5. Prevention and Harm reduction of obesity - clinical prevention Flashcards
T/F - Short-term behavioural interventions (generally six months or less) aimed at preventing weight gain in young adulthood, menopause, smoking cessation and breast cancer
treatment have been shown to be effective.
false
T/F - Causes of and risk factors for weight gain are wide ranging,
extending beyond personal lifestyle choices such as food intake and exercise, and include factors that you may or may not be able to control.
True
Average weight gain in Canada is per year?
0.5-1kg
People are prone to greater weight gain during certain life stages, including ?
adolescence, young adulthood and pregnancy
T/F - Regular weighing by healthcare providers can help to identify
patterns and factors contributing to weight gain early.
True
in addition to nutrition and physical activity, what are other modifiable factors for obesity?
sleep, stress,
use of medications that cause weight gain, gut dysbiosis secondary
to antibiotic use,1 other chronic conditions or smoking that may also
influence weight regulation
what are Other factors that influence weight gain which are much less modifiable?
age, genetics, epigenetics,
income, physical environment, socio-political environment and
adverse childhood events, including abuse and neglect.
The aim of primary prevention is?
to minimize weight gain and prevent obesity from developing in the first place
what is the most cost-effective option for addressing obesity?
primary prevention
Commonly proposed targets for primary preventions are?
unhealthy food/beverage taxation,4 calories on menus,5 healthy food
programs and subsidy, limiting food and beverage advertisement,
affordable physical activity options, increasing mixed land use and
improving the walkability of the built environment6 and addressing
social determinants of health that negatively impact an individual’s
ability to dedicate time or resources to healthy living fundamentals
what are several challenges and barriers that are
inherent to conducting prevention research in general?
Science is designed to see changes, not a lack of changes
Obesity develops over a very long time
Clinicians routinely counsel on prevention efforts for
other health conditions despite little evidence
Canadian recommendations suggest weight gained through pregnancy should be between?
5-18kg
studies demonstrate that many women retain xx kg per pregnancy.
2-5 kg
one study reported that individuals who quit smoking gained
xx kg more than those who continued to smoke over six years.
2.6 kg
post-cessation weight
gain is a significant concern,32 and may negatively impact smoking
cessation efforts, particularly in individuals of which ethnicity and
those with existing weight concerns?
white
Weight gain associated with smoking cessation is largely attributed
to what factors?
increased energy intake and reduced energy expenditure
T/F - post-smoking weight management may be far more complicated than can be explained by behavioural habits alone
true
does pharmacotherapy prevent post-cessation weight gain?
no- only delays it
is there an evidence to strongly recommend any single type of intervention to prevent post-cessation
weight gain?
no
in which cancer treatments, the weight gain is more common?
breast, colorectal, prostate, ovarian cancers
less than what % of
women who gain weight after receiving a breast cancer diagnosis
return to their pre-diagnosis weight, even after six years?
10
which medications can cause weight gain?
anti-psychotics, antidepressants, anti-hyperglycemics and corticosteroids
which anti-psychotics are associated with the largest amt of wt gain?
olanzapine, clozapine
how does anti-psychotic weight gain occur?
changes in appetite and altered metabolism
if anti-psychotic medications got switched, what side effects should be monitored?
rebound insomnia;
relapse of psychosis
which are associated with medium effect sizes for weight loss trials and large effect sizes for weight gain prevention trials?
Medical
nutrition therapy, physical activity and cognitive behavioural strategies
what can be used for adjunt therapy with already obese patient with anti-psychotic med?
metformin
which antidepressant classes have moderate risk of weight gain?
tricyclic anti-depressants, monoamine
oxidase inhibitors and selective serotonin reuptake inhibitors
which diabetes meds are associated with wt gain?
thiazolidinediones,
rosiglitazones,
pioglitazones,
sulfonylureas,
meglitinides,
insulin (higher weight gain 5-6 kg)
what is the mechanisms responsible for wt gain due to diabetes meds?
increases in appetite, increased lipid storage and fluid retention
what masks the accelerated gains in fat mass in menopausal woman?
losses in muscle mass
Menopause is also associated with increases in which factors that
further exacerbate cardiovascular risk?
sedentary time and physical inactivity
what is secondary prevention?
early detection and
treating the disease as soon as possible in order to slow or stop its
progression
what is the goal of 2ndary prevention?
to return
the patient to their original health and functional status to prevent
long-term problems.
in terms of obesity, what are 2ndary prevention?
regular screening and
preventing further weight gain in individuals with uncomplicated
mild obesity (i.e., Edmonton Obesity Staging System stage 0 or 1).
For stage 0, what do you need to manage?
Identify factore contributing to increased body weight
Counselling to prevent further weight gain through behavioural measures, including healthy eating and increased physical activity
What is stage 1?
Presence of obesity-related subclinical risk factors (e.g., borderline hypertension, impaired fasting glucose, elevated liver enzymes, etc.), mild physical symptoms (e.g., dyspnea on moderate exertion, occasional aches and pains, fatigue, etc.), mild psychopathology, mild functional limitations and/or mild impairment of wellbeing
What is stage 2?
Presence of established obesity-related chronic disease (e.g., hypertension, type 2 diabetes, sleep apnea, osteoarthritis, reflux disease, polycystic ovary syndrome, anxiety disorder, etc.), moderate limitations in activities of daily living and/or wellbeing
What is stage 3?
Established end-organ damage such as myocardial infarction, heart failure, diabetic complications, incapacitating osteoarthritis, significant psychopathology, significant functional limitations and/ or impairment of wellbeing
What is stage 4?
Severe (potentially end-stage) disabilities from obesity-related chronic diseases, severe disabling psychopathology, severe functional limitations and/or severe impairment of wellbeing
What is management for stage 1?
Investigation for other (non-weight-related) risk factors More intense behavioural interventions, including nutrition therapy, exercise and psychological treatments to prevent further weight gain Monitoring of risk factors and health status
Management for stage 2?
Initiation of obesity treatment, including considerations of all psychological interventions, pharmacological and surgical treatment options Close monitoring and management of comorbidities as indicated
Management for stage 3?
More intensive obesity treatment including consideration of all psychological interventions, pharmacological and surgical treatment options Aggressive management of comorbidities as indicated
Stage 4 management?
Aggressive obesity management as deemed feasible Palliative measures including pain management, occupational therapy and psychosocial support
Which has been shown to be a better predictor of all-cause mortality when compared to BMI or waist circumference measurements alone?
EOSS
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