Chapter 9 Energy Balance and Body Weight Flashcards
What is body composition?
Proportions of muscle, bone, fat and other tissues that make up a person’s total body weight.
What is more important than controlling for body weight?
Controlling for body composition
T or F, we can control our weight?
F, We can control behaviours, not weight.
When are people who are underweight most at risk? x3
- During Famine
- When Hospitalized
- When fighting a disease (die from starvation not disease)
T or F, Too little body fat is a wide spread problem in Canada?
False, Obesity is the problem
Underweight people often have the problems? x4
- Undernutrition
- Osteoporosis
- Infertility
- Impaired Immunocompetence
How may underweight people benefit from gaining weight? x2
-Energy Reserve
-Reserves of nutrients that can be stored
What are the problems associated with overweight/obesity? x7
- T2D
- Dyslipidemia
- Hypertension
- CHD
- Gallbladder Disease
- Sleep Apnea
- Certain Cancer
What are the most common diseases associated with obesity?
- Hypertensions
- Diabetes
- Heart Disease
What contributes to more preventable diseases and premature death?
Tobacco
What is Central Obesity?
Visceral fat is the fat that collects deep within the central abdominal area of the body
What does visceral fat increase the risk of?
-Diabetes
-Stroke
-Hypertension
-Coronary artery disease
Why is visceral fat bad?
Readily released into the blood stream
What is the worst place to hold fat, most increased risk?
Central Obesity
What is subcutaneous fat?
Fat just below the skin
(Abdomen, thighs, hips, legs)
Who is most prone to central obesity (apple shape)? x4
- Males and Females postmenopausal
2.Smokers - Moderate to high alc. users
- Low PA
What is the pear shape?
Females are more prone to carrying fat around hips and thighs prior to menopause.
How to measure Bodyweight/Fat Assesment?
- BMI kg/m2
2.Waist Circumference
3.Disease risk profile
What does BMI correlate to? x2
- Degree of body fatness and disease risk
What does waist cirumference coorelated to?
Reflects the amount of visceral fatness
What is Disease risk profile correlated to?
-Hypertension, Diabetes, High Cholesterol
-The more risk factors, the greater the obesity
-The more significant the body fatness and the higher the disease profile the greater the risk
How to calculate BMI?
Weight (in KG) / Height (M2, take hight in m and square it)
How may pounds (lbs) in a Kg?
2.2 lbs = 1 Kg
How many times to move decimal over cm to M?
twice to right
How many inch to 1 cm?
1 Inch = 2.54 cm
What are the 2 limitations to BMI?
- No indication about how much of the weight is fat.
2.No indication of location of body fat
Who is BMI not appropriate or effective for? x5
- Athletes
- Preggo and lactating women
- Adults over 65 (Og based on people under 65 )
4.Need more research on cutoffs for different races and ethnic groups (made for white Europeans and Americans) - Under 18
BMI does not reflect?
Body composition (only height and weight)
BMI needs consideration/grain of salt for what groups of people?
- Young adults who have not fully grown
- Adults who naturally have a very lean body build
- Highly muscular adults
- Adults over 65 years of age
- Certain ethnic and racial groups
What is the most practical indicator of fat distribution and abdominal fat?
Waist circumference
An increased risk of developing health problems such as diabetes, health disease and high blood pressure is associated with a waist circumference at or above males and females.
Males 102 cm (94 cm)
Females 88cm (80 cm)
-WC just below these values should also be taken seriously
What may be a greater determinant of the risk of death for obese people than body fat?
Physical Activity/ Fitness
Who exhibits the lowest risk of death from chronic diseases?
Seen in normal weight fit people.
What improves health and longevity, independent of BMI?
Cardiovascular Fitness
What are 4 ways people with elevated BMI’s are treated unjustly?
-Are sometimes judged on their appearance
-Less often hired
-Pay higher insurance premiums
-Less often admitted to college or Universities
What is weight bias?
Refers to neg, attitudes and views about obesity and about people with disability
What is weight Stigma?
-Refers to social stereotypes an misconceptions about obesity
What are the social stereotypes and misconceptions that may occur due to weight stigma? x7
-lazy
-awkward
-sloppy
-non-compliant
-unintelligent
-unsuccessful
-lacking self-discipline or self-control
What is weight discrimination?
We enact our personal biases and social stereotypes about obesity and treat people with obesity unfairly
What contributes to weight discrimination? x2
Weight Bias and Weight Stigma
What is the Edmonton Obesity Staging System? EOSS
-5 Stage system of obesity classification
-Considers the metabolic, physical and psychological parameters in order to determine the optimal obesity treatment.
T or F EOSS has been reported to be a better predictor of mortality than BMI
True
What is stage 0 of EOSS?
-No apparent risk factors:
-BP, serum lipid, and fasting glucose levels are normal.
-Physical systems
-Psychopathology
-Functional limitation and/or impairments leading to disability
What is Stage 1 of EOSS?
-Presence of obesity-related subclinical risk factors:
-Borderline Hypertension, Impaired Fasting Glucose Levels, Elevated Levels of Liver Enzymes
-Mild Physical Systems:
-Dyspnea on moderate exertion, occasional aches and pains, fatigue
-Mild Psychopathology
-Mild Functional Limitation and/or mild impairment of well-being
What is Stage 2 of EOSS
-Presence of established obesity-related chronic disease
-Hypertension, T2D, Sleep Apnea, Osteoarthritis
-Moderate Limitations in activities of daily living and/or well-being
What is Stage 3 EOSS?
-Established end-organ damage :
-Myocardial infarction, Heart Failure, Stroke
-Significant Psychopathology
-Significant Functional Limitations and Impairment of Well-Being
What is Stage 4 EOSS?
-Severe (End-Stage) disabilities from obesity-related chronic diseases
-Severe Disabling Psychopathology
-Severe Functional Limitations and Impairment of Well-Being
What percentage of Canadians in 2019 -18-70 where overweight, based on what scale?
59.8%, BMI
What are the 4 Recommendations of the clinical practice guidelines for weight bias for health care professionals working with people with obesity?
- Healthcare providers need to assess their attitudes and beliefs regarding obesity and consider how their attitudes and beliefs may influence care delivery
- Healthcare providers should recognize that internalized weight bias in people living with obesity can affect behavioural and health outcomes
- Healthcare providers should avoid using judgmental words, images and practices when working with people with obesity
4.Healthcare providers avoid making assumptions that an ailment of complaint a patient presents with is related to body weight
What is the point of the Canadian Adult Obesity Clinical Practice Guidelines (CPGS)?
Reduce Weight Bias in Obesity Management, Practice and Policy
What are the CPGS for healthcare providers of indigenous people living with obesity? x5
- Engage with patient social realities
- Validate the patient’s experiences of stress and systemic disadvantage influencing poor health and obesity, exploring elements of their environment where reduced stress could shift behaviours
- Advocate for access to obesity management resources with publicly funded healthcare systems, recognizing that resources beyond may be unaffordable and unattainable for many
4.Help patients recognize that good health is attainable, and they are entitled to it
- Self-reflect on anti-indigenous sentiment common within healthcare systems, explore patient motivations and mental health as alternative understandings of causes and solutions to their health problems (explore own bias of racism)
When we use BMI do we know where body weight is being held?
No, cant tell if its subcutaneous fat or visceral fat
Where does excess fat accumulate?
Fat Cells of bodies Adipose Tissue
How many kcal is 1 pound of body fat?
3500kcal = 1 pound of body fat
Daily energy balance is?
Change in energy stores = Energy in - energy out
How do we burn food?
bomb calorimeter
What is the equation of weight maintenance?
Energy Input = Energy Output
What is direct calorimetry?
When food is burned energy is released in the form of heat
What is Indirect Calorimetry?
CO2 and H2O are produced. The amount of O2 used gives a indirect measure of heat produced
What contributes to NRG in?
Food and Drink
What are 3 contributors to energy output?
Basal Metabolism
Voluntary Activities (PA)
Thermic effect of food
What is Basal Metabolism?
Sum total of energy expended on all of the involuntary activities needed to sustain life
Excludes digestion and voluntary activities
What are voluntary activities?
-Intentional activities
-Very changeable
What is the most variable element of energy output (day to day, person to person)?
Voluntary Activties
What is the Thermic Effect of Food? (TEF)
-5-10% of a meal’s energy is expended in stepping-up metabolism following meal
-Total amount of energy needed to digest, absorb metabolize and store the food you eat?
-Eating - GI tract muscles speed activity, enzymes produce, produces heat
Is TEF counted in energy output?
NO
What is TEF infuenced by? x3
- Meal Size
- Meal Frequency
- Meal composoition
Is there research of no calorie foods in TEF?
No
TEF for Fat
0-5%
TEF Carbs
5-10%
TEF Protein?
20-30%
TEF Alcohol
15-20%
What is Basal Metabolic Rate (BMR)?
The rate at which the body uses energy to support its basal metabolism
-Varies person to person
-Varies with activity level
-Lowest during sleep
Will BMR increase with short term PA?
No
Will BMR increase with long term PA?
yes
Which tissues has higher BMR: Lean Tissue or Fat Tissue?
Lean Tissue
BMR is higher in which groups of people/situations x8?
- Younger People (lean body mass declines with age)
- Taller People (Larger SA)
3.People who are growing (children, preggo) - People with more lean muscle mass (Physically fit people and men)
5.Fever
6.During Stress - Environment temp- adjusting to heat and cold
- Hyperthyroidism
What is lean body mass?
Weight of body-fat
BMR is lower in? x4
- Older people -lean body mass declines with age
- Fasting - Body slows to perceive energy
- Malnutrition
- Hypothyroidism
What are the conditions needed to measure BMR?
BMR: Rate of energy use for metabolism under specific conditions
-12 hour fast and restful sleep
-Without PA or Emotional Excitement
-Comfortable temp/setting
What are the differences between BMR and RMR (resting metabolic rate)?
BMR:Rate of energy use for metabolism under specific conditions
RMR: Measure of energy use of person at rest in comfortable setting but LESS STRINGENT CRITERIA FOR FOOD INTAKE AND PA
What is the equation for estimated energy requirements for women?
kg body weight x 22 =kcal/day
What is the equation for estimated energy requirements for men?
kg body weight x 24 =kcal/day
EER often include x4?
- Sex (females have less lean body mass than males)
- AGE (BMR declines by average 5% per decade)
- PA (generally cluster activities according to their typical intensity)
4.Body weight and size (higher BMR of taller and heavier people need to be factored)
What is Anthropometry?
Fatfold Measures -caliper
What is density?
Underwater weighing or air displacement plethysmography
Lean tissues is more/less dense than fat tissue?
More
What is conductivity?
Bioelectrical impedance
What is radiological techniques?
DEXA
What are the 4 ways to measure body composition and fat distribution?
- Anthropometry
2.Density
3.Conductivity
4.Radiological Techniques
% body fat of males should be?
12-20%
% body fat for females
20-30%
What contributes to determining how much body weight is ideal for health? x4
- Sex
- Age (increases after 40)
- lifestyle (athletes, fishing)
- Stage of life (pregnancy, elderly benefit from higher)
What percentage of eating disorder start in adolescents?
85%
What is the female athlete triad?
1) Disordered eating/eating disorder
2)Amenorrhea
3)Osteoporosis
Why are athletes at high risk for eating disorders?
- Ultra-slim appearance has ling been considered desirable in some sports and activities
Why may a eating disorder be prevalent in males x2?
1) Making Weight Practices, compromise athletic abilities and endanger their lives (diminished strength and reduced endurance)
2) Muscle Dysmorphia
-Athletes with well-muscled bodies can sometimes see themselves and underweight and weak
What are the characteristics of anorexia nervosa? x5
1) Often come from middle or upper-class families
2)Men account for 5-10 % of cases (most female)
3)Distorted body images that overestimate body fatness (malnutrition is known to affect brain functioning and judgment)
4)May be a way of gaining control
5)Self-Starvation
What are characteristics of self-starvation?
- Discipline is used to strictly limit portions of low-calorie foods
- Hunger is strong but denied
- Person is starving, but doesn’t eat (extreme self control)
- Calorie contents of foods are often memorized
- Exercise excessively and/or use laxatives
What are the physical perils of anorexia nervosa similar to?
Same damage as classic protein-energy undernutrition
What are the physical perils of anorexia nervosa?
- Body tissues depleted of needed ft and proteins
- YOUTH: Growth ceases and normal developmental falters; BMR slows
- Heart pumps inefficiently and irregular
- Low BP
- Imbalance of electrolytes
6.Deaths due to heart failure
7.Brain looses tissue
8.Nerves function abnormally - Intestinal tract lining shrinks
10.Pancreatic production of digestive enzymes slow
11.Food is not adequately digested - Diarrhea
- Anemia
- Dry Skin
- Impaired Immune Response
- Altered blood lipids
- Low body temp.
- Fine body hair
- Loss of sex drive in adults
What are the 3 things a person with anorexia nervosa demonstrates?
- Restriction of energy intake relative to requirements
- Intense fear of gaining weight or becoming fat/ persistent behaviour that interferes with weight gain (already at a low body weight )
- Disturbance in the way in which one’s body weight or shape is experienced (dont relize skinny)
What are the 2 types of anorexia?
- Restricting Type
2.Binge eating/purging
What is the restricting type of anorexia?
-During the last 3 months, the individual has not engaged in recurrent binge eating or purging episodes.
-Presentations in which weight loss is accomplished primarily through dieting, fasting and/or excessive exercise
What is the Binge eating/purging type of anorexia?
During the last 3 months, has engaged in self induced vomiting or the misuse of laxatives, diuretics, or enemas
What are the treatments of anorexia?
1)Supplemental formulas (tube feeding may be needed)
2)Denial makes treatment difficult
3)Many relapses
4)Require many different healthcare professional and supports working together
-Approaches relating to relationships, food and weight as well as to oneself and others
What is more common Bulimia or Anorexia?
Bulimia
Often secret and may deny the behaviours
What is bulimia nervosa? x6
Binge Eating and Purging
-Food is not consumed for its nutritional value
-Binge is a compulsion
-Eating is often accelerated by hunger from previous caloric restriction
-Large binges (often exceed 1000kcal)
-Easy to eat, low fibre, smooth, high-fat and high-carb
-Several binges a day
What is RED-S
-Another better term for female athlete triad
-Olympic Committee
-Impaired physiological function caused by relative energy deficiency:
-Metabolic Rate
-Menstrual Function
-Bone Health
-Immunity
-Protein Synthesis
-Cardiovascular health
What are the 4 aspects of the binge/purge cycle?
- Negative self-perception
- Dieting/severe energy restriction
- Binge
4.Purge
cycle
What occurs after a binge in bulimia nervosa and how?
Purge the food using CATHARTIC (strong laxative) and EMETIC (agent that causes vommiting)
After a binge and purge what are symptoms? x3
- Hands scrapped and cute from the teeth during induced vomiting
- Swollen neck glands and reddened eyes from straining to vomit
- Bloating, fatigue, headache, nausea, pain
What are the physical and psychological perils that may occur in bulimia nervosa?
1)Fluid and electrolyte imbalances caused by vomiting or diarrhea
-abnormal heart rhythm and injury to the kidneys
2) Vomiting Symptoms
-irritation and infection of the pharynx, esophagus, and salivary glands
-Erosion of teeth and dental cavities
-The esophagus or stomach may rupture or tear
-Overuse of emetic can lead to death by heart failure
Who is more likely to recover anorexia or bulimia?
Bulimia: Less likely to be in denial and more likely to recover than those with anorexia
T or F, everyone with bulimia vomits?
False, lots of possible way, excessive exercise
What are the 4 criteria for bulimia nervosa diagnosis?
- Recurrent episodes of binge eating
-Eating in a discrete period, amount of food larger than normal in that period
-A sense of lack of control and inability to stop or know how much one is eating - Recurrent inappropriate compensatory behaviours to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting or excessive exercise
- binge eating and inappropriate compensatory behaviours both occur, on average, at least once a week for three months
4.Self evaluation is unduly influence by body shape and weight
What are the 4 treatments of bulimia?
- Multidisciplinary team
- Regain control over doos and establish regular eating patterns requires adherence to a structured eating plan
- Regular exercise may be of benefit
- Restrictive eating forbidden
What are the goals of bulimia treatment? x3
1)Steady maintenance of weight
2)Learning to consistently at enough food to satisfy hunger is a major step towards recover
3)Medication, such as antidepressants, may be used in treatment
T or F obesity is a eating disorder
False
What is Binge Eating Disorder BED?
Recurrent episodes of eating large quantities of food and then experiencing shame, distress or guilt afterward
How is BED different from BN?
-Consume less during a binge
-Rarely purge
-Exert less restraint during times of dieting
What eating disorder responds best to treatment?
BED
What are the criteria for a BED x5
1)Recurrent episodes of binge eating:
-Eating in a discrete period of time, any amount of food that is larger than usual
-Lack of sense of control over eating during episode
2)Associated for 3 of the following:
-Too much more rapidly than usual
-Eating until uncomfortably full
-Eating large amounts when not hungry
-Eat alone due to embarassment
3)Marked distress regarding binge eating is present
4)The binge eating occurs, on average once a week for 3 months
5) Does not occur solely in BN or AN and not associated with recurrent use of inappropriate compensatory behaviours
How is BED different then BN?
No recurrent use of inappropriate compensatory behaviours like drugs to vomit
What is EDNOS?
Eating disorder not otherwise specified
What is orthorexia?
A colloquial term referring to problematic eating behaviours that can seriously impact someone’s life
Is orthorexia a diagnosable DSM 5 disorder?
NO
What are examples of orthorexia? x7
-Eating only foods regarded as healthy
-Relying on only natural products to treat illness
-Finding more pleasure in eating correctly than enjoying tastes and textures
-Leads to an obsessive focus on food
-Weight is a measure of success
-Can become AN
-Social Isolation and Ill Health
What are the common causes of eating disorders x4?
-Sociocultural
-Known only in developed nations
-Becomes more prevalent as wealth increases and food becomes plentiful
-Psychological
-Heredity
-Probably Neurochemical
What are the 2 things that eating behaviour is regulated by?
1)Signals and Mechanisms that stimulate eating
2)Signals and Mechanism that stop eating or lead on to refrain from eating
What does hunger stimulate?
Eating Behaviour
Is satiation and satiety a weaker stimulus that hunger?
Yes, can be ignored
What is Hunger?
Unpleasant sensation that signals need for food
How often does hunger occur?
4-6 hours after eating
What hormone triggers hunger?
Ghrelin: produced between meals as well as chemical and nervous signals in the brain
What triggers hunger?
1) Contracting empty stomach and empty small intestine
2)Ghrelin
What are the factors influencing hunger? x6
- Nutrients in the bloodstream
- Size and composition of the previous meal
- Weather: heat reduce, cold induce
4.Exercise
5.Sex Hormones - Illness
What is the result of the restriction of hunger?
-Hunger Lessen but does return
-Can lead to bouts of overeating that overcompensate for the calories lost during the deprivation period
How is the stomach adaptive?
-Can adapt to small and larger quantities of food
What is appetite?
The psychological desire to eat
-Sight and smell of food can stimulate the brain’s endorphins, molecules hat create an appetite despite an already full stomach
T or F appetite can be experienced without hunger?
true
What is the result of illness or stress on appetite?
Result in loss of appetite in a person in physical need of food
What are the factors that affect appetite? x7
- Hormones
- Inbrone Appetites (salty, fatty, sweet)
- Learned preferences, aversions, timings
- Customary eating habits
- Social Interactions
- Appetite stimulants, depressants, mood-altering drugs
- Environmental conditions (prefer cold foods in hot weather)
What is satiation?
The perception of fullness that builds throughout a meal eventually reaches the degree of fullness and satisfaction that halts eating.
How does satiation occur? x2
- Stretch receptors in the stomach send signals to the brain that tell it that the stomach is full
- The brain also detects nutrients in blood
What is Satiety?
The perception of fullness that lingers after a meal and inhibits eating until the next mealtime
-Suppresses Hunger
What determines the length of time between meals?
Satiety
What is sensory-specific satiety (SSS)?
-SSS is the concept that we tend to get bored of food as we eat it.
-More variety, the more likely it is that we will increase overall consumption
What is the satiety hormone?
Leptin, produced by adipose tissue and stomach
What hormone is directly related to appetite control and body fattness?
Leptin
Body fatness gain has what effect on leptin?
Body fat stimulates leptin production.
What is the effect of reduced body fat and leptin?
Reduced leptin production = increased appetite
Which of the energy-yielding nutrients is the most satiating?
Protein
Fat is known to effect satiety or satiation?
Satiety
What hormone does protein and fat intake release and what is its role?
Intestinal Hormone (CCK), slows stomach emptying and prolongs feelings of fullness
High-fibre foods and water have water effect on hunger?
Delay Hunger
Protein effects satiety or satiation?
Both
What are the 3 selected metabolic theories?
- Set Point Theory
- Fat cell number theory
3.Thermogenesis 1: Brown Fat theory
What is the set point theory?
Body somehow attempts to maintain a stable body weight
What is the fat cell number theory?
Fat cells may increase faster in children who are obese contributing to obesity as adults
What is the thermogenesis 1: Brown fat theory?
Brown fat has abundant energy-wasting proteins:
-Lean ppl may have more brown fat
-Infants may have abundant brown fat
How does intestinal microbiota contribute to inside-the-body causes of obesity?
Investigation undergoing looking for links btwn intestinal bacteria and body weight
Do genetics have a role in obesity?
Genetics influence a person’s tendency to become obesity, lifestyle choice determine if the tendency is realizes
What are 2 external cues to overeating?
- Variety leads people to eat when not hungry (sweets/appealing food)
- Response to loneliness, craving, addiction, compulsion, depression, time of day, stress
How do food price, availability and advertising contribute to overeating?
High calorie fast foods are inexpensive, widely available an heavily advertised, and delicious
How does physical inactivity contribute to obesity?
Lack of PA
-Lack of physical work is required for most people resulting from a built enviroment
What is a built environment, and how does it contribute to obesity?
Enviroment the buildings, roads, utilities, homes, fixtures, parks and human-made entities that form the physical characteristic of a community.
-Do they promote/ allow for PA to occur? (Stairs, Sidewalks, Public Transport)
T or F Diet histories of those who are obese often report energy intakes similar to or even less than others?
True
-Reported intake often inaccurate (lies)
-Sedentary people: Low energy requirement
What are the 2 things PA is made up of?
- EAT: Exercise-related activity thermogenesis
- NEAT: non-exercise activity thermogenesis
What is NEAT?
Corresponds to all of the energy expended with occupatiom, leisure time activity, sitting, standing, stair climbing, ambukation, toe-tapping, dancing, etc,
What is an obesogenic environment?
All the factors surrounding a person that promote weight gain
What are the 5 best ways to maintain optimum body weight?
- Maintain a healthy and balanced diet
2.Engage in daily PA - Practice behaviour modication
4.Maintain a healthy relationship with food - Consider pharmacological therapy or bariatric surgery in addition to the above
What is the issue with the statement “eat less and move more”?
Simplified
-Issues surrounding body weight and weight changes are extremely complex
What determines if you gain, lose, or maintain body fat?
Balance between energy intake and output
A change in body weight may not reflect change in body fat; it could be the result of? x4
- Body fluid content
- Bone Minerals
- Muscle
- Bladder or digestive tract contents
-Changes often coorelate with time of day
Why do smokers weigh less than non-smokers?
Nicotine blunts feelings of hunger
Why is moderate weight loss better than a restriction fast?
Moderate calorie restriction promotes fat loss and better retention of lean tissue
How does a body respond to a fast?
Less than day into fast:
-Liver glycogen stores are used up
-Protein is broken down in order to meet brains need for glucose
Continues:
-Breakdown of protein (muscle: skeletal, heart, liver)
-To slow breakdown, the body converts fat into KETONE Bodies: a. fuel the nervous system can adapt to using
What is Ketosis?
-The body takes partially broken-down fat fragments and combines them to form ketone bodies
-After 10 days of fasting, most of the nervous systems energy needs are met by ketone bodies
-Survival mechanism: a healthy person starting with average body fat content can live totally deprived of food for 6-8 weeks
T or F: Fasting cleanses body?
False, no evidence, the body tolerate short-term fasting
How does fasting harm the body x5?
- ketosis upsets the acid-base balance of the blood, promoting excessive mineral loss in urine
- 24 hours of fasting and the intestinal lining looses integrity
- Food deprivation can lead to binge eating (could last)
- Fasting degrades the body’s lean tissues
- Body adapts to fasting by decreasing metabolic rate
What are 3 diets that bring about large initial weight loss? and why
- Low Carb
- High Protein
- Ketogenic Diet
-Primarily the water and glycogen losses when carb is laking
(Glycogen holds lot water, water loss to urinate )
Why is weight loss reversed when low-carb, high protein and ketogenic diets when these diets stop?
Restore glycogen stores
Reinforces the diea that carbs are bad
What are the 4 reasons that low-carb, high protein and ketogenic diets cause rapid weight loss?
- Limited Variety
- Protein-rich foods are often slow to prepare
- Energy-rich desserts and snack are often high in carbs (removed in these diets)
4.- Primarily the water and glycogen losses when carb is laking
(Glycogen holds lot water, water loss to urinate )
What is the bodies response to a low carb diet?
Similar to fasting
-Body breaks down fat and protein for energy and ketones form to feed brain
What is the DRI recommendation fro carbs?
-Min. 130g/day (RDA 1 yr)
-45%-65% of total energy intake is recommended for health
What is weight gain the result of?
Energy-yielding nutrients contributing to excess body fat stores
How do excess proteins result in weight gain?
Excess AA have their nitrogen removed and re used for energy or converted to glucose or fat
How do excess fat result in weight gain?
fatty acids are broken down for energy pr converted to triglycerides and stored as body fat with great efficiency
How do excess carbs result in weight gain?
Excess sugars may be built up to glycogen and store, used for energy, or converted to fat and stored
How does alc result in weight gain?
Used for fuel or converted to body fat and stored
-Slows down the body’s use of fat for fuel by 33%, causing more fat to be stored, primarily visceral fat
What is the safest diet?
Balanced Diet
-Adequate essential nutrients and limiting saturated, trans fat and refined carbs
How to get weight loss?
- Energy in must be less than energy expended
- Increase PA
3 Goals for weight loss?
- Prevent weight gain
- Reduce body weight 5-10% over a year
- Focus on healthy behaviours
What are the best strategies for weight loss? x10
- Set Goals
- Keep Records
- Weight Loss needs to be individualized
- Choose realistic calorie intakes
- Balancing carbohydrates, fats and proteins
- Portion Sizes
- Limit Alcohol
- Reduce Energy Density
9.Consider Milk and Milk Products for high calcium - Meat spacing
What goals should be made for weight loss?
-Determine if weight maintenance or loss is most appropriate
-Set goals
-Small goals for diet, PA an behaviour changes
-Slow weight loss is likely to result in rapid regain
Why is keeping records important for weight loss?
A tool to spot trends and identify areas in need of improvement
-Measure waist circumference to track obesity changes
Is a caloric intake lower than 800 calories sufficient and why x3?
No:
-Unsuccessful at achieving lasting weight loss
-Lack necessary nutrients
-May promote eating disorder
What is the suggested caloric intake for waist loss BMI greater than 35?
Reduce kcalorie intake by 500-1000kcal/day
What is the suggested caloric intake for waist loss BMI 27-35?
Reduce kcalorie intake by 300-500kcal/day
How to balance carbs, fats and proteins recommendations?
Fall within AMDR
Carb: 45-65%
Fat: 20-35%
Protein: 1-=35%
Why are high-fibre, unprocessed or lightly processed food important for weight loss?
Offer bulk and satiety for fewer calories than quickly consumed refined foods
What are 2 ways to choose fats sensibly?
1)Avoid trans fat and limit saturated fat
2) Include enough of the health-supporting fats to provide satiety by not oversupply calories
What proteins should be picked for weight loss?
Lean
How to balance portion sizes for weight loss?
Eat until satisfied no more
T or F eating large portions of reduced-calorie foods is not beneficial
true
Why should milk products be considered for weight loss?
High calcium intake especially rm low-fat milk products correlates with low body fat
What types of meal spacing are recommended for those wanting to lose weight?
-Small, frequent meals are reported to be more successful at weight loss and management
-Mild hunger should prompt eating not appetite
Physical Activity for weight loss should be greater/less ?
Greater
Why PA is important for weight loss?x3
-Diet in combo with PA promotes fat loss, promotes muscle retention and inhibits weight gain
-Helps follow diet plans more closely
-Improves BP, IR, Heart and lung fitness even without Weight loss
PA _____ metabolism
Increases Metabolism
-Short-term increase in energy expenditure from exercise and a slight rise in metabolism
-Long-term increase in BMR from an increase in lean tissue
Can PA reduce Spot by targeting fat and exercising a certain area?
NO PA cannot target fat from an area
-Aerobic promotes the release of abdominal fat
-Improves the strength and tone of muscle in the area
What are 4 additional PA benefits?
- Appetite control
- Stress reduction & control of stress eating
- Physical & psychological well-being
- Improved self-esteem
What are the 3 pillars to support medical nutrition therapy and PA?
-Psychological Intervention
-Pharmacotherapy
-Obesity Surgery
Who is surgery for obesity management a option for?
1) BMI greater than 35 with co-existing disease, according to CPG
2)BMI greater than 30 with poorly controlled Type 2 diabetes or severe obesity-related disease not responding to medical management
What are the benefits of surgery for weight loss? x6
-Sig. Weight Loss
-Improve Hypertension
-Improve High Cholesterol
-Improve Diabetes
-Improve sleep apnea
T or F Surgery is a always a cure for excess adiposity?
F, some do not lose the expected weight or lose and then gain it back over time
Long-term safety and effectiveness of gastric surgery depends on?
Compliance with dietary instructions
Long-term complications of gastric surgery includes x2?
-Vitamin and mineral deficiencies
-Psychological Problems
What is Gastric Banding?
-Provides restrictive methods for weight loss.
-An adjustable band is placed where the esophagus and the stomach meet
-The band is a silicone ring filled with saline with a port placed in the muscle of the abdominal wall adjusted with saline
What is Gastric Bypass (roux-en-y)
Provides a restrictive and malabsorptive method for weight loss because the stomach and small intestines are reconfigured
-A small stomach is created by dividing the stomach, creating a stomach pouch that can hold a few bites
-The intestines are cut and the entire duodenum and part of the jejunum are bypassed
What is a duodenal switch?
Provides a restrictive and malabsorptive method to weight loss because the stomach and small intestines are reconfigured
-The stomach reduction is less than the gastric bypass but more of the small intestine is bypassed
What is a sleeve gastrectomy (Gastric Sleeve)
-Provides a restrictive approach
-A long slender sleeve is stapled
-Other part of stomach is removed
-Stomach is banana-sized
What are the surgery options to treat obesity?
1.Gastric Banding
2.Gastric Bypass
3. Duodenal switch
4. Sleeve Gastrectomy (Gastric Sleeve)
What is a example of gastric bypass nutrition supplement regimen?
-Multivitamin/mineral 2 tablets/day
-Vitamin B12
-Calcium Citrate
-Vit D
-Iron
-Crushed, chewable or liquid for the first 2 months
-Specific brands are generally recommended because of their vitamin and mineral make up
What is the diet for the Bypass Surgery?
x5
- Clear fluids for a day
- Full fluids for about 10 days
- Pureed diet
- Overall, very small amounts - about 4 tablespoons per meal
- Need to ensure adequate: Protein supplements, Liquids, Vitamins and minerals supplements
True or False: Medications for obesity are prescribed far more infrequently than medication for other chronic conditions.
TRUE!
Why do medications need to be considered early?
-Medications need to be considered early because obesity-related health conditions tend to increase or worsen over time.
What are the clinical considerations that need to be made when starting obesity pharmacotherapy? x4
1) Identify individualized goals of therapy prior
2)Set reasonable expectations and time required to see these benefits
3) Targets of treatment should include outcomes that the patient identifies as important to them
4)Discuss whether treatment should be long term
What are possible targets of treatment for obesity pharmacotherapy?
- Weight Loss
2.Improvement in health parameters - Weight maintenance after lifestyle-induced weightloss
4.Control of Cravings
5.Improve QofL
T or F -Medications are not a quick fix. They are a long term strategy, that if stopped weight gain occurs.
True
When can prescription medication to treat obesity prescribed?
BMI greater than 27 and obesity-related complication elevated disease risk may benefit from prescription medication, along with diet, exercise
What is Sibutramine?
Suppresses appetite by inhibiting serotonin reuptake
-NOT on market in Canada (est. 2010)
What is the problem with Herbal Products?
Effectiveness and Safety have not been proven
T or F Ephedrine can be used for weight loss?
True
What is the problem with ephedrine?
Side effects can include stroke or death.
-Not reccomendded
What is known as dieters tea?
Herbal Laxatives: senna, aloe, rhubarb root, cascara, castor oil or buckthorn
What is the problem with herbal laxatives?
-Cause temp. water loss of 1-2kg
-Nausea, Vomiting, Diarrhea, Cramping, Fainting
What gimmicks to weight loss?
1) Steam baths and saunas do not melt off fat (dehydration resulting in water loss)
2) Brushes, sponges, wraps, and creams/massages intended to move burn or break up cellulite are useless for fat loss
What is the the key to weight loss?
Key: Weight Maintenance is accepting it as a lifelong endeavour of healthy habits
-Healthy Diet
-Portion Control
-Exercise
However many factors which can influence PA and Food access/choices
T or F an underweight person should not necessarily try to gain weight
T: If healthy should maintain current weight
What are the ways to gain weight? x4
1)PA to gain muscle and fat
2)Choose food with high energy density
3)Portion Size and Meal Spacing
4)Weigh Gain Supplements
What is a good way to choose foods with high energy density/ nutritious energy-dense foods?
Generally increasing fat but not sat or trans fat
How to use portion size and meal spacing to increase weight?
1)Increase Portion sizes
2)Eat Frequently
(start with main course, drink milk/milk alt. or snoothies in btwn meals)
T or F Weight Gain supplements have benefits without PA
F, Weight-gain supplements are useless without PA
-No benefits beyond adding calories and few nutrients
T OR F To gain weight somebody should increase tabacoo use?
F, AVOID Tobacco
-Supresses appetite an dmakes taste buts and olfactory organs less sensitive
How does XenicalⓇ Orlistat OTC Alli Ⓡ work?
Stops some fat eaten from being absorbed by the body
How does SaxendaⓇ
liraglutide work?
Decreases appetite and amount eating
How does Contrave®
naltrexone & bupropion work?
Controls hunger and craving
How does WegovyⓇ Semaglutide work?
Decreases appetite and slows stomach emptying helping to control amount eaten
What is ephedrine not approved for?
Weight Loss
Increased NRG
Body-Building
Euphoria
What are the only ways to have ephedrine in Canada?
Nasal Decongestions
Products Carry a Drug ID Number
What are the 4 prescribed drugs for weight loss?
1) XenicalⓇOrlistat, OTC Alli Ⓡ
2)SaxendaⓇ,liraglutide
3)Contrave® naltrexone & bupropion
4)WegovyⓇSemaglutide
