of food. The results showed that looking at novel foods was not sufficient to increase preference and that tasting was necessary

Question 49

Associative eating of the developmental model has two parts which are

Answer 49

Rewarding eating Behaviour

Food as the reward

Question 50

Rewarding eating Behaviour 1980

Answer 50

Associative learning refers to the impact of contingent factors on behaviour. Some research has examined the effect of rewarding eating behaviour as in ‘if you eat your vegetables I will be pleased with you’. For example, Birch et al. (1980) gave children food in association with positive adult attention compared with more neutral situations. This was shown to increase food preference

Question 51

Food as the reward 2017

Answer 51

Barker et al 2017.

Emotional feeding and eating in a representative group of 801 Norwegian 4-year-olds, looking at these issues again at ages 6, 8, and 10.

They sought to determine whether parents involved in the study (mostly mothers) shaped their children’s later behaviour by offering food to make them feel better when they were upset (emotional feeding).

Young children whose parents offered them food for comfort at ages 4 and 6 had more emotional eating at ages 8 and 10. Thus, emotional feeding increased emotional eating, and emotional eating increased emotional feeding. The findings held even after accounting for children’s body-mass index and initial levels of feeding and eating.

Question 52

Who are Thompson and Thompson 1968 and what did they discovery

Answer 52

They provide evidence for the body distortion model of weight concern.

30 men and women were selected from a general college population.

On the average, all subjects overestimated their body sizes. Females had significantly higher body distortion scores than males, but significantly lower self-esteem scores. These findings could explain why females are more prone to eating disorders.

Question 53

Curtis et al 2014

Answer 53

Curtis et al 2014 describes a huge impact that family had on eating behaviour. Family and friends promote the thin ideal through teasing, negative comments, and modelling of weight concerns.

Question 54

What did Galani et al 2007 look at and how many studies in their meta analysis

Answer 54

Galani et al 2007 - Lifestyle interventions which include exercise, diet plus another component like counselling were more likely to be successful. This other component could include things like stress management, smoking cessation as well. In a meta-analysis of 17 studies, compared to obese patients receiving standard care, these patients had more significant weight loss by about 3 kg and this was a sustained weight loss