Exam 2: Nutrition in Weight Management Flashcards
Identify the components of fat-free mass
Everything in body besides the fat.
*Water 2/3
* Organs
* Bones
* Minerals
* Lean body mass
(muscle)
Identify the components of fat mass
- Essential fat
- Storage fat
⚬White adipose tissue - brown adipose tissue
Components of storage fat
- Subcutaneous (skin)
- Visceral (organs and peritoneum)
White adipose vs Brown Adipose
both component of visceral storage fat
- WAT: stores TG
BAT: more mitochondria
Describe the changes in adipocytes with growth and weight gain
- increase in number
- increase in size
- increase in number
- repeats
Describe the changes in adipocytes with weight loss
with fat loss the size of the fat cells shrinks but not the number
identify factors that affect body weight
- energy intake
- energy expenditure
- genetics
- inflammation
- sleep deprivation
- obesogens
How does energy intake affect body weight
- CHO 4
- Fat 9
- Protein 4
- Alcohol 7
How does energy expenditure affect body weight?
- RMR: resting metabolic rate
- AT: activity thermogenesis (most variable)
- TEF: thermic effect of food
- NEAT: non exercise activity thermogenesis
How does genetics affect body weight?
⚬ Size and # of fat cells
⚬ Regional distribution of body fat
⚬ RMR: fast/slow meta
⚬ Set point theory
⚬ Epigenetics: gene plus environment exposure and lifestyle
set point theory
intractable tendency to regain weight after weight loss
- body can adjust energy expenditure
How does inflammation affect body weight?
⚬ Insulin resistance
⚬ Muscle protein loss
⚬ Leptin resistance
muscle protein loss
muscle loss = lower RMR
insulin resistance
- reduce insulin so glucose is not going into cells to use for energy then that glucose get converted to fat
leptin resistance
How does sleep deprivation affect body weight?
⚬ ↑ ghrelin, ↓ leptin
⚬ ↑ kcal intake and
cravings for CHO
foods
⚬ Gene expression
⚬ Insulin resistance
⚬ ↑ ghrelin, ↓ leptin
- ghrelin promotes hunger
- leptin promotes satiety
- get more hunger and increase calories and cravings
How does obesogens affect body weight?
- affect endocrine disruptors (hormone secretion system)
- environmental factors like packaging and cosmetics
⚬ Disruption of lipid
metabolism →favors fat storage
⚬ Gene expression
⚬ Hunger/appetite
regulation
Role of cholecystokinin
- stimulated by protein and fat
- suppress gastric emptying
- decrease hunger
- reduce food intake
role of leptin
- WAT
- stimulated by the release of insulin
- less hunger and appetite
- inc metabolism
role of insulin
- stimulate by glucose level after eating
- dec hunger by production of leptin
role of ghrelin
- stomach
- inc appetite and hunger
- inc before food and dec after food
role of glucagon like peptide 1
- SI, stimulate by food intake
- increase satiety, slow gastric emptying, inc metabolism
role of pancreatic peptide YY
- ileum/colon, stimulate by food
- delay digestion, satiety, curb appetite
role of triodothyronine and thyrodine
- thyroid gland
- regulate metabolism
role of cortisol
- highest in morning because running out of glucose
- adrenal cortex
- inc appetite, regulate metabolism
__________ promote hunger and ___________ promote appetite
ghrelin and cortisol
The majority of energy expenditure comes from _____ ?
RMR
What is the metabolic syndrome
how is metabolic syndrome diagnosed?
What are the medical complications of obesity?
- idiopathic intracranial hypertension
- stroke
- cataracts
- coronary heart disease
- diabetes
- dyslipidemia
- hypertension
- severe pancreatitis
- cancer
- phlebitis
- gout
- skin
- osteoarthritis
- gynecologic abnormalities
- gallbladder disease
- nonalcoholic fatty liver disease
- pulmonary disease
Define metabolic syndrome
- increase risk for CVD and comorbidities
How is metabolic syndrome diagnosed
includes 3 or more of the
following:
* Waist circumference
⚬ Men: > 40 inches
⚬ Women: > 35 inches
* SerumTG≥150 mg/dl
* HDL
⚬ Men: < 40 mg/dl
⚬ Women: < 50 mg/dl
*BP: ≥ 135/85 mm Hg
*FastingBG ≥100mg/dl
Why is rapid weight loss not ideal?
- higher protein loss
- sharp decrease in RMR
Make recommendations for the rate and extent of weight loss and for weight
management
- Weight loss recommendations
⚬ BMI 27-35: 0.5 – 1 lb/week
⚬ BMI > 35: 1-2 lbs/week
⚬ Goal: 10% reduction in 6
months
-
What are the top 3 weight loss strategies
- Lifestyle/behavior
modification - Diet modification
- Increased physical activity
other - Pharmacotherapy
- Surgery
- weight maintenance
components of lifestyle and behavior modification
- Goal setting 75%
- Stimulus Control: ID stimuli that encourage eating and limit exposure
- Problem Solving: Define problem, generate solutions, implement, and evaluate
- Cognitive Restructuring: ID, challenge, and correct negative thoughts
- Self-monitoring: Food and PA records
- Relapse prevention: Anticipate and plan coping strategies
what are the 4 diet modification strategies
- Energy restricted diet
- meal replacement program
- commercial programs
- very low calorie diets
components of the diet modification strategy: energy restricted diet
- Energy-restricted diet
⚬ 500-1000 kcal daily deficit
⚬ 1.2 g/kg/d protein
⚬ Increased fiber, decreased alcohol and sugar
⚬ MVT recommended if <1200 kcal/d for women or < 1800 kcal/d for
men
components of the diet modification strategy:* Meal replacement programs. adv and disadv
Advantage: fast easy on the go, easy to follow, support groups, few calories with all nutrients
Disadvantage: less satieting, more eating, hard to sustain longterm, no healthy choices learned
components of the diet modification strategy: * Commercial programs
adv: convenient. support, groups
dis: purchase products, expensive no skill learned
components of the diet modification strategy: * Very Low-Calorie Diets
⚬ Physician-supervised
⚬ 200-800 kcals/d
⚬ Include adequate protein, micronutrients, and essential fatty acids
⚬ 12-16 weeks
What is our major determinate of resting metabolic rate (rmr)?
Lean body mass (muscle mass)
Explain relationship between RMR , calories burnt and muscle mass
Calories we burn at rest, depends largely on how much muscle mass we have so the more muscle mass we have the faster our metabolism is. Similarly as our muscle mass decreases the resting, metabolic rate decreases.
Lean body mass ________ with exercise, and __________ with.
Increase, decrease
What particular exercise increases lean body mass?
Weight training
Why is it hard to manage weight with age?
Resting metabolic rate decreases with lean body mass
What is essential fat? Purpose?
All the fat we need to survive.
Protection of organs
Reproduction
What is storage fat? Purpose ?
Fat under our skin
⚬ Subcutaneous
⚬ Visceral
⚬ White adipose tissue
⚬ Brown adipose tissue
explain why women have a much higher percentage of body fat compared to men
Women have higher amounts of essential fat due to reproduction function
Essential fat percentage in female and male
Women, 12%
Men 3%
Total fat
18% to 24% men
25% to 31% women
Women have lower ______ compared to men and slightly lower _________ then men, which explains why women in general have a lower __________ than men
Muscle mass; bone mass; resting metabolic rate
Adipose tissue. Composition.
White adipose tissue
Brown adipose tissue
Adipocytes
What is white adipose tissue?
Fat tissue that makes up the majority of fat in the body
White adipose tissue functions
Energy storage
Oregon protection
Insulation
Brown adipose tissue facts
Burns energy
Adults have little brown
Higher amount of brown adipose tissue, the more weight you’re going to burn
What is the difference between brown and white adipose tissue?
White adipose, tissues, stores energy, and brown adipose tissue burns energy
What is hyperplasia of adipocytes
Increase the number of fat cells
What is hypertrophy of adipocytes
Increase in the size of fat cells
How does weight gain affect adipocytes
Hyperplasia and hypertrophy the increase in the number of fat cells, and the fat cells increase in size
How does weight loss affect adipocytes
Only hypertrophy a curse. Once you’ve gained a significant amount of weight, you never be able to get rid of your fat cells, you can only decrease them in size.
What is the progression of adipocytes during weight game?
Adipocytes increase in number, then increase in size, then increase in number, then increase in size again
Weight loss strategies: FAD diet modifications
- high protein diet
- low carnohydrate diet
- very low fat diet
- volumetrics
- intermittent fasting
Weight loss strategies: FAD diet modifications: high protein diet
⚬ 40-45% kcals from CHO
⚬ 25-30% kcals from pro
⚬ ~30% kcals from fat
- preserve lean body mass
- no spike in blood sugar
- more satiating than carb
- strain on the kidney, dehydration, inc CVD/cancer/ kidney stones
Weight loss strategies: FAD diet modifications: low carbohydrate diet
⚬ <10-20% kcals from
CHO
⚬ 55-65% kcals from fat
- body will shift to use of ketones/fat for fuel
- must be extremely low calorie
- slow process for fuel
- ketosis, acidosis, poor microbiome
- hard to sustain and regain weight
- water loss
- prevent heart disease
- reverse plaque build up in arteries
- less calories
- might eat more carbs
Weight loss strategies: FAD diet modifications: very low fat diet
⚬ <10-20% kcals from fat
⚬ 10-20% kcals from pro
⚬ 60-80% kcals from CHO
Weight loss strategies: FAD diet modifications: volumetircs
20-30% of kcals from fat
⚬ 15-20% of kcals from pro
⚬ 55-60% kcals from CHO
⚬ Focus on energy density
- greater volume of nutrient dense foods
Weight loss strategies: FAD diet modifications: intermittent fasting
⚬ Alternate-day fasting
⚬ Modified fasting
⚬ Time-restricted fasting
-
Weight loss strategies of physical activity
- Increased energy expenditure
- Preservation of LBM and RMR
- Increased insulin sensitivitydec resistance
- 30-60 min/day
⚬ Aerobic activity
⚬ Resistance training
Weight loss strategies of pharmacotherapy: who is recommended
BMI ≥ 30 or BMI ≥ 27 w/ risk
factors
Weight loss strategies of pharmacotherapy: 4
- orlistat
- contrave
- qsymi
- ozempic/wegovy
orlistat
⚬ Inhibits lipase
⚬ ↓ absorption of fat-soluble
vitamins
⚬ GI side effects
⚬ May improve blood lipids
contrave
⚬ Combo of antidepressant
and opiate antagonist
⚬ Appetite suppressant
qsymia
⚬ Combo of CNS stimulant and
anti-epileptic drug
⚬ Suppresses appetite and
makes food less appealing
ozempic/wegovy
⚬ GLP-1 agonist
⚬ Suppresses appetite and
delays gastric emptying
⚬ Increases insulin, decreases
glucagon
WEIGHT LOSS STRATEGIES –
BARIATRIC SURGERY WHO?
- BMI ≥ 40 or BMI ≥ 35 w/
risk factors
WEIGHT LOSS STRATEGIES –
BARIATRIC SURGERY categories
- Restrictive
- Malabsorptive
WEIGHT LOSS STRATEGIES –
BARIATRIC SURGERY types
- gastric banding
- vertical sleeve gastrectomy
- gastric bypass
gastric banding
⚬ Adjustable band
reduces stomach
pouch
- restrictive
- not effective
- safest
vertical sleeve gastrectomy
⚬ Removal of ~80% of stomach
- restrictive
- removes ghrelin hormone
gastric bypass
⚬ Staples partition the
stomach
⚬ Stomach opening
connected to small
intestine
⚬ Side effect – dumping
syndrome
- gold standard, reduce comorbidities,
- risky
DIET PROGRESSION AFTER BARIATRIC
SURGERY
- Clear liquids
Start within 24 h after surgery. Duration 2–3 meals
Sugar-free clear liquids such as water, unsweetened decaffeinated tea, sugar-free gelatin, sugar-free popsicles, broth - Stage 2—Full liquid diet
A few days to 1 week
Protein drink, fat-free (skim) milk, unsweetened nondairy milk, strained cream soups - Stage 3—Puréed
A few weeks to about 1 month
Foods that are the consistency of a smooth paste or thick liquid, without any solid pieces. Examples include low-fat cottage cheese, low-fat or fat-free ricotta cheese, blended meats, fish, eggs, beans, fruits, and vegetables - Stage 4—Soft foods
About 1 month
Ground or finely diced meats, canned or soft fresh fruit, cooked vegetables without skin, eggs, beans - Stage 5—Solid foods
Start about 8 weeks post surgery
Gradually incorporate firmer, diced, or chopped foods.
POST-BARIATRIC SURGERY
- RD monitoring and evaluation
⚬ Weight and fat loss
⚬ Anemia
⚬ Electrolyte deficiencies - Supplementation
⚬ MVT
⚬ Calcium and vitamin D
⚬ Vitamin B12
⚬ Iron w/ vitamin C
Underweight/
Involuntary
Weight Loss Assessment
⚬ % IBW: < 80-85%
⚬ BMI: < 18.5
⚬ % weight change
Underweight/
Involuntary
Weight Loss Causes
⚬ Inadequate intake
⚬ Excessive physical
activity
⚬ Altered absorption
⚬ Catabolic illness
⚬ Stress
Underweight/
Involuntary
Weight Loss TREATMENT
High-kcal diet
⚬ SFM
⚬ Snacks or
supplements
between meals
⚬ Liquids separate
from meals
* Physical activity
* Appetite stimulants
⚬ Remeron
⚬ Megace
⚬ Marinol
* Nutrition support
The NWCR identified which behavior that resulted in successful long-term weight loss?
Group of answer choices
Use of very low-calorie diets
Use of pharmaceuticals
Attending support groups
Eating breakfast
During starvation, the body’s adaptive response is a
Group of answer choices
drop in the RMR as much as 15% in 2 weeks.
rise in the RMR as much as 15% in 2 weeks.
drop in the RMR as much as 25% in 1 month.
rise in the RMR as much as 25% in 1 month.
drop in the RMR as much as 15% in 2 weeks.
Aerobic exercise is effective in weight management because it
Group of answer choices
promotes the use of fat for fuel.
decreases lean body mass in proportion to fat.
increases resistance to insulin.
decreases sensitivity to insulin.
promotes the use of fat for fuel.
Which of the following does the NIH identify as being an appropriate candidate for bariatric surgery?
Group of answer choices
A person with metabolic syndrome
A patient with BMI of 25 to 29 with high blood pressure
A patient with BMI of 30 to 34
A patient with BMI of 40 or higher
