Week 5

Question 1

Obesity - definition for now

Answer 1

Excess body fat accumulation that may impair health
- usually measured by body mass index

Question 2

Adults BMI and obesity

Answer 2

A persons body weight in kilograms divided by their heigh in meters squared (kg/m2)
- overweight: BMI 25.0-29.9 kg/m2
- Obese: > 30.0kg/m2

Question 3

Children - BMI and obesity

Answer 3

• overweight: BMI 85-95 percentile on growth chart (for age and sex)
• obese: BMI > 95 percentile on growth chart (for age and sex)

Question 4

BMI controversy

Answer 4

A body builder who has a BMI that is 30.2 kg/m2 is not overweight or obese but clinically we can say he is

Question 5

Increasing Obesity - Canada

Answer 5

increasing from 2003-2022
- weird spike in about 2014-2015
- 2003 was about 20% and 2022 was about 30%

Question 6

Adult obesity prevalence by region

Answer 6

BC - 22%
Alberta - 29%
Saskatchewan - 35%
Manitoba - 29%
Ontario - 26%
Quebec - 27%
New Brunswick - 38%
PEI - 30%
Nova Scotia - 35%
Newfoundland and Labrador - 38%

Question 7

Changing rates of obesity in world

Answer 7

Most places are increasing but Americans are greatly increasing.

Question 8

Prevalence in Indigenous population

Answer 8

• higher in indigenous communities compared to non-indigenous people
• higher on reserves

Question 9

Health risks associated with obesity

Answer 9

People w obesity are less likely to:
- get married
- have a family
- get prompted
due to stigma!!

health risks:
- type 2 diabetes
- gallbladder disease
- metabolic syndrome
- breathlessness
- sleep apnea
- cardiovascular disease
- hypertension
- osteoarthritis
- hyperuricemia, gout
- cancer
- psychosocial issues
- reproductive hormone abnoramilites
- polycystic ovary syndrome
- impaired fertility
- low back pain
- fetal defects
- dyslipidemia

Question 10

High BMI increases risk of CVD mortality

Answer 10

likelihood is higher in men with obesity
- people w low BMI due to eating disorders can also die and women are more common in this aspect

Question 11

Fat around the waist

Answer 11

Increases the risk of cardio vascular disease, type 2 diabetes, cancer, metabolic diseases, etc. in comparison to fat elsewhere on the body
- if someone is obese but they have low fat around the waist they are at less risk of developing certain diseases

Question 12

visceral adipose tissue is associated with

Answer 12

• high triglycerides
• low HDL-C
• small dense LDL particles
• high insulin/glucose
• high blood pressure
• prothrombotic state
• endothelial dysfunction (arteries dilating and constricting)
• atherosclerosis

Close to the organs thats why its bad!

Question 13

Obesity in adults - a clinical practice guideline

Answer 13

Obesity - complex disease in which abnormal or excess body fat impairs health
Effects: lowered health, quality of life, and lifespan
- people w obesity experience weight bias and stigma
- increased complications and mortality independent of weight or BMI
- BMI is NOT an accurate tool for identifying obesity-related complications

Stigma: acting on weight-biased beliefs

Question 14

weight bias

Answer 14

thinking that people with obesity do not have enough willpower or are no cooperative

Question 15

The lancet Commission

Answer 15

defined obesity, clinical obesity, and pre-clinical obesity

Question 16

obesity - Lancet Commission

Answer 16

obesity is characterised by excessive adiposity, with or without abnormal distribution or function of the adipose tissue

Question 17

Pre-clinical obesity - Lancet Commission

Answer 17

pre-clinical obesity is characterised by a state of excess adiposity with preserved function of other tissues and organs. Pre-clinical obesity confers an increased risk of developing clinical obesity as well as several other non-communicable diseases (NCDs), including type 2 diabetes, CVD, certain types of cancer and mental illness

Question 18

clinical obesity - Lancet Commission

Answer 18

clinical obesity is a chronic, systemic illness characterised by alterations in the function of tissues, organs or the individual, due to excessive ardor abnormal adiposity

Question 19

Obesity defined for 2 to 20 year old

Answer 19

Underweight - BMI <5th percentile for age and sex
Normal weight - BMI between the 5th and 85th percentile for age and sex
Overweight - BMI between 85th to 95th percentile for age and sex
Obesity - BMI > or equal to 95th percentile for age and sex

Question 20

Childhood obesity and excess weight rates in Canada

Answer 20

1978/79 - aged 2-17 23% overweight or obese
2004 - aged 2-17 35% overweight or obese
2017 - aged 5-17 30% overweight or obese

Question 21

longitudinal retrospective study: Netherlands - weight gain first 3 months

Answer 21

87 people, 18-24 years assed for cardiovascular risks
- assessed rate of weight gain age 0-1
Rapid increase in weight first 3 months:
- increased insulin resistance
- decreased HDL-C
- increased total cholesterol/HDL-C ratio, triglycerides, central adiposity
Compared to gradual weight gain over the year

Question 22

Do children eat more calories within the home or outside of the home?

Answer 22

Children eat nearly twice as many calories at restaurants compared to their homes

Question 23

Milk in children over the years

Answer 23

• replaced with high calorie sodas
• not meeting RDA (recommended daily allowance) of calcium for growing bones
  non-dairy sources of calcium: fish bones (salmon, sardines), fortified products (soy/almond milk), supplements
• no protein in replacement drinks
  Milk is a better post-sport drink
• between 1977-78 and 2000-01 milk consumption decreased by 39% in children aged 6-11
• consumption of fruit drink rose by 69% and carbonated drinks rose by 137%

Question 24

Early obesity leads to early Type 2 diabetes

Answer 24

Type 2 diabetes were once a disease that occurred primarily in adults:
- 10-to-30 fold increase in American children with type 2 diabetes in the past 10 to 15 years
- one in every 3 American children born in 2000 will likely be diagnosed with diabetes in their lifetime
- type 2 diabetes is being diagnosed in Canadian First Nations children as young as 8 years old

95% of children w Type 2 diabetes are obese

Question 25

The energy balance

Answer 25

Energy out on one side, weight management in middle, and energy in on the other side - fat gain occurs when energy in (food) > energy out (physical activity, metabolism)

Question 26

Physical activity and weight loss

Answer 26

- studies of exercise-induced weight loss demonstrate variable results - compared to diet, exercise not as effective - meta-analysis reveal exercise only-induced weight loss at 0.1-0.2 kg/week intervention - however, exercise combined with diet is most effective

Question 27

maintaining ideal body weight

Answer 27

- combine a regiment of diet and exercise - recommended weight loss of 1 to 2 pounds per week - easier to prevent weight gain than to lose weight - weight cycling may be worse than not losing weight: better to maintain weight - no fad diet or over-the-counter supplement demonstrates prolonged weight loss - concentrate on health behaviours

Question 28

Perceptions of causes and responsibility of obesity

Answer 28

- both individuals and communities 12% - its something whole communities need to deal with 34% - its something individuals should deal with on their own 52%

Question 29

International plans/action: common themes

Answer 29

- multiple interventions at multiple levels - high intensity school-based programs - limited screen time - built environment - attention on socially and economically disadvantaged - education - workplace programs - community programs - early childhood development - regulations: labelling, advertising to children

Question 30

Obesity in adults: a clinical practice guideline (more in-depth)

Answer 30

- obesity is a prevalent, complex, progressive and relapsing chronic disease, characterised by abnormal or excessive body fat (adiposity) that impairs health - people living with obesity face substantial bias and stigma, which contribute to increased morbidity and mortality independent of weight or BMI - this guideline update reflects substantial advances in the epidemiology, determinants, pathophysiology, assessment, prevention, and treatment of obesity, and shifts the focus of obesity management toward improving patient-centred health outcomes, rather than weight loss alone. - obesity care should be based on evidence-based principles of chronic disease management, must validate patients lived-experiences, move beyond simplistic approaches of "eat less, move more" and address the root drivers of obesity - people living with obesity should have access to evidence-informed interventions, including medical nutrition therapy, physical activity, psychological interventions, pharmacotherapy and surgery

Question 31

Syndrome

Answer 31

a recongizable complex of symptoms and physical or biochemical findings for which a direct cause is not understood. with a syndrome the components coexist more frequently than would be expected by chance alone

Question 32

metabolic

Answer 32

refers to biochemical processes involved in the bodys normal functioning

Question 33

metabolic syndrome

Answer 33

- recognition of the clustering of metabolic risk factors related to CVD - majority of individuals with metabolic syndrome have insulin resistance and/or are obese - combination of risk factors at 'low' levels may markedly increase CVD risk - prevalence increases with age

Question 34

Harmonisation of metabolic syndrome criteria

Answer 34

any 3 or more of the following: - waist circumference: use population and country-specific criteria - triglycerides: > 1.69 mmol/L - HDL-C: men <1.00 mmol/L women <1.30 mmol/L - blood pressure: >= 130/85 mmHg - glucose: > or equal to 6.0 mmol/L

Question 35

potential problems with the metabolic syndrome

Answer 35

- loss of data using dichotomous variables - components of the metabolic syndrome differ in their ability to predict type 2 diabetes and cardiovascular disease (CVD) - does the metabolic syndrome predict CVD independently of its components? - does the metabolic syndrome have a single ethology?

Question 36

Potential advantages of the metabolic syndrome

Answer 36

- metabolic syndrome is an operational definition for "cardio metabolic" risk - nobody measures global risk or uses multivariate predicting equations (metabolic syndrome is easier) - encourages providers to look for other risks factors - encourages behavioural therapy rather than just treating risk factors individually - metabolic syndrome better predictor of diabetes than CVD?

Question 37

Metabolic syndrome "treatment:

Answer 37

- no treatment - treat each risk factor independently (in the absence of known cause for the whole syndrome) - healthy lifestyle: --> 5-10% weight loss - moderate calorie restriction --> moderate increases in physical activity - pharmacologic measures for each of the syndrome components