5. Prevention and Harm reduction of obesity - clinical prevention

Question 1

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.

Answer 1

false

Question 2

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.

Answer 2

True

Question 3

Average weight gain in Canada is per year?

Answer 3

0.5-1kg

Question 4

People are prone to greater weight gain during certain life stages, including ?

Answer 4

adolescence, young adulthood and pregnancy

Question 5

T/F - Regular weighing by healthcare providers can help to identify
patterns and factors contributing to weight gain early.

Answer 5

True

Question 6

in addition to nutrition and physical activity, what are other modifiable factors for obesity?

Answer 6

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

Question 7

what are Other factors that influence weight gain which are much less modifiable?

Answer 7

age, genetics, epigenetics,
income, physical environment, socio-political environment and
adverse childhood events, including abuse and neglect.

Question 8

The aim of primary prevention is?

Answer 8

to minimize weight gain and prevent obesity from developing in the first place

Question 9

what is the most cost-effective option for addressing obesity?

Answer 9

primary prevention

Question 10

Commonly proposed targets for primary preventions are?

Answer 10

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

Question 11

what are several challenges and barriers that are
inherent to conducting prevention research in general?

Answer 11

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

Question 12

Canadian recommendations suggest weight gained through pregnancy should be between?

Answer 12

5-18kg

Question 13

studies demonstrate that many women retain xx kg per pregnancy.

Answer 13

2-5 kg

Question 14

one study reported that individuals who quit smoking gained
xx kg more than those who continued to smoke over six years.

Answer 14

2.6 kg

Question 15

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?

Answer 15

white

Question 16

Weight gain associated with smoking cessation is largely attributed
to what factors?

Answer 16

increased energy intake and reduced energy expenditure

Question 17

T/F - post-smoking weight management may be far more complicated than can be explained by behavioural habits alone

Answer 17

true

Question 18

does pharmacotherapy prevent post-cessation weight gain?

Answer 18

no- only delays it

Question 19

is there an evidence to strongly recommend any single type of intervention to prevent post-cessation
weight gain?

Answer 19

no

Question 20

in which cancer treatments, the weight gain is more common?

Answer 20

breast, colorectal, prostate, ovarian cancers

Question 21

less than what % of
women who gain weight after receiving a breast cancer diagnosis
return to their pre-diagnosis weight, even after six years?

Answer 21

10

Question 22

which medications can cause weight gain?

Answer 22

anti-psychotics, antidepressants, anti-hyperglycemics and corticosteroids

Question 23

which anti-psychotics are associated with the largest amt of wt gain?

Answer 23

olanzapine, clozapine

Question 24

how does anti-psychotic weight gain occur?

Answer 24

changes in appetite and altered metabolism

Question 25

if anti-psychotic medications got switched, what side effects should be monitored?

Answer 25

rebound insomnia;
relapse of psychosis

Question 26

which are associated with medium effect sizes for weight loss trials and large effect sizes for weight gain prevention trials?

Answer 26

Medical
nutrition therapy, physical activity and cognitive behavioural strategies

Question 27

what can be used for adjunt therapy with already obese patient with anti-psychotic med?

Answer 27

metformin

Question 28

which antidepressant classes have moderate risk of weight gain?

Answer 28

tricyclic anti-depressants, monoamine
oxidase inhibitors and selective serotonin reuptake inhibitors

Question 29

which diabetes meds are associated with wt gain?

Answer 29

thiazolidinediones,
rosiglitazones,
pioglitazones,
sulfonylureas,
meglitinides,
insulin (higher weight gain 5-6 kg)

Question 30

what is the mechanisms responsible for wt gain due to diabetes meds?

Answer 30

increases in appetite, increased lipid storage and fluid retention

Question 31

what masks the accelerated gains in fat mass in menopausal woman?

Answer 31

losses in muscle mass

Question 32

Menopause is also associated with increases in which factors that
further exacerbate cardiovascular risk?

Answer 32

sedentary time and physical inactivity

Question 33

what is secondary prevention?

Answer 33

early detection and
treating the disease as soon as possible in order to slow or stop its
progression

Question 34

what is the goal of 2ndary prevention?

Answer 34

to return
the patient to their original health and functional status to prevent
long-term problems.

Question 35

in terms of obesity, what are 2ndary prevention?

Answer 35

regular screening and
preventing further weight gain in individuals with uncomplicated
mild obesity (i.e., Edmonton Obesity Staging System stage 0 or 1).

Question 36

For stage 0, what do you need to manage?

Answer 36

Identify factore contributing to increased body weight

Counselling to prevent further weight gain through behavioural measures, including healthy eating and increased physical activity

Question 37

What is stage 1?

Answer 37

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

Question 38

What is stage 2?

Answer 38

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

Question 39

What is stage 3?

Answer 39

Established end-organ damage such as myocardial infarction, heart failure, diabetic complications, incapacitating osteoarthritis, significant psychopathology, significant functional limitations and/ or impairment of wellbeing

Question 40

What is stage 4?

Answer 40

Severe (potentially end-stage) disabilities from obesity-related chronic diseases, severe disabling psychopathology, severe functional limitations and/or severe impairment of wellbeing

Question 41

What is management for stage 1?

Answer 41

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

Question 42

Management for stage 2?

Answer 42

Initiation of obesity treatment, including considerations of all psychological interventions, pharmacological and surgical treatment options Close monitoring and management of comorbidities as indicated

Question 43

Management for stage 3?

Answer 43

More intensive obesity treatment including consideration of all psychological interventions, pharmacological and surgical treatment options Aggressive management of comorbidities as indicated

Question 44

Stage 4 management?

Answer 44

Aggressive obesity management as deemed feasible Palliative measures including pain management, occupational therapy and psychosocial support

Question 45

Which has been shown to be a better predictor of all-cause mortality when compared to BMI or waist circumference measurements alone?

Answer 45

EOSS