Obesity & Eating Disorders

Question 1

A BMI over what equals overweight or obese

Answer 1

Over 25 = overweight
Over 30 = obese

Question 2

Obesity global epidemic stats

Answer 2

• Rates have tripled since 1975
• 38 million children under 5 were overweight or obese in 2019
• 39% of the world adult population was overweight with 13% obese in 2016

Question 3

Why has obesity risen?

Answer 3

• Portion sizes
• Convenience food
• Food abundance/exposure
• Flavour enhancers
• Alcohol
• Snacking
• Speed of eating

Question 4

Drivers of obesity:
How does a sedentary lifestyle add to this?

Answer 4

• Reduced energy expenditure
• Exercise increases glucose uptake and mitochondrial activity

Question 5

Drivers of obesity:
Sleep

Answer 5

Sleep disruption creates hormonal imbalance that promotes overeating and weight gain
- Reduced glucose tolerance and insulin sensitivity
- Inflammatory pathways are activated

Work on sleep hygiene - epsom salts, stress, valerian, B6

Question 6

Drivers of obesity:
Chronobiology (shift work, sleep deprivation, exposure to light at night increase adiposity)

Answer 6

Irregular eating patterns affect circadian rhythm and glucose control

Question 7

Drivers of obesity: processed foods - palatability

Answer 7

Strong dopamine stimulators - fat, starch, alcohol, caffeine
Bliss point - combining fat, sugar and salt to maximise dopamine release
Artificially sweetened drinks have a 47% higher risk of increased BMI

Question 8

Drivers of obesity:
High cortisol

Answer 8

An overactive HPA axis includes high GI consumption, stress, pain, alcohol, sleep deprivation

Stress can equal eating 50% more food and eating energy dense comfort foods

Question 9

Drivers of obesity: Microbiome

Answer 9

E.g Lack of akkermansia munciniphilia

Question 10

Drivers of obesity:
Genes

Answer 10

E.g A SNP on FTO is a strong predictor of obesity

Question 11

Insulin resistance causes and risk factors:

Answer 11

Reduced physical activity
Chronic stress
Poor methylation
Dysbiosis

Question 12

Signs and symptoms of insulin resistance

Answer 12

Lethargy
Hunger
Brain fog
Overweight
High blood pressure
High blood glucose

Question 13

Naturopatic approach to insulin resistance

1. Stabilise blood glucose levels

Answer 13

Increase fibre - it slows gastric emptying and a slower release of glucose
Restrict calories
Increase protein especially at breakfast as it helps normalise insulin secretion
Avoid processed food
B vits, chromium, magnesium

Question 14

Naturopathic approach to insulin resistance

2. Reduce inflammation

Answer 14

• Avoid inflammatory foods e.g damaged fats and refined carbs
• Increase antioxidants
• Prioritise sleep
• Green tea polyphenols help HBA1C
• Prebiotic foods e.g leeks, onions, chicory

Question 15

Naturopathic approach to insulin sensitivity

Optimise insulin sensitivity

Answer 15

• Time restricted eating
• Increase exercise
• Vit D, zinc, chromium

Question 16

Fasting glucose should be this for the lowest mortality

Answer 16

4.4-5.2mmol/l

Question 17

How to reduce obesity

Answer 17

Chew well - 30 times
Palm sized protein with every meal
Fasting 16:8
Smaller portions
Exercise daily: 35 mins low intensity
Always have breakfast

Question 18

5HTP obesity function

Answer 18

Increase satiety
Promotes sleep (enhances melatonin production)

50-100mg twice daily

Question 19

Green tea obesity function

Answer 19

Polyphenols may stimulate thermogenesis and far oxidation

600-900mg daily
(3-4 cups of green tea)

Question 20

L- carnitine obesity function

Answer 20

Improves leptin resistance
Reduces BMI and fat mass

Up to 2000mg daily

Question 21

Chromium obesity function

Answer 21

Increases insulin sensitivity
Reduces carb cravings
Increases lean body mass

200-1000mcg chromoum picolinate

Question 22

Breaking habits

Answer 22

Identify the cue
Change the routine
Change the reward
Repetition is key

Question 23

Eating disorder environmental risk factors

Answer 23

Bullying and abuse
Difficult family relationships
Media - body image
Sports e.g ballet, dancing

Question 24

Eating disorder genetics

Answer 24

SNPs
Family history
Deficiencies e.g efa, zinc
Perfectionism

Question 25

Anorexia Nervosa characteristics

Answer 25

Low body weight Fear of gaining weight Distorted perception 10% of all eating disorder Adolescence/early adulthood onset Males 25% 50% recover

Question 26

Anorexia signs and symptoms (behavioural)

Answer 26

Excessive calorie counting Avoiding all fats Vegan/vegetarian Overexercising Excessive water intake/appetite supressants Socially isolated esp around mealtimes

Question 27

Anorexia symptoms physical

Answer 27

Lack of energy Poor stress resilience Dizzy spells Amenorrhoea Constipation Poor concentration

Question 28

Anoreixa concomitanr symptoms and complications

Answer 28

Anxiety and depression Poor skin, hair and nails Poor immunity Food intolerances Menstrual irregularities

Question 29

Diagnosing anorexia

Answer 29

Intense fear of gaining weight BMI 17.5 and under Body dysmorphia Denies weight is an issue Dark circles under eyes Low mood due to less tryptophan Baggy clothing

Question 30

Anorexia nutrient deficiencies Zinc

Answer 30

Confusion Depression Low stomach acid Recurrent infections Loss of motivation

Question 31

Anorexia symptom deficiencies (magnesium)

Answer 31

Irritability Constipation Depression Insomnia

Question 32

Anorexia tryptophan symptoms

Answer 32

Anxiety Low mood Bow irregularity

Question 33

Anorexia protein deficiency

Answer 33

Fatigue and weakness Poor hair, skin and nails

Question 34

Anorexia Omega 3 deficiency

Answer 34

Depression Dry skin

Question 35

Anorexia B vits symptoms

Answer 35

Anxiety Confusion Poor stress resilience

Question 36

Anorexia naturopathic nutrition aims

Answer 36

Redefine relationship with food Build a rapport and gain trust Emphasis on nutrients and health not kcal and weight Correct deficiencies

Question 37

Anorexia consultation

Answer 37

Keep focus on nutrients Never recommend exclusions e.g gluten or dairy unless clear evidence ro help health Contain own self beliefs Avoid conversations about calories Do not discourage foods e.g chocolate etc just focus on reintroducing foods

Question 38

Anorexia therapeutics - weight gain

Answer 38

Focus on nutrient dense warming foods Include bitters and probiotics Introduce essential fats for reproductive function Be empathetic but stay firm and consistent Focus on health not BMI Keep plans simple

Question 39

Anorexia therapeutics re-establishing healthy eating

Answer 39

Focus on high energy, calorie and nutrient rich foods Co create a plan Acknowledge fear foods and try to expand safe foods list Only ask for food diary if necessary Negotiate how much willing to eat. It doesn’t need to be 3 meals and 2 snacks

Question 40

Anorexia therapeutics - high calorie nutrient dense foods

Answer 40

Nut butters Avocado Quinoa Eggs Omega 3 fish Natural yog

Question 41

Anorexia therapeutics - supplements

Answer 41

Zinc - must always be included as it helps with weight gain and depression (plus B6 for absorption Probiotics - yoghurt with certain strains increase immunity L-arginine is cardioprotective

Question 42

Anorexia bach flowers

Answer 42

White chestnut - obsessive thinking Star of Bethlehem - past trauma Rock water - perfection Aspen - anxiety/impending doom

Question 43

Bulimia characteristics

Answer 43

Bingeing followed by inappropriate methods of weight control Subtypes - Purging (vomiting, laxatives, diuretics, enemas) Non purging (fasting, excessive exercise) Must happen 2x week for 3 months

Question 44

Bulimia signs and symptoms

Answer 44

Normal to slightly overweight Fasting/laxative abuse Binge eating Visiting toilet after meals Frequent weight changes Associated depression/anxiety Tooth erosion

Question 45

Bulimia causes/risk factors

Answer 45

Shift working Alcohol consumption Glucose/food intolerances Jobs which require weight control