L2 Obesity and Overweight Flashcards
Obesity
chronic metabolic disease with the defining feature of excess body fat
Obesity is caused by a complex interaction of…
excessive caloric intake
insufficient PA
behavior
genetics
family history
metabolism
social determinants
Prevalence of obesity/overweight
> 70% of adults and 35% of children and adolescents
Obesity and overweight increase the risk for
type 2 diabetes
HTN
stroke/MI
gallbladder disease
OA
sleep apnea
cancer
low QOL
mental illness
mortality
Important statistics about obesity in america
-No state has a prevalence of obesity <20%
-16 states have a prevalence of obesity of 35% to 40%
-50% of non-hispanic blacks are obese
What causes racial disparities in obesity?
- Different behaviors for PA, lifestyle
- Different attitudes and cultural norms concerning body weight
- Decreased access to healthy foods
Worldwide prevalence has ____ between 1975 to 2016
tripled
Energy balance idea
Food intake has to be balanced with PA, metabolic rate, thermogenesis
if input and output equal each other, you possibly have weight balance
Outputs of energy balance
Physical Activity = 20%
Basal metabolic rate = 70%
Adaptive thermogenesis = 10%
Many of our outputs are…
genetically determined
What causes obesity?
Increased weight is a polygenic condition combined with energy intake exceeding energy output
Monogenic conditions
failing to produce leptin, causes obesity
Weight Set Point Hypothesis
-Individuals have a genetically inherited set point that governs ideal body mass
-the environment acts upon this genetic background
Thrifty Gene Theory
set of genes has been selected to ensure survival in an environment with a limited food supply and marked seasonality
Individuals with wasteful genes were less likely to survive vs those with thrifty genes would be more likely to survive
Obesigenic environment acts upon each person’s genetic background
FTO
Fat mass and obesity associated gene , strongest known susceptibility gene locus for obesity
increases risk of obesity by 1.2x
regulates food intake, reduced satiety, poor food choices, loss of control
Can physical activity decrease the effect of FTO on obesity risk?
PA reduced the risk of obesity in adults with FTO risk by 27%
Understanding of genetics and obesity
majority of genes are involved in CNS pathways that regulate hedonic aspects of food intake, food preference, reward processing
genetics makes weight loss or gain difficult
Why should clinicians understand that obesity has a strong genetic component?
- SCIENTIFIC EVIDENCE SUPPORTS THIS
- Makes you ignorant if you ignore this component
- You need to be the best health advocate
Daily expenditure decreases
Time spent in sedentary activities has increased
Labor saving devices
decrease in number/frequency of PE classes
lack of sidewalks/safe places to be outside
long work hours and long commute times
Sleep deprivation
short sleep (less than 7 hours) makes it harder for individual to lose and maintain weight loss, more likely to develop diabetes
contributes to insulin resistance, inhibits beta cells from increasing insulin release, decreases leptin and increases ghrelin
Stress-induced hypercortisolemia
long-term increased plasma cortisol leads to abdominal obesity
teach and implement stress reduction techniques
Overweight BMI
25 to 29.9
Obese BMI
greater or equal to 30
Why is BMI used?
it is inexpensive and easy to perform
it is a surrogate measure of body fatness that correlates with health risk
moderately correlated with more direct measures of body fat. Strongly correlated with adverse health outcomes
Limitations of BMI
based primarily on data from white people
highly specific, but only moderately sensitive
does not account for where weight is distributed
women, older adults, non-athletes will generally have higher BMIs
BMI does not
predict disease risk
Hydrostatic weighing
Gold standard for determining body composition
-it is time-consuming, expensive, and difficult to perform
those with higher body fat will displace more water
DXA
increasingly accepted as gold standard
-not accurate with extremely obese, expensive
uses x-rays to determine between different tissues
BOD POD
Air-displacement
estimates composition from bone density
may emerge as the EASIEST gold standard
it is expensive, not a lot of machines still
Skin-fold thickness
Measures subcutaneous fat at several sites, equation to determine total body fat
Advantages: portable and relatively easy
Problems: Poor reliability and poor validity. Error can be >8%. Subcutaneous fat is not equal to total body fat.
Bioelectrical impedance
Electrical current passes through tissue differently. a person with higher fat will have higher resistance
Advantages: easy, quick, non-invasive
Problems: hydration status impacts measurement. Poor reliability/validity. Requires lots of controls
Distribution of body fat related to disease risk
Visceral fat is the most important predictor of the development of metabolic syndrome
subcutaneous fat around thighs is a negative predictor of metabolic syndrome
Waist to Hip ratio
Low health risk were associated with
Males <.8
Females <.7
Waist to hip circumference
body fat stored at hips is associated with some protection against CVD
body fat stored in abdomen is associated with health risks and obesity
This method is easy to perform and correlates with disease risk
Fat in nonfat cells
In obesity, the ability of adipose tissue to store excess calories is impiared b/c fat cells become insulin resistance. They can no longer take up glucose. So ectopic fat accumulates in organs and muscle.
Waist circumference
is an indicator of abdominal fat
increased waist circumference can be a marker for increased disease risk (even at a healthy weight)
disease risk increases with increasing waist measurement
Waist Circumference Measurements
Risk increases with
Males >40 in
Females >35 in
Bariatrics
Branch of medicine that deals with causes, prevention and treatment of obesity
Goals of overweight/obesity treatment
Help individuals achieve a healthier weight, not an ideal one
Weight loss as small as 5-10% of initial weight is sufficient to improve obesity related complications
Treatment methods for overweight obesity
Diet
Exercise
Drugs
Bariatric surgery
Behavioral modifications
Psychotherapy
Decreasing sedentary activity
Orlistat
oral drug that prevents fat absorption by inhibiting pancreatic lipase
Semaglutide
also known as Ozempic weekly SQ injection
MOA: activates glucagon-like-peptide (GLP-1) receptor, which increases insulin secretion, decreases glucagon
ADR: GI, injection site reactions
Newest drug that has shown superiority with improving glycemic control, reducing weight, BP, and cardioprotective effect
Alli
OTC version of orlistat (reduced strength)
inhibits lipase, which decreases the ability to digest ingested fat
about 3+ lbs a year
ADRs: Gas with oily discharge, loose stools, hard to control bowl movements
Roux-en-Y gastric bypass procedure
performed on individuals >100 lbs over ideal body weight, BMI >40
most effective weight loss intervention for those with class 3 obesity. Also resolves comorbidities
Improvements after bariatric surgery
migraines, liver disease, diabetes, quality of life, GERD, cardio diseases, mortality
Different treatments compared
Gastric bypass had the most people without using medication in comparison to medical therapy and sleeve gastrectomy
What makes a successful loser?
-changes in eating and exercise
-walking regularly
-ate breakfast
-weighed themselves once a week
-watched less TV
Role of Diet in weight loss
deficit of 500 kcal/day should result in initial weight loss of 1 pound a week
dietary adherence is the most important predictor of weight loss, irrespective of type of diet
Eliminate caloric beverages and processed foods, portion control, self-monitoring
Sugar and belly fat
excess calories from foods high in sugars or saturated fats may be more likely to settle in deep belly fat
Cutting calories vs Exercise More
those that are told to cut calories lose more weight than those that are told to exercise more
Why exercise won’t make you thin
do not over-compensate because you are exercising
it is more important to incorporate activity throughout the day rather than relying on exercise bouts
Role of Exercise in body weight
exercise only modestly improves weight loss
it is difficult to maintain to exercise programs, weight loss is not seen on the scale
It is important in preventing obesity and maintaining long term weight loss and preserving lean body mass while dieting
Requires >1 hour per day of mod intensity to maintain weight loss
Benefits of Exercise (Not weight loss)
glycemic control
lipid profiles
blood pressure
body composition
aerobic fitness
hemostatic factors
Why do individuals who lose weight often regain it?
huge decrease in basal metabolic rate
Major changes in hormones that drive appetite
10,000 steps a day
reasonable estimate of daily activity for healthy adults
not reasonable for children or certain groups
helpful for those that are pedometer dependent
individuals who achieve 10,000 are seen as “active)
Walking intensity
need about 100 steps/min for 30 min/day to acheive moderate exercise intensity by walking
Health benefits can be acheived with exercise bouts lasting at least 10 min. Try to get 1000 steps in 10 min
Decreasing Sedentary Activity
activity that occurs in the remaining time OUTSIDE of the 150 min of exercise is critical to health
prolonged sitting was a risk factor for all-cause mortality, independent of PA
Try to sit less than 8 hours a day and meet PA requirements to decrease mortality rates
Sedentary Behavior
sitting and lying down while being awake, and incur no more than 1.5 mets
most individuals are sedentary and inactive
Why is prolonged sitting bad for health?
increased plasma triglyceride levels
decreases plasma HDL level
affects carb metabolism
decreases insulin sensitivity
Strategies to decrease sedentary time
- Get past the concept of scheduled exercise sessions
- Change commuting habits
- Stand up every 30 min and walk for 5 min
- Stand up for tasks
- Walk up stairs
- Educate that threshold for benefits is low!
5 things obesity researchers agree on
Avoid processed carbs
fill up on fiber
exercise for your health
cut yourself some slack
ask for help
How long does a conversation has to be in order for a patient to make changes to their weight?
3 to 5 minutes
Patients who were obese and were advised by their HCPs to lose weight were ________ more likely to try to lose weight
3x
What do patients want from HCPs regarding weight?
Talk
Non-offensive terms
Advice they can use
Tips for talking about weight with patients
- Address your pts’ chief health concerns or complaints first, independent of weight
- Open the discussion
- Decide if the pt is ready to control weight
- Set a weight goal
- Prescribe healthy eating and PA behaviors
- Follow up
Sensible weight goals
5 to 10% reduction in body weight over 6 months
1.5 to 2 lbs per week
Weight Myths
- I can lose it later
- Once its off, it will stay off
- Fat is fat, no matter where it is
- You have to go out of your way to overeat
- All extra calories are equal
- You can boost your metabolism
- There’s a magic bullet diet
- I can work off the extra calories
Bottom Lines of Weight myths
- Slower metabolism and less lean mass make it hard to lose extra pounds
- Many dieters gain back weight because they begin to eat more
- Extra calories can lead to fat, like deep-belly which is dangerous
- What is typically served in restaurants is high calories
- Excess calories from food high in sugar or unhealthy fats may be more likely to settle in the belly
- Don’t depend on “metabolism boosters”
- Don’t depend on a miracle diet
- Don’t count on exercise alone to lose weight
