Healthy-Obesity Flashcards

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1
Q

Obese

A

describes a person who’s very overweight, with a lot of body fat. It is a common problem in the UK where its estimated to affect around 1 in 4 adults and 1 in 5 children. (NHS Website)

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2
Q

Body Mass Index (BMI)

A

used to measure obesity. A measure of whether you’re healthy for your height.

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3
Q

Biological factors:
Genetic explanation
-Family clusters

A

The weight of your parents is likely to determine the weight of their children.
If one parent is obese=40% chance child being obese.
Both parents=80% chance.
Parents thin=7% chance.
Same observations are found cross culturally (Maes et al 1997).
BUT parents and children share the same environment.

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4
Q

Biological factors:
Genetic explanation
-Twin studies

A

Stunkard et al (1990) examines BMI of 93 pairs of identical twins reared apart= found that genetic factors accounted for 66-70% of variance in body weight.
Suggests a strong genetic component in obesity.
But what about other 30%?

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5
Q

Biological factors:
Genetic explanation
-Adoption studies

A

Stunkard et al (1986): gathered information about 540 adults adoptees and their biological parents and their adoptive parents.
Results= strong relationship between the weight category of the adoptee and of their biological parents. (=suggests major role of genetics).

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6
Q

Biological factors:

Thrifty gene hypothesis

A

As it’s a global problem-suggests evolutionary.
• An evolutionary explanation=storing fat as an adaptive response.
• Functional to store fat when food is in short supply, however this is inappropriate now as food is abundant.
Neel (1962): “in such an environment, genes that predispose to obesity increase energy stores and provide survival advantages in times of famine.”
• Individuals who were most energy efficient in terms of burning off excess energy and remaining thin would have been less successful.
• Therefore we are now left with those who were best adapted to surviving harsh winters and floods, which resulted in food shortages and famine.
• Now, lots of food and increasingly sedentary lifestyles, these people overeat=obese=health problems.
Ψ The environment no longer needs their thrifty gene.

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7
Q

Strengths of biological explanations

A
  • Drug treatments can be used.

* Useful to know-can educate to prevent.

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8
Q

Limitations of biological explanations

A
  • Gives people an excuse-removing the blame from an individual suggesting that their weight is out of their control.
  • Some people more susceptible than others=hard to control.
  • Reductionist- increase in obesity within the last 20 years has occurred over too short a period for genetic makeup to have changed substantially.
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9
Q

Cognitive factors:

Cognitive restraint theory

A

Suggests that people who diet replace physiological hunger sensations with “cognitive restraint”- they put a cognitive limit on what they eat.
BUT this is not enough in eliminate hunger signals and according to cognitive restraint theory, dieting lead to obesity.

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10
Q

Herman and Mack (1975)

A

Aim: Investigate cognitive restraint theory using Preload/taste test method.
Method:
• Told 45 female students they were participating in a taste test, half we given a high calorie preload and half a low calorie preload.-half the participants of each group were dieters and the other half non-dieters.
Findings:
• Restrained eaters in high calorie preload went on to eat the most.
• Whereas the non-dieters showed compensatory regulatory behaviour and ate less during the taste test after high calorie preload, the dieters consumed more in the taste test if they had the high calorie preload than the low calorie preload.
Evaluation:
+
Approach they used was novel and interesting and finding challenged some of the contemporary ways of thinking about eating behaviour.
Demonstrated trying not to eat could result in overeating.
Took place in controlled lab setting= credibility.
-
Lab=low EV.
Small sample.

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11
Q

Sociocultural:

Physical activity

A
General decline in physical activity is recent years.
Why?
Increases in:
•	Car use
•	Internet 
•	Mobile phones
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12
Q

Prentice and Jebb (1995)

A

Aim: investigate the association between reports of car ownership and TV viewing and population changes in obesity.
Results: strong positive correlation between an increase in both car ownership and television viewing and an increase in obesity.
Conclusion:
Low levels of physical activity in Britain and reduced energy needs must have played an important role and, possibly even a dominant role, in the development of obesity.
Evaluation:
+
Used a large population=results generalizable.
Objective measure of activity in the form of car ownership, which is less contaminated by the problems of self-report than other measures used in questionnaires.
Population data of obesity were used rather than using people’s self-report height and weight, which are known to be inaccurate.
Suggests in can easily be controlled through change in lifestyle.
Compliments thrifty gene hypothesis.
-
Correlational not clear whether decreases in activity cause obesity or whether increases in obesity cause decreases in activity. Also possible are not directly related and some unidentified factor may determine both obesity and activity.
May overall individual differences as at population level eg people who are obese and active, people who are thin and inactive.
Doesn’t explain why some active people/good eaters are still ‘fat’ and vice versa.

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13
Q

Relationship between physical activity and excess weight gain

A

also been observed in Finland with Rissanen et al (1991) following 12,000 adults over a five 5 period. They found that lower levels of activity were a greater risk factor for weight gain than any other baseline measure.

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14
Q

Bullen et al (1964)

A

Observed adolescent girls on a summer camp and found that during swiiming obsess girls spent less time swimminh and more time floating than their non-obese counter[arts and during tennis, obese girls were inactive 77% of the time compared with 56% of the time in non-obese girls.
Evaluation:
+
Did show clear relationship between activity levels and obesity in female adolescents.
Observation= high EV
-
May be subject to observer bias
Ethics of observation
Young female only sample= low generalizability

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15
Q

Summary sociocultural factors

A

Summary
• Positive correlation between population decreases in activity and increases in obesity.
• Evidence for obese people exercising less than obese people.
• BUT in inactivity a cause or a consequence for obesity.

While the research is undeniable that a lack of physical activity causes obesity, it is important to take a holistic approach when looking at the development of obesity as biology and cognition both clearly also play a role.

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16
Q

Treatments:

CBT

A

Cognitive behavioural therapy (CBT)
Aims to change cognitions related to eating as well as unhealthy eating behaviour.
The focus is on cognitions that lead directly to eating such as the client’s permission giving thoughts (Its ok to eat I’m upset).
The programme involves:
1. Focus on behaviours- identify and adjust destructive eating patterns; monitor calorie intake; identify alternatives to social and emotional eating; start manageable exercise programme.
2. Focus on cognitions- identify and confront dysfunctional thinking that prevents healthy eating habits; improve body image and self-confidence; increase social support and adjust thinking to prevent feelings of shame and hopelessness.
3. Focus on strategies to maintain weight loss- maintain motivation and strengthen coping skills to deal with challenging situations and setbacks.

17
Q

Stahre et al (2007)

A

Aim: to examine the effectiveness of CBT in treating obesity.
Method: participants were obese women in Sweden (mean age=48.5 mean BMI=36.5). The experimental group joined a weight loss programme that included CBT. The control group did moderately intense physical activity. The treatment lasted for 10 weeks (2 hours per week). Participants’ weight was controlled periodically over an 18-month period. There was small drop out in both groups.
Results: significantly greater weight loss (5.9kg) in the treatment group compared to the control group who on average gained 0.3kg.
Conclusion: CBT seems to be an efficient way of treating obesity and it’s also a cost effective alternative to many weight loss programmes.
Evaluation:
* Generalisability.
* Use of control group.

18
Q

Evaluation of CBTa

A
  • Cost effective.
  • Beneficial for people who don’t want to mess with their biology.
  • Useful when better diet and more exercise alone hasn’t worked.
  • Strategies you learn can be used in life even after treatment has finished.
  • Takes a while-needs commitment.
  • Can be time-consuming.
  • Involves confrontation which may be uncomfortable.
  • Only addresses individual capacity to change, doesn’t address wider problems in their environment (family) which may affect their behaviour.
19
Q

Treatments:

Surgical treatments

A

Used with severe obesity. Two most common are:
• Gastric bypass- surgical procedure that cuts off parts of the stomach to prevent overeating by limiting the ability to absorb food.
Gastric banding- a surgical procedure where a band in ties around the upper part of the stomach to reduce food intake and help the patient to feel full earlier

20
Q

Maggard et al (2005)

A

Meta-analysis of effectiveness of surgical treatments of obesity.
Method: reviewed the results of 147 studies.
Results: the gastric surgery resulted in weight loss of 20-30kg. Results maintained for up to 10 years and patients reported an overall improvement in health. Gastric bypass was overall more effective than gastric banding.

21
Q

Evaluation of surgical treatments

A
  • Improvement in other health conditions associated with obesity.
  • Can lead to side effects such as food intolerance.
22
Q

Treatments:

Drug treatments

A

National Institute of Health in the USA considers obesity to be a chronic disease. Two types of drugs are used:
• Appetite-suppressant drugs- decrease appetite or increase the feeling of being full because they act on neurotransmitters that affect mood and appetite (serotonin and adrenaline levels). Some evidence for the effectiveness of these drugs, although they have some side effects such as nausea, constipation and dry mouth.
• Lipase inhibitors- reduce fat absorption. The drug has some unpleasant side effects, especially after eating fat. This may have a preventive effect since eating fat becomes associated with unpleasant consequences such as diarrhoea.

Few studies have evaluated the safety and long term effectiveness of drugs and some are concerned that they may be over-prescribed. Sibutramine has been taken off the market in many countries due to its serious health risks-heart failure, sudden death.

23
Q

Berkowitz et al (2006)

A

Aim: to test the effectiveness of the drug sibutramine in reducing weight compared with a placebo.
Method:
• Sample of 498 obese adolescent boys and girls. The study was longitudinal.
• Sibutramine was given to 386 participants and 130 had the placebo. All participants had counselling about healthy eating, physical activity, stress reduction and keeping track of how much they ate.
Results:
• Participants in sibutramine group usually lost weight rapidly during the first 8 months and then maintained their weight for the rest of the trial. Main side effect=increase in HR.
• In placebo usually gained weight.
• About ¼ left the study, which ran for 1 year.
Evaluation
+
Longitudinal.
-
No follow up of long term benefits or harm of drug.
No control of weight changes after study, difficult to determine whether the weight loss was permanent.

24
Q

Treatments:

Dieting

A

Treatment always involve dieting in some form. Although it seems to be somewhat ineffective.

25
Q

Wadden (1993)

A

Wadden (1993)
Method: reviewed randomized control studies on the effectiveness of either moderate of severe calorie restriction on weight loss.
Results:
• Patients stayed in treatment for 20 weeks and 50% lost around 9kg or more.
• Modern approaches to dieting with councelling were more effective in the short term compared to previous methods, which mainly focused on dieting and weight loss.
• The majority of obese patients in researched trials tended to regain their lost weight.
• Wadden’s findings are supported by data from a meta-analysis of 92 studies of the interventions for the treatment and prevention of obesity (NHS Centre for Reviews and Dissemination 1997). The conclusion of that study was that weight gain after treatment is the norm.

26
Q

Evaluation of dieting

A
  • Can cause health problems.
  • Results aren’t permanent-after diet can easily go back to original weight.
  • Weight loss not quick and this may result in many negative emotions and giving in to eat more than allowed.
  • Many dieters guided by all-or-nothing thinking: belief that one little transgression ruind the overall attempt to lose weight could make them stop the diet and indulge in food.
  • Known as the ‘what the hell effect’ and repeatedly seen in chronic dieters.
27
Q

Prevention strategies:

Health promotion

A

Campaigns on healthy eating in principle could be a useful form of prevention strategy when they focus on families because they could change the food preference for both adults and children. Food preferences are established in childhood. Parents food choice may influence what children eat and prefer for the rest of their lives. Education of parents of obese children has produced positive changes in the children’s eating habits (Golan et al 1998).

28
Q

Prevention strategies:

Eat well plate

A

A balanced diet requires a balanced intake of macronutrients and micronutrients. The British Nutrition Foundation (2007) created ‘The Eatwell Plate’, which gives an overview of healthy diet showing the recommended proportion and types of food.
Key message=the importance of a balance diet with a variety of foods.

29
Q

Evaluation of Eatwell plate

A

Evaluation
+
• Visual/simple easy to understand concept (even for children).
• Easy to remember lots of people know about it which raises awareness from a young age as designes for children.

-
• Cant’t measure its success.
• Can be interpreted in different ways. (wrongly)
• Lacks detail.

30
Q

Prevention strategies:

California Children’s 5 a Dat-Power Play! Campaign

A

Community based campaign ran from 1993-1996. Used TV sports and various initiatives to educate on the benefits of a diet and physical activity.
Aimed to motivate children 9-11 to eat 3-5 cups of fruit and vegetable and get 60 minutes of exercise a day.
Promoted environmental changes that make it more accessible.

31
Q

Foerster et al (1998)

A

One-year evaluation of California Children’s 5 a Dat-Power Play! Campaign.
Method: conducted the study with 3966 children in 49 schools. Behavioural and attitudinal changes were based on one0day food diaries administered pre intervention and post intervention.
Groups
T1- Schools
T2- School and community
T3- Control.
Results:
T1 and T2 ate better and did more activity.
Key message: has to be a combines effort (parents, school, community).

32
Q

Evaluation of California Children’s 5 a Dat-Power Play! Campaign

A

Holistic in both approach and who it involves

33
Q

Prevention strategies:

Fat and sugars tax

A

Some countries have introduced taxed on unhealthy food such as fat and sugar in order to encourage a more healthy diet and reduce the cost of obesity. When the price of food increases, the consumption of that food normally decreases. The fat and sugar tax is a way for governments to control people’s diets and encourage them to eat more healthily-social engineering.

34
Q

Fat and sugar was: Denmark

A
  • Introduced in October 20011 and abolished in November 2012.
  • On foods which contained more than 2.3% saturated fat.
    • encouraged cross border trading, jobs at risk.
35
Q

Evaluation of fat and sugar tax

A
\+
•	Can reduce cost of obesity.
•	Encourage healthy eating.
-
•	Social palatability. 
•	Difficult to know which foods deserve a tax.
•	Not an holistic approach.