5As and PA for Weight Loss Flashcards
What is the prevalence of obesity in Canada?
~20% and ~34% for OW
When was obesity declared a chronic disease?
CMA, 2015
What are the key components that have changed regarding obesity since 2007?
- Declaration of obesity as a chronic disease
- Impact of bias, stigma, and discrimination
- Advances in the science of obesity and weight regulation
- Advances in obesity treatments & therapies
- Recognition of patient-centered care and outcomes, beyond weight loss
How is obesity defined?
A prevalent, complex, progressive, and relapsing chronic disease characterized by abnormal or excessive body fat (adiposity) that impairs health
BMI and waist circumference can still be used as screening tools.
Previously defined by BMI (measure of size, not health).
What screening tools can be used to diagnose obesity?
- BMI
- Waist circumference
What should the diagnosis of obesity be based on?
The presence of functional, medical, and/or psychosocial impairments related to abnormal or excess body fat
What is the goal of the obesity guidelines?
To improve the standard of, and access to, care for individuals with obesity across Canada
What are the key principles of obesity management?
- Evidence-based chronic disease management principles
- Validate patients’ lived experiences
- Address root drivers of obesity
- Access to evidence-informed interventions
Which evidence-informed interventions should be included in obesity management?
- Medical nutrition therapy
- Physical activity
- Psychological interventions
- Pharmacotherapy
- Surgery
What is weight bias?
Bias and stigma faced by people living with obesity that impacts their health and access to care
How should healthcare providers address their own beliefs towards patients living with obesity?
They should assess their beliefs and attitudes and how these may influence healthcare delivery
Being aware of internalized weight bias, as well as the use of non-judgemental words, and avoiding making assumptions.
True or False: Not everyone with a large body size or high BMI has obesity.
True
What is the 5-Step (5As) Approach to Obesity Management?
- Step 1 (ASK): Recognition of obesity as a chronic disease
- Step 2 (ASSESS): Assessment of the individual (identifying root causes)
- Step 3 (ADVISE): Discussion of treatment options and adjunctive therapies
- Step 4 (AGREE): Agreement on therapy goals
- Step 5 (ASSIST): Engagement and follow-up
What is the first step in the 5-Step Approach to Obesity Management?
Recognition of obesity as a chronic disease
Asking patient’s permission to discuss obesity prior to the conversation
What should healthcare providers assess in Step 2 of the 5-Step Approach?
Root causes, complications, and barriers to obesity treatment
What are core treatment options discussed in Step 3 of the 5-Step Approach?
- Medical nutrition therapy
- Physical activity
- Psychological, pharmacological, and surgical interventions
What are the three pillars of obesity management discussed in step 3?
Psychological intervention, pharmacological therapy, bariatric surgery.
Describe the first pillar of obesity management discussed in step 3.
Psychological intervention: implementing behaviour modification, manage sleep/ time/ stress, cognitive behavioural therapy and/or acceptance therapy.
Describe the second pillar of obesity management discussed in step 3.
Pharmacological therapy: liraglutide, orlistat, naltrexone.
Criteria: BMI > 30 kg/m2 OR
BMI > 27 kg/m2 with obesity related complications
Describe the third pillar of obesity management discussed in step 3.
Bariatric surgery: Sleeve gastrectomy, gastric bypass, biliopancreatic diversion.
Criteria: BMI > 40 kg/m2 OR
BMI > 35-40 kg/m2 with obesity related complications OR
BMI > 30 kg/m2 with poorly controlled T2D
Describe step 4 and 5.
Agree and assist: agree on realistic expectations and sustainable goals (as well as an action plan). Assist in identifying drivers and barriers, while providing education and resources.
What is the Edmonton Obesity Staging System (EOSS)?
A staging tool used to classify adult obesity levels.
Describe stages 0-2 of EOSS.
Stage 0: No sign of obesity related risk factors, no symptoms, no limitations.
Stage 1: Subclinical risk factors OR mild symptoms (physical or psychological)
Stage 2: Established comorbidities OR moderate psychological symptoms or limitations
Describe stages 3-4 of EOSS.
Stage 3: Significant organ damage OR significant symptoms, limitations or imparment of well-being
Stage 4: Severe (potential end-stage) comorbidities OR severe psychological symptoms or limitations
What constitutes clinically significant weight loss?
> 5% of baseline body weight
Reduces cardiovascular disease and T2D risk factors
Define success in weight loss.
Prevention (1 pound per year), losing weight, maintaining weight loss.
All 3 require understanding of energy balance.
What factors contribute to achieving weight loss?
- Diet
- Exercise
- Medications
- Surgery
- A combination
Is it possible to maintain energy balance in a state of low energy flux?
Yes, but difficult.
Satiety signal, stomach distension, preference for sweet or high fat foods, social factors.
Low energy flux = Low EI/Low EE
What does the “Appropriate PA Intervention Strategies for Weight Loss” paper discuss?
…
What does the FITT principle in exercise stand for?
- Frequency
- Intensity
- Time
- Type
Total volume of PA determines EE.
How is volume determined in terms of PA?
Volume = frequency x time
OR
Volume = Energy Expenditure
How would increasing EE work for weight loss?
Effect on energy balance is proportional to increase in EE.
Increase fat and CHO oxidation would be expected to have favorable health consequences
Achievable amounts of exercise lead to small increases in EE
But… adherence to changes in exercise/PA is poor and increasing EE could be linked to compensatory increases in EI.
What is the evidence supporting increasing EE for weight loss?
STRRIDE Trial: Changes in bodyweight seen after vigorous activity (either high or low amounts).
Equivalent EE seen between both groups if adherence is the same.
What are the pros and cons of increasing exercise intensity for weight loss?
Pros
* Same EE in less time
* Greater improvements in fitness and other risk factors
* Greater preservation of FFM
* Decreased appetite after High Intensity exercise
* Variety/More enjoyable for some people
Cons
* Less enjoyable
* Less accessible
* Greater risks/safety concerns
* Less self efficacy (belief in ability to perform such activities)
What is the best exercise intensity for weight loss?
Low intensity exercise
ie. Intensity that maximizes fat oxidation (Lipoxmax; Fat(ox)max; Fatmax)
High intensity exercise
ie. High intensity interval training (HIIT), EPOC
Intensity that leads to highest energy expenditure
At what intensity is the greatest caloric expenditure, absolute and relative fat oxidation?
Absolute fat ox: ~65%
Relative fat ox: 25%
Caloric expenditure: 85%
What is the role of resistance training in weight loss?
Not very effective for weight loss alone but can contribute to change in body composition
Effect on FFM is small, and during energy restriction it is even smaller.
Effect on RMR is likely not meaningful
How does resistance training affect older populations?
30 frail adults, 70yrs, BMI 37
Six months of diet or diet + exercise
Resistance training attenuated muscle mass during weight loss
Critical to maintaining function?
What is the evidence supporting the effectiveness of high-intensity exercise for weight loss?
Greater improvements in fitness and other risk factors, preservation of FFM, and decreased appetite after high intensity exercise
Can resistance training prevent the decrease in FFM that comes with diet induced weight loss?
So far, only partially… BUT may be more important in certain populations…
ie. Older populations
How does exercise play a role in individuals with class 2/3 obesity?
Can contribute to negative energy balance and improve health/ quality of life
Improves response to bariatric surgery
BUT…
Fitness is often too low to achieve meaningful energy expenditure
Too many co-morbidities that could be worsened by exercise (e.g., joint pain…)
Time for exercise and fatigue from exercise could interfere with other activities
What is the impact of weight bias in healthcare settings?
It can reduce the quality of care for patients living with obesity and worsen outcomes
What are responders and non-responders?
Seen in case studies for exercise in populations with class 2/3 obesity. Some individuals respond to exercise, while others don’t.
This can be due to adherence, compensatory behaviours, or a miltitude of other factors.
What is the Edmonton Obesity Staging System used for?
To determine the severity of obesity and guide clinical decision making
What are some barriers to exercise for individuals with Class II/III obesity?
- Low fitness levels
- Co-morbidities
- Time constraints
Fill in the blank: The greatest absolute fat oxidation occurs at an intensity of approximately _____ of VO2max.
65%
What are non-responders in the context of exercise?
Individuals who do not show expected improvements or benefits from an exercise program
This term refers to those who may not experience weight loss or fitness gains despite adherence to an exercise regimen.
What is adherence in exercise programs?
The degree to which individuals stick to their prescribed exercise routines
Adherence can significantly impact the effectiveness of exercise interventions.
What are compensatory behaviours in relation to exercise?
Behaviours that may counteract the effects of exercise, such as increased caloric intake or decreased activity outside of prescribed exercise
These behaviours can hinder weight loss and fitness improvements.
What factors should be considered for exercise in Class II/III obesity?
Access to facilities, equipment, adapted exercises, and changing facilities
These factors play a critical role in ensuring that individuals can safely and effectively participate in exercise.
What is the recommended duration of aerobic physical activity for adults?
30-60 minutes of moderate to vigorous intensity most days of the week
This activity level is suggested for achieving various health benefits, including weight loss.
What are the benefits of aerobic physical activity for adults with overweight or obesity?
- Small amounts of body weight and fat loss
- Reductions in abdominal visceral fat
- Maintenance of weight loss
- Increase in cardiorespiratory fitness
- Improvement in mobility
These benefits are supported by varying levels of evidence.
What role does resistance training play for adults with overweight or obesity?
It may promote weight maintenance or modest increases in muscle mass or fat-free mass and mobility
Resistance training can complement aerobic exercise for overall health.
How can increasing exercise intensity affect fitness outcomes?
Greater increases in cardiorespiratory fitness and reduced time to achieve benefits compared to moderate-intensity aerobic activity
High-intensity interval training can be more efficient.
What cardiometabolic risk factors can be improved through regular physical activity?
- Hyperglycemia and insulin sensitivity
- High blood pressure
- Dyslipidemia
Regular physical activity can lead to significant health improvements.
What psychological benefits can regular physical activity provide for adults with overweight or obesity?
Improvement in health-related quality of life, mood disorders, and body image
These psychological aspects are important for overall well-being.
What are some advantages of physical activity beyond weight loss?
- Fitness
- Quality of life/ Independence
- Improvements in risk factors (glucose, BP)
- Prevention of weight regain
These advantages highlight the multifaceted benefits of regular exercise.
What is the significance of exercise capacity in relation to mortality risk?
It is the strongest predictor of death, with lower METS indicating higher risk
1 MET improvement is associated with a 12% improvement in survival.
What is the recommended amount of physical activity to maintain significant weight loss?
275 minutes per week, combined with a reduction in energy intake
This combination is essential for sustaining weight loss of more than 10%.
What effect does 30-60 minutes of moderate to vigourous activity have on adults?
Achieve small amounts of body weight and fat loss, and reductions in abdominal visceral fat/ ectopic fat (in the absence of weight loss)
Aid in weight maintenance after weight loss and the maintenance of fat-free mass during weight loss.
Increase cardiorespiratory fitness
What is the relationship between exercise capacity and mortality in men referred for exercise testing?
Exercise capacity was the strongest predictor of death, with absolute fitness being a better predictor.
Twice the risk of death in METS < 5, with 1 MET = 12% improval in survival
