EXSC 480 Exam 2 Flashcards
Things that need to be evaluated before beginning a weight loss program
Risk Motivation Medical History Body weight history diet history Repro history Social history Drug history
Risk is based off of
BMI Wasit circumference Coronary Risk Diabetes Dyslipidemia Cigarette smoking Sleep apnea
Motivation steps
Precontemplation Contemplation Preparation Action Maintenance Termination
Medical history
Risk factors
CVD, diabetes, hypertension, gallstones, etc
Physical Exams
Vital signs
BMI
BP/HR, fasting lipids, blood sugar levels
sleep apnea
sleep apnea symptoms
STOP BANG snoring tired apnea pressure
BMI >35
age >50
neck circumference >16 in
Gender
Body weight history
weight gain/loss over time previous weight loss attempts diet history PA family history
Social history
cigarette smoking
Body compartments
Fat mass
Fat Free mass
Fat-free mass
everything excluding fat
bone, body water (73%), protein
Anthropometric clinical tools
height/weight
skinfold thickness
bodily circumference
Body composition clinical tools
BIA
DXA
BOD POD
Hydrostatic weighing
Imaging clinical techniques
MRI
CT Scan
Ultrasound
BMI strengths
easy to use on large populations
quick, effective, inexpensive
BMI weaknesses
only assesses weight not % body fat
Skinfolds strengths
easy to use, quick, effective, inexpensive
Skinfold weaknesses
age/gender, skill of person giving test, prediction equations
greatest error
BIA strength
easy to use, quik, effective
BIA weaknesses
hydration
temp
menstruation
not as good as skinfold
hydrostatic weighing strengths
more accurate than skinfolds or BMI
2 compartment
hydrostatic weighing weaknesses
varies w/menstruation
BOD POD strengths
retest reliability
suited for many people
quick
easy to use
BOD POD weaknesses
expesnive
not common
DXA strengths
GOLD STANDARD
high validity, closest to CT/MRI
DXA weaknesses
expensive
type of beam
hydration
CT/MRI strengths
noninvasive
most accurate
measures all body compartments
CT/MRI weaknesses
high cost
time consuming
need experts
optimal method for research studies would…
correlate w/dietary intake
Be free of social bias
Be independent of patient memory
Not be limited by subject’s ability to describe the food
Not influence how the patient eats normally
Be inexpensive
is there a gold standard for dietary assessment?
no
Duplicate diet approach
collection of duplicate diet samples
ACTUAL INTAKE
Duplicate diet strengths
measurement of dietary exposures possible
actual intake
Duplicate diet weaknesses
expensive
not suitable for large groups
Food consumption record
household’s normal diet is assessed/viewed by trained staff
actual intake info
Food consumption strengths
ease of application
actual intake
Food consumption weaknesses
doesn’t focus on the individual, focuses on group
only works if they eat at home
interviewers
24-hour dietary recall
subjective
open-ended
trained interviewer asks questions about food eaten over the past day
24-hour dietary recall strenghts
small respondent burden
detailed
easy
24-hour dietary recall weaknesses
recall bias
trained interviewer
expensive and time-consuming
Dietary record
subjective mesure
self-administered, questionnaire
Dietary record strenghts
no interviewer required
no recall bias
detailed, actual intake info
Dietary record weaknesses
large respondent burden
can influence intake over a few days
Dietary history
subjective
open and closed questions
trained interviewer
USUAL intake over long time
Dietary history strengths
usual dietary intake
Dietary history weaknesses
high cost and time consuming
not suitable for epidemiological studies
Food frequency questionnaire
subjective mesure that asks what foods have been eaten and how often
self or interviewer
USUAL intake for longgg time periods
Food frequency questionnaire strengths
suitable for epidemiological studies
simple
cost effective
Food frequency questionnaire weaknesses
low accuracy
recall bias
close ended
relies on memory
RMR
resting metabolic rate or energy required to keep your body functioning
RMR supports
breathing, blood movement, organs, and neuro functions
RMR increases with
BMI
RMR is determined by
weight
height
age
equations used to figure out RMR
harris-benedict
mifflin st. jeor
TDEE activity factors
increases as you become more active or injuries/illness can increase RMR
indirect calorimetry
amount of oxygen consumed under resting conditions
Recommendations for diets/calories
500-750 kcal per day deficit
1200-1500 for women
1500-1800 for men
Energy deficits
BMR/RMR
adjust for activity and stress levels
estimate nutrition needs
energy deficit level
Why is PA essential for weight loss?
exercise only accounts for 15-30% of energy expenditure
PA increases/multiplies the METs
EE quantifies PA and measures PA
1 MET
3.5 mL/kg/min
5 kcal
1 L of oxygen
1 KG
2.2 lbs
how to calculate energy expenditure?
intensity (METS) x Duration (time) x Body Mass
Direct measures of EE
direct calorimetry
doubly labeled water
Indirect measures of EE
Oxygen uptake
Heart Rate
Doubly labeled water
gold standard of EE
estimates daily EE by average
person consumes water; 1-4 weeks. Differences between elimination rates of different isotopes
Doubly labeled water strengths
good estimation of energy balance
no participant work needed
free living environment
not reactive or intrusive
Doubly labeled water weaknesses
expensive
not day to day variations
expensive analysis
invalid if body isn’t stable
Heart rate indirect measurements
useful for cycling, swimming
doesn’t work well w/heart conditions
discomfort
Physical Activity Compendium
METs
METs importance
o Helps you know how to compare the physical activity of one person to another
Quantify dose-response relationships with health outcomes
Document changes and differences within and between individuals
Validate intervention programs
Compare physical activity levels between populations/cultures
PA questionnaire global
short, 1-4 items, asessing status
PA questionnaire global pros
simple and easy
PA questionnaire global cons
difficult to measure compliance and dose-response
PA questionnaire short-term
7-20 items, over past week/month
frequency, duration, type
PA questionnaire short-term pros
easy to measure compliance and establish dose-response
PA questionnaire short-term cons
math/average
hard to figure out frequencies and durations during the time
PA questionnaire quantitative
60+ items over past year/lifetime
PA questionnaire quantitative pros
can estimate long-term impact of PA
PA questionnaire quantitative cons
difficult to recall PA details from year/lifetime
PA logs
usually a checklist of activities that are checked as completed
PA logs pros
simple to use, don’t need duration
PA logs cons
subject burden, it’s a daily task
PA diaries
recording details of PA as completed
frequency, intensity, duration, mode
PA diaries pros
allow for a breadth of detail
PA diaries cons
over and under reporting, subject burden
Pedometers
attached to arm
Pedometers pros
low cost, behavioral feedback and motivation. reliable
Pedometers cons
can’t measure anything besides walking
Accelerometers
measure change in velocity/accleration
can assess multiple planes
Accelerometers pros
detailed, precise. minimally invase. can be used for days, weeks, or longer
Accelerometers cons
poor in compared to doubly-labeled water. not sensitive to different types of PA
HR monitors/multi-system
combine multiple bodily functions. may include HR, skin response, core temp, accelerometry
HR monitors/multi-system pro
high precision
HR monitors/multi-system cons
expensive, complex, no gold standard
Gold standards for EE and PA
EE = doubly labeled water PA = no gold standard
how much weight loss produces benefits?
3 to 5%
how much weight loss is recommended?
5-10% to help lower CVD risk
Patients expectations
on average, women believed that they were going to lose 32% of their weight
Patient’s expectations/acceptable weight loss
their acceptable weight loss goals are usually 2-3x more than achieved
How much weight percentage was lost?
15%
47% didn’t even reach their disappointed goals
Did those who needed bariatric surgery have realistic expectations?
no
Weight loss maintenance
o Maintenance therapy for at least a year
o Acknowledging lifetime challenge
o Monthly contact with therapist
o Frequent self-weighing (at least weekly)
o Reduced-calorie diet
o High levels of physical activity (more than 200 min per week)
Max weight is…
lost at 6 months
followed by a plateau and then a regain period
Obesity is caused by
long-term energy balance
kcals to pounds
3500 kcals for one pound
Energy balance
between energy intake and energy expenditure
Energy expenditure
- Thermic effect of feeding
- Energy expenditure of physical activity
- Resting energy expenditure
Is energy expenditure of PA more important for energy balance
PA
increases expenditure by more than 50 fold
causes 15 fold increase in total energy expenditure
Why does increasing PA help a person maintain lower weight?
o Those that are obese expend more energy when exercising
o 100 kcal per day would prevent weight gain in most people
o Kids = 150 kcals
o Weight loss = 200 kcals
Energy density
kcal/g
Amount of energy or calories in a particular weight of food and is generally presented as the number of calories in a gram kcal/gram
Examples of high density food
butter bacon chips dressings cheese pretzels
Examples of low density foods
lettuce
soup
apple
fish
how to calculate energy density?
calculate by dividing calories by grams per serving
Volumetrics
humans tend to eat about the same weight of food every day
maintaining volume and changing density can help w/weight control
What affects the energy density of foods most?
water, fiber, dietary fat
High water = lower energy density
High fat = higher energy density
Having a salad before a meal…
decreased meal intake by about 100 caloreis
How to passively under-consume calories
large portions of fruits and veggies
starchy healthy foods
portion sizes
satiety/satiation
Satiety
how long you can wait to eat
Satiation
feeling full
Environmental reasons for why it’s hard to maintain weight
Industrialization of food system Inexpensive unhealthy foods Fewer meals at home Occupations more sedentary Less walking, more driving
Physiological reasons it’s hard to maintain weight
Reduced energy expenditure: 20-30 kcals decrease per kg lost
Increased appetite: 100 kcals increase
Decreased satiety
Regainers
more than half of weight lost is regained within 2 years
5 years; more than 80% of weight loss regained
waning efforts as time progressed
Maintainers
had a deficit of 100 kcals even with appetite rising by 400-600 kcals
intakes increased of both
Predictors of weight maintenance
Self-monitoring low-cal, low-fat diet eat breakfast daily regular PA (2500-3000 kcal) weight-maintenance counseling
Self-monitoring
Diet: record food intake daily, limit certain foods or quantity
Weight: check body weight more than 1x week
Low-cal, low-fat diet
Total energy intake: 1300-1400 kcal
Energy intake from fat: 20-25%
Weight-maintenance counseling
Helps to build satisfaction Relapse prevention Cognitive restructuring Deeper motivations Manage expectations
National dietary data trends
o Carbohydrate intake has increased
o Fat increase stayed the same
o Increase in energy intake could explain the obesity epidemic
Portion sizes have
increased
Bowl size
increased, and has slightly increased food intake. Only .2 effect
Provided more food
ate higher percentages of food when offered more
Front box serving size
the larger it is, it can increase portion size or how much is eaten
Single food offered
decreases how much food was eaten by 60%
Things that increase how much is eaten
portion size provided more food increased fast food bowl size serving size on box multiple foods proximity/visbility friend's weight obese people present
Obese friend
57% increased chance of becoming obese
Obese person in proximity
lower health requirement
Which body assessments total body fat percentage?
DXA
Bod Pod
Hydrostatic weighing
Bioelectrical impedance
Which are direct measures of energy expenditure?
doubly labeled water
whole-room calorimeter
Energy flux
encourages increasing physical activity to assist in regulating body weight
Too little physical activity results in a reduced ability to match intake with expenditure to regulate body weight
Adjusting energy intake and/or expenditure results in compensatory metabolic and behavioral changes
Intervention effort is
what determines if you gain back weight
energy intake increases, energy expenditure decreases, and appetite increases. so intervention is the best prevention
Food frequency tech
questions that ask for multiple details, ability to submit photos
ability to collect complex data
24-dietary recall tech
software/internet
standardized data collection possible
Dietary record tech
software, internet, phone
standardized real-time dat collection possible
improves feasibility