KIN 334 Flashcards
What are some things in terms of obesity that have changed since 2007
- declaration of obesity as a chronic disease
- impact of bias, stigma, and discrimination
- advances in the science of obesity
- advances in treatment
- recognition of patient center care
What was the previous definition of obesity
- defined by BMI, a measure of size not health
What is the newer definition of obesity
defined as prevalent, complex, progressive and relapsing chronic disease characterized by abnormal or excessive body fat that impairs their health
how should obesity be manages?
evidence- based chronic disease management principles, must validate patients’ lives experiences
What is weight bias?
Weight stigma refers to social stereotypes and misconceptions about obesity
What are the 5 A’s in approaching obesity management
- Ask
- assess
- advise
- agree
5 assist
explain the ask stage when talking about obesity management
asking the patient permission to offer advice and help treat this disease in an unbiased manner
explain the assess stage when talking about obesity management
using appropriate measurements, identifying the root causes, complications, and barriers to obesity treatment
explain the advise stage when talking about obesity management
discussion of core treatment options and therapies that may be required, including psychological, pharmacological and surgical interventions
explain the agree stage when talking about obesity management
agreement with the person living with obesity regarding goals of therapy, focusing mainly on the value that the person derives from health-based interventions
explain the assist stage when talking about obesity management
engagement by health care providers with the individual with obesity in continued follow-up and reassessments, and encouragement of advocacy to improve care for this chronic disease
What does it mean to recognize obesity as a chronic disease
that obesity is a complex, heterogeneous chronic disease that requires individualized treatment and long-term support.
Don’t assume all patients living with obesity are prepared to initiate obesity management.
What are some suggestions for assessing people with obesity
that healthcare providers involved in screening, assessing and managing people living with obesity use the 5As of Obesity Management framework to initiate the discussion
Healthcare providers can measure height, weight and calculate Body Mass Index (BMI) in all adults
We suggest a comprehensive history to identify root causes of weight gain as well as complications of obesity and potential barriers to treatment be included in the assessment
What are some things that will be encompasses in discussion of treatment options
Medical nutrition therapy and physical activity are part of any chronic disease management strategy, including obesity management
What are some different types of treatment options that could be available to people with obesity?
- psychological intervention
- pharmacological therapy
- bariatric surgery
What are some things to consider when agreeing and assisting people with obesity
- agree on realistic expectations, sustainable behavioural goals , personalized action plan
what could some things that could show succes?
prevention
losing weight
maintaining weight loss
What is the percentage of clinically significant weight loss?
> = 5% of baseline body weight
in what way is exercise often described?
FITT principle
frequency
intensity
time
type
why would increasing energy expenditure 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
why wouldn’t increasing energy expenditure work for weight loss?
Achievable amounts of exercise lead to small increases in EE Adherence to changes in exercise/PA is poor
Increasing EE could be linked to compensatory increases in EI .
Why would an increase in exercise intensity work for weight loss?
Same energy expenditure in less time
Greater improvements in
Greater fitness and other risk factors preservation of FFM Decreased appetite after High Intensity exercise
Variety/More enjoyable for some people
Why wouldn’t an increase in exercise intensity work for weight loss?
Less enjoyable
Less accessible
Greater risks/safety concerns
Less self efficacy (belief in ability to perform such activities)
why wouldn’t resistance training work for weight loss?
Effect on FFM is small
Effect on FFM during energy restriction is even smaller.
Therefore effect on RMR is likely not meaningful
Energy cost of resistance training is small (see compendium of physical activity.
what can resistance training cause a change in?
body composition
what is class 1 obesity
BMI of 30 to < 35
What is class 2 obesity
BMI of 35 to < 40
What is class 3 obesity
BMI of 40 or higher. Class 3 obesity is sometimes categorized as “severe” obesity.
Why would exercise for class 2/3 obesity work
Can contribute to negative energy balance
Can improve health
Can improve quality of life
Improve response to bariatric surgery
Why wouldn’t exercise for class 2/3 obesity work
Fitness too low to achieve meaningful energy expenditure
Too many comorbidities that could be worsened by exercise (e.g., joint pain…)
Time for exercise and fatigue from exercise could interfere with other activities
what sort of things do you have to consider when working with class 2/3 obesity?
access to your facility
access to your equipment
adapated exercises
adapted places to sit
Explain the decision to eat food complex
–psychological & environmental
–initiation/termination of meals, size, composition, frequency
–lifestyle habits, drive to seek tasty foods, enjoyment, social
What are the 4 components to the physiology of energy intake?
1) Afferent peripheral hormonal signaling
*Appetite (orexigenic)
*Satiety (anorexigenic)
2) Central integration
3) Efferent signaling
4) Behaviouralchange
What is the vagus nerve and what is it responsible for?
the main nerves of your parasympathetic nervous system, controls digestion, heart rate, immune system
Important source of indirect neuronal stimulation
● Composed of efferent/ afferent sensory fibers
● May be involved directly with CNS or indirectly with these peripheral peptides
Difference between HIIT and SIT interval training
HIIT- intervals up to maximal
SIT- intervals above maximal
What is important to note about exercise for an individual
different exercise can affect a person differently
what can high intensity exercise do to your body
affect blood flow to your gut- affects appetite
gastrointestinal motility
fatty acid factors
blood glucose insulin
What do high doses of bicarbonate do to blood lactate levels
High doses of sodium bicarbonate increase lactate levels and delay exhaustion in a cycling performance test
What do high doses of bicarbonate do to blood lactate levels
High doses of sodium bicarbonate increase lactate levels and delay exhaustion in a cycling performance test
What is the definition of a diet
the sum of food and drink that someone habitually consumes
- practice of attempting to achieve or maintain a certain weight through nutritional intake
what are some factors that someone’s dietary choices could be based upon
including ethical and religious beliefs, clinical need, income (money)
what is the definition of a vegetarian diet?
is one which excludes meat and animal by-products (e.g. gelatin and rennet)
what are the different types of vegetarian diets
- fruitarian diet
- lactovegetarian diet
- lacto-ovo vegetarian
- vegan diet
What is a fruitarian diet
only eat raw fruit
what is a lactovegetarian diet?
can eat certain types of dairy but it excludes eggs and rennet foods
what is a lacto-ove vegetarian diet?
includes eggs and dairy but no animal flesh
what is a vegan diet?
contains only plants and foods made from plants. It excludes any food derived from animals (e.g. eggs, dairy, honey)
what is a semi-vegetarian diet
a flexitarian diet where you mostly consume plant-based food but occasionally consume meat
What is a pescetarian diet?
a diet that includes fish but no other meat
