L13-Weight Management Flashcards
BMI.
Describe.
List categories.
-Most common tool to determine weight status
-Categories of BMI:
1. under weight <18.5
2. normal 18.5-24.9
3. overweight 25-29.9
4 obesity >30
BMI.
Who can it not used for?
- it applies to ages 20-65 (not outside)
- does not apply to infants, children, adolescents, preg, BF
How to reduce weight?
- NRG intake < NRG expenditure
- safe weight loss <2 lbs/wk
- aerobic exercise 45 min= reducing cal intake by 40 kcal
Describe Brazil Food Guide.
- golden rule: always prefer natural or minimimally processed foods and freshly made dishes and meals to ultra processed foods
- want to use oils, fats, salt and sugar in small amounts; limit processed foods
over _____ CNDs try to lose weight via _____
1/4, dieting
F>M
Trade settlement w weight loss settlement in 2007.
WHAT IS IT?
they were making claims of effectiveness wo reliable scientific evidence
> since then: weight loss industry has tried to make some changes, but they have not been very successful (at least there are more studies being done)
-note: they can no longer claim HOW much weight loss a pill has (BUT they still make claims like mirable use, easy way to lose weight, sold out fast-> ppl see these claims and then beleive it!
OTC Products.
Are they recommended?
List some effects.
NO!
- increase nrg expenditure
- modulate CHO metab
- incrase satiety
- increase fat ox or reduce fat synthesis
- block dietary fat absorption
- increase water eliminaiton
OTC Products.
List types.
- Fat burners
- CHO burners
- Fat blockers
- Appetite sups
- Lose water
- Metabolism booster
FAT BURNERS:
claim, evidence, risks, examples
- Claim: “Melt away fat” and increase muscle
- Evidence: Insufficient
- Risks: some products are not authorized for use
- Examples: Conjugated linoleic acid, Vitamin B5
CHO BURNERS
claim, evidence, risks, examples
Claim: burns carbs
Evidence: lacking
Risks: potentially serious
Examples: chromium, ginseng
FAT BLOCKER
claim, evidence, risks, examples
- Claim: absorption of fat decreased
- Evidence: Weak, wnt work unless low calorie diet
- Risk: some agents induce diarrhea and block vitamin absorption. AR risk for chitosan because contains shellfish
- Examples: Chitosan, Hydroxycitric Acid*
APPETITE SUPPS
claim, evidence, risks, examples
- Claim: feel full, so eat less
- Evidence: Few studies done
- Risk: unknown due to lack of studies
- Examples: Guar gum, psyllium, hoodia gordonii, glucomannan
LOSE WATER
claim, evidence, risks, examples
Claim: increased water elimination
Evidence: weak
Risks: dehydration, diarrhea, allergy
Examples: Dandelion
METAB BOOSTER
claim, evidence, risks, examples
• Claim: burn more calories and fat
• Evidence: may help use more energy
• Risk: SIGNIFICANT as will increase hr and bp
• Examples: ephedra, bitter orange, DMAA, caffeine, green coffee, 7-Keto- DHEA, catechin, capsaicin, raspberry ketones
-> these are known as the thermogenic agents
METAB BOOSTER
Describe Ephedra.
____ is where the active compound is.
- shrub native to china and mongolia
- bitter orange and country mallow contain related chemicals
- active cmpds in stem
METAB BOOSTER
Ephedra.
List some phenylalanine derived alkaloids.
- Ephedrine
- Pseudoephedrine
- Phenylpropanolamine (norephedrine)
- Cathine (norpseudoephedrine)
METAB BOOSTER
Ephedra results in wight loss because the muscles are burning more cals. Describe the specific effects on the body.
- alpha and beta aognist
- alpha: PVR increases, bp increases; receptors on smooth muscle cells in bladder to increase resistance to outflow of urine
- beta: stimuate rate and force of contraction; promotes bronchodilation in lung - CNS stim
- enhances release of NE from sympathetic neurons
- act as anorectic by acting on satiety center
METAB BOOSTER
Ephedra - efficacious?
Recommend?
there were very slight benefits from (couple pounds/ month) BUT severe AE
- linked to serious AE (heart attack, arrythm, stroke, psychosis, seizure, death)
- HC recalled all products marketed for weight loss w ephedra (only allowed for nasal decongestant)
METAB BOOSTER
Ephedra - list SE.
- Hypertension
- Cardiac arrhythmias
- Insomnia
- Tachyphylaxis (acute, sudden decrease in response to drug after its admission)
- Anxiety and changes in mood
- N/V
there were very slight benefits from (couple pounds/ month) BUT severe AE
METAB BOOSTER - Caffeine.
Describe.
- alkaloid
- occurs naturally in leaves, seeds and fruit of tea, coffee, cacae, kola trees, ect
- Botanicals: guarana, yerba mate, kola nut, and green tea extract
METAB BOOSTER - Caffeine.
Described as “thermogenic”, what does that mean?
MOA?
- inhibits degradation of cAMP thereby stims lipolysis by stimulating lipase;
- antagonizing the neg modulatory effect of adenosine on increased noradrenalin release
- reduced food intake after caffeine intake
METAB BOOSTER - Caffeine & Ephedra.
Safety?
- ephedrine serious health risks (not recommended whether w or wo caffeine bc risks»> benefits)
- caffeine probably safe but shows no long term efficacy
METAB BOOSTER - Caffeine.
Recommend?
NAH - safe but not LT efficacy.
-admin (3x200mg/d) for 24wks w nrg restricted diet showed no greater weight loss than placebo
METAB BOOSTER - Dimethylamylamine (DMAA).
T/F: HC has authorized use it for use.
Sources?
Recommend?
FALSE!
- no good trials done (too short/small) but no benefits found
- found in weight loss and pre-workout supps
METAB BOOSTER - Dimethylamylamine.
Safety?
AE?
-not allowed to be sold in canada
-potential AE:
>HTN, SOB, chest pain, stroke, psych disorders
-1 product containing DMAA linked to serious AE (csv, metabolic, NS, psych); acute hep/liver failure
METAB BOOSTER - Catechin.
Describe.
____ is the most abundant catechin in tea.
=green tea
• All types of tea (green, black, oolong) produced from Camellia sinensis plant using different methods.
• Epigallocatechin gallate (EGCG)
METAB BOOSTER - Catechin.
MOA?
- thermogenic
- beleived to have role in increasing nrg metab, which may lead to weight loss
METAB BOOSTER - Catechin.
Safety?
SAFE IN MOD AMOUNTS
- AE: insomnia, anxiety, irritability, upset stomach, n/d, freq urination; high doses increase bp, seizures, delirium or irregular heart rhythms
- cases of hepatic failure/injury following consumption of green tea has been documented
METAB BOOSTER - Catechin.
DI?
Anticoags - makes them less effective b/c has Vit K
METAB BOOSTER - Catechin.
Efficacy?
Recommend?
-causes small, statistically non-significant weight loss in overweight or obese adults
-no signift effect on the maintenance of weight loss.
-most adverse events were judged to be mild to moderate.
NO
METAB BOOSTER - GREEN COFFEE.
AI?
Effect?
chlorogenic acid (from raw coffee beans before they are roasted)
Thought to:
1. help control glucose metabolism
>May decrease glucose conc & absorption in intestines after a meal
2. inhibit fat accumulation and alter and body fat distribution
METAB BOOSTER - GREEN COFFEE.
AE?
-well tolerated w no signif se
some produts are decaf, others have caffeine
METAB BOOSTER - Capsaicin.
Source?
MOA?
Red hot peppers
- Thought:
1. if you eat spicy foods you will eat smaller portions
2. dose dependently enhancing catecholamine secretion from the adrenal medulla - likely based on beta-adrenergic stim
METAB BOOSTER - Capsaicin.
AE
minor:
- skin inflam
- contact derm
- skin blister
METAB BOOSTER - Capsaicin.
Efficacy.
Human studies
• Short and long term fat oxidation
• Energy expenditure increases nearly 25% after meal including capsaicin (as chili)
• Satiety appears to be affected as well
• Effects are more pronounced with a high fat meal
• One long-term study: no improvement in weight maintenance or suppressed fat gain
METAB BOOSTER - Raspberry ketones.
Describe.
- compound that gives raspberries their odor
- structurally similar to capsaicin
METAB BOOSTER - Raspberry ketones.
Claims to burn fat all over body - how?
(Based on shitty studies)
- Increased production of adiponectin (hormone that is secreted by fat cells; said to regulate insulin sensitivity))
- may inhibit fructose-associated accumulation and inhibition of fat absorption through reduction of pancreatic lipase activity
METAB BOOSTER - Raspberry ketones.
AE.
-Antiandrogenic effect
high adiponectin levels associated w low bone density
-pt may need higher warfarin for maintainence of therapeutic INR
-reports of palps
? - Forskolin.
Describe.
MOA?
- part of the mint family
- theorized MOA: activate cAMP –> triggers lipase resulting in release of fa from adipose tissue (but lack of evidence and conflicting results)
? - Forskolin.
AE
-signif ae BUT
>tachycardia and arrhytm been reported
-avoid in pts w polycystic kidney disease
-IV formulation can cause flushing and hypotension
? - Forskolin.
DIs
Major: (Avoid combining with) • Calcium channel blockers • Nitrates Moderate: (Caution with combining) • Anticoagulants/antiplatelets • Antihypertensives • CYP P450 2C9 substrates
CHO metabolism - CHROMIUM.
Which one is trivalent? Hexavalent?
Essential mineral
• Trivalent (chromium 3+)= is biologically active, in food
• Hexavalent (chromium 6+)= toxic, from industrial pollution
• Often as chromium picolinate
CHO metabolism - CHROMIUM.
MOA?
- Enhances action of insulin
- Involvement in CHO, fat and pro metab
CHO metabolism - CHROMIUM.
Efficacy?
- No effect in enhancing body fat reduction found
- statistically signif neg evidence (ie lack of evidence of benefit)
CHO metabolism - CHROMIUM.
SE?
- many supps are far over the adequate intake of 20-35mcg/d
- concerns of free radical damange; rhabdomyolysis; renal failure
CHO metabolism - Ginseng.
Describe.
- traditionally used to support overall health, boost IS
- also used for weight loss
CHO metabolism - Ginseng.
Effect?
- Improving the health of people recovering from illness
- Increasing a sense of well-being and stamina, and improving both mental and physical performance
- Lowering blood glucose and controlling blood pressure
CHO metabolism - Ginseng.
MOA?
- Ginsenosides
- CHOs are one of the main fuel sources for activity (stored in liver and skeletal muscle as glycogen)
- Ginseng appears to mimic insulin
- Improve glucose tolerance
- Lowers blood glucose levels
- Lack of evidence
CHO metabolism - Ginseng.
SE?
- ususally well tolerated but suggested to not be used for more than 3m
- most common se: headache, GI, sleep
- allergic reactions
- caution in DM bc it mimics insulin
APPETITE SUPPS - Psyllium
Describe
- increase satiety
- derived from seed husk of plantago psyllium, leafy plantain
- e.g. found in Metamucil
- soluble fiber
APPETITE SUPPS - Psyllium
MOA
- combines w water in stomach to form gel
- provides sense of fullness
- bulk-forming
APPETITE SUPPS - Psyllium
Efficacy
- most studies in obest show superiorty to diet alone; lowers chol
- no effect on weight, just gives feeling of fullness
APPETITE SUPPS - Psyllium
SE
- Bloating
- Allergy -> allergy from inhalation of powder
- N/D/C (while it is a laxative, too much can cause constipation)
- Dyspepsia
- Flatulence
- Abdominal Pain
APPETITE SUPPS - Guar gum
Describe.
- increase satiety
- several studies, but does not help w weight loss
APPETITE SUPPS - Glucomannan
Describe.
- increase satiety
- fibrous polysacch from konjac plant
- more research needed
APPETITE SUPPS - Hoodia
Describe.
-increase satiety
>appetite supp through P57, an oxypregnane steroidal glycoside
-NON-stimulating appetite suppressant
APPETITE SUPPS - Hoodia
SE
allergy
FAT BLOCKER- hydroyxcitic acid/ garcinia
Describe.
- Increase fat oxidation or reduce fat synthesis
- plant from india
- efficacy: contradictory evidence
FAT BLOCKER- hydroyxcitic acid/ garcinia
MOA.
- increase hepatic glycogen synthesis, inhibiting lipogenesis, increased lipid oxidation
- decreased food intake, decrease weight gain
FAT BLOCKER- hydroyxcitic acid/ garcinia
SE
- well tolerated
- headache, GI
FAT BURNER - conjugated linoleic acid
Describe
-Increase fat oxidation or reduce fat synthesis, induce apoptosis of fat cells
• Mix of isomers of linoleic acid
• Marketed alone or in combo with triacyglycerol or FFA
• NS: mostly in beef and dairy
FAT BURNER - conjugated linoleic acid
Efficacy
-seems to signif decrease body fat & might increase lean body mass
BUT doesnt seem to reduce total body weight or BMI
-seems to reduce hunger and improve satiety and feeling of fullness, but does not lower nrg intake or improved body weight maintenance
FAT BURNER - conjugated linoleic acid
SE
-GI: nausea, dyspepsia, loose stools
FAT BURNER - conjugated linoleic acid
caution if:
person already has HIGHER glc
-can increase hyperproinsulinemia & insulin resistance in pts w abdominal obesity
FAT BLOCKER - Chitosan
Describe
- block dietary fat absorption (binds to fats to reduce their absorption… similar to orlistat)
- Deacetylated chitin- chitin is a polysaccharide found in the exoskeleton of shellfish (shrimp, lobster and/or crabs)
- Cationic mucopolysaccharide of glucosamine and N-acetyglucosamine
FAT BLOCKER - Chitosan
MOA
- Plausible BUT probably ineffective at reasonable doses (in effective for weight loss)
- May block fat soluble vits
FAT BLOCKER - Chitosan
SE
- safe, except for indivs allergic to shellfish
- constipation, flatulence
LOSE WATER - Dandelion
Describe.
-increase water eliminiaton
-Tx: liver & kidney diseases & spleen problems
>root=hepatic stimulant; leaves=diuretic & choleretic action
>less common: digestive probs & skin conds
-Monitor for: minor digestive problems
LOSE WATER - Dandelion
MOA?
Contains: potassium & theophylline
• Inhibits reabsorption of Na+ and increases glomerular filtration rate
• Only modest effects-> NOT comparable to an Rx diuretic
LOSE WATER - Dandelion
Safety?
SE?
- safe
- SE: upset stomach/ diarrhea; some allergic (rare)
- Avoid in: ppl w inflamed or infected gallbladder or blocked bile ducts
the 7 gut check claims for products you are unsure of:
1) causes weight loss of 2lbs+/ wk for a month or more wo diet/exercise
2) causes substantial weght loss no matter what/how much you eat
3) causes permanent weight loss even after stpping product
4) blocks absorption of fat/cals to enable loss of substantial weight
5) safely enables consumers to lose more than 3+lb/wks for more than 4wks
6) causes substantial weight loss for all uses
7) causes substantial weight loss by wearing product on body or rubbing it in
