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NUTR 482 Dietetic Practice > Lecture 4 Adult Obesity > Flashcards

Lecture 4 Adult Obesity Flashcards

1
Q

Define obesity

A

Obesity is a chronic, progressive disease
characterized by abnormal or excessive body fat
(adiposity) that impairs health and decreases life
span.

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2
Q

Main messages from 2020 CPGs for obesity

A

The ’obesity’ field is starting to apologize for the stigma/bias it has caused. Everyone deserves to be treated with respect, dignity and care
* Not all people with higher weights, BMIs or larger body sizes have obesity
* NEW: Obesity is a chronic, progressive disease characterized by abnormal or excessive body fat (adiposity) that impairs health
* BMI should NOT be used at the individual level to diagnose obesity
* Emerging evidence is shifting our understanding and treatment options. Move away from weight, body size or shape to focus on
improving health outcomes. Research community to shift the focus from BMI and weight towards health based outcomes (regardless of weight change)

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3
Q

CPG recommendation

A

Adults living with obesity should receive
individualized medical nutrition therapy
provided by a registered dietitian (when
available) to improve weight outcomes
(body weight, BMI), waist circumference,
glycemic control, established lipid and
blood pressure targets.
* Level 1A, grade A.

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4
Q

5 key steps from CPG

A
  1. Ask permission to offer advice and help treat this disease in an unbiased manner recognizing obesity as a chronic disease.
  2. Assessment of an individual living with obesity, using appropriate measurements, and identifying the root causes, complications and barriers to obesity treatment.
  3. Discussion of the core treatment options (medical nutrition therapy and physical activity) and adjunctive therapies that may be required, including psychological, pharmacologic and surgical interventions.
  4. Agreement with the person living with obesity regarding goals of therapy, focusing mainly on the value that the person derives from health-based interventions.
  5. Engagement by health care providers with the person with obesity in continued follow-up and reassessments, and encouragement of advocacy to improve care for this chronic disease.
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5
Q

What is the 5 As framework for obesity management in adults?

A
  • Ask
  • Assess
  • advise
  • agree
  • assist
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6
Q

Where is nutrition information gathered from?

A
  • 80% online
  • 70% social media or health celebs
  • <5% nutrition professionals
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6
Q
A
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7
Q

What are typical expectations from people wanting to lose weight?

A
  • Expect body weight and shape can be changed to what is desired
  • Evidence-based outcomes for weight loss are lower than what is desired
  • Want permanent weight loss when regain is normal
  • Effort and outcome are mismatched
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8
Q

What is weight bias?

A

Weight bias is the inclination to form unreasonable judgments, negative attitudes and views about obesity and about people based on a person’s weight.

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9
Q

What is weight stigma?

A

Stigma is the social sign (stereotypes and
misconceptions) that is carried by a person who is a victim of prejudice and weight bias

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10
Q

What leads to weight discrimination?

A

weight bias and weight stigma

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11
Q

Consequences of weight bias

A
  • Poor body image & body dissatisfaction
  • Low self-esteem
  • Low self-confidence
  • Loneliness
  • Sense of worthlessness
  • Depression, anxiety and other psychological disorders
  • Suicidal thoughts & acts

leading to…
* maladaptive eating disorders
* avoidance of activity
* stress induced pathohpysiology
* avoidance of medical care

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12
Q

Recommendations regarding weight bias for health professionals

A

Healthcare providers should
1. Assess their own attitudes and beliefs regarding obesity and consider how their attitudes and beliefs may influence care delivery
2. Recognize that internalized weight bias (bias towards oneself) in people living with obesity can affect behavioural and health outcomes
3. Avoid using judgmental words, images and practices when working with patients living with obesity.
4. Avoid making assumptions that an ailment or complaint a patient presents with is related to their body weight.

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13
Q

How to set the tone when working with someone living with obesity.

A
  • Be positive
  • Be understanding
  • Be aware of non-verbal communication
  • Be helpful and supportive
  • Be collaborative
  • Be environmentally aware
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14
Q

What is the preferred term to describe obesity?

A

Weight (for both makes and females)
* excess weight was next followed by BMI for both
* weight problems for men (although very small) but not for women

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15
Q

Undesirable terms to describe obesity

A
  • weight problem (for females)
  • unhealthy body weight
  • unhealthy BMI
  • heaviness
  • large size
  • excess fat
  • obesity
  • fatness
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16
Q

Person first language

A

patient with obesity
* instead of obese patient

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17
Q

Good versus bad language to use

A

Seek to not be
* Authoritarian “You must not eat these foods”
* Disapproving “You shouldn’t eat that” (red circle on records)
* Demanding “Before you come and see me, fill out this food chart so I can see what’s going wrong”
* Threatening “If you don’t lose weight, you’ll get diabetes”

Seek to be more
* Encouraging “I can see the effort you’re putting in…”
* Empowering “What changes do you feel are needed?”
* Collaborative “Let’s talk together about the different options and see what you think would suit you best”
* “How can I help you achieve your goals? “

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18
Q

Criteria for a disease

A
  1. Impairment of normal functioning of some
    aspect of the body;
  2. Characteristic signs or symptoms;
  3. Harm or morbidity

Therapeutic interventions reduce morbidity
and mortality

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19
Q

Obesity as a chronic relapsing progressive disease process

20
Q

Clinical component of the medical diagnosis of obesity

A

candidates for weight-loss therapy can present with either excess adiposity (i.e. anthropometric component) or weight-related complications (i.e. the clinical component)

21
Q

What is included in the science of obesity?

A
  • appetite control - homeostatic, hedonistic
  • energy balance dysregulation
  • obesity paradox - MHO (metabolically healthy obesity)
22
Q

Iceberg of obesity

A

The root causes lie below the surface and need to do more digging to find changes

23
Q

Complex factors affecting weight

A
  • sleep
  • Environment
  • Body composition
  • Genetics
  • Psychological
  • Stress
  • Medications
  • Health conditions
  • Life stage
  • Neuroendocrine

Simplistic: food and activity

24
How might pharmacotherapy impact weight?
* appetite, satiety * metabolic rate * respiratory or heart rate * digestion, gastric emptying rate * alertness and cognition Evidence for the efficacy of a dietary supplement in stimulation of weight loss is absent or inconclusive
25
Use of obesity medications
Obesity medication in conjunction with health behaviour changes can help when health behaviour changes have not been effective or sustainable on their own. * GLP-1 analog → Liraglutide 3 mg (Saxenda®) * lipase inhibitor → Orlistat (Xenical®) * opioId receptor antagonist + antidepressant → Naltrexone/bupropion (Contrave®) Medications (prescription or OTC) not approved for obesity treatment may not be safe or effective and should be avoided.
26
Contraindications to obesity interventions
* New diagnosis or change in medical conditions where treatment could impair or impede treatment of management of that condition * Pregnancy or recent post-partum (within 6 months of delivery or lactation) * Unstable psychiatric illness, including acute substance abuse * Eating disorders- refer to specialized care * Individuals unwilling/unable to follow directions or implement recommended changes
27
What is included in the nutrition assessment for the NCP?
* patient history * Biochemical Data, Medical Tests and Procedures * Anthropometric Measurements * Nutrition-Focused Physical Findings * Food / Nutrition Related History
28
Why gather patient history?
* Helps you understand their lived experience * Helps patients share their story, reflect, find patterns/triggers * Helps to target treatment and explore supports/providers needed * Helps to establish realistic expectations
29
Key processes for gathering patient history
* Active listening: paraphrase, summarize to ensure you understand and validate the patient’s thoughts and experience * Show compassion * Build trust * Acknowledge strengths * Explore and reframe misconceptions
30
Getting consent for a virtual visit
1. Hello, my name is (NOD). 2. Can you please confirm your identity by providing me with (REQUEST 2 PATIENT IDENTIFIERS)? 3. We are scheduled to meet today to (PROVIDE NATURE OF THE VISIT & INITIATE VISIT) 4. Do you have any questions about the information you received regarding attending a virtual visit? 5. Would you like to proceed with the virtual visit today? 6. If at any time you wish to end this virtual visit, please let me know and I will arrange an alternate appointment type for us to meet at another time.
31
What is included in patient history?
* Personal history * Medical and health history * Family medical and health history * Social information
32
What is social information to gather in patient history?
* Living/housing situation * Occupation / work schedule * Financial * Food security * Access, environment
33
Gathering weight history
Did you ask first? Before measurement explain the purpose and ask for permission * Current weight * Weight change (gaining, losing, stable) * Is your weight impairing your health? * Peak and lowest weight as adult, last 5 years? * Pattern? Slow, steady gain; “Yo-yo” with each attempt at loss – what interventions?; Major life event(s) associated with weight change * Age of onset of excess weight
34
Talking about weight when setting goals
* “When people see a dietitian to help them improve their health and weight, some people have a goal in mind. Do you have a specific weight goal? What weight are you are trying to get to?” * “Can you share with me how you set (or the reasons for) that specific weight goal?” * “If you were this weight, can you describe to me what your life would be like? (i.e. compared to now - what do you think gets better, what would stay the same and what might get worse?)” * “If you were to not able to achieve or stay at this goal weight – what do you expect to happen or not happen?
35
How to gather intervention history
*Many people have tried different ways to manage their health and weight. I’m interested in learning more about what you have tried, what you liked, what you didn’t, what worked or didn’t work for you? Would it be ok if we talked about what you have tried in the past?* * Look for ideas what may be most helpful now * Screen for inappropriate methods in past (risk) * Need referral to other health care provider?
36
What to screen for nutrition risk
* inadequate intake * increased needs * other: SGA:C or MST+; Weight loss of >10% or more than 1 kg/week
37
screening for inadequate intake
* Less than 1500 kcal/day * Food restrictions * Food security * Loss of muscle, function * Hypoglycemia * Vitamin/mineral deficiencies * Bariatric surgery
38
Screening for nutritional risk with increased needs
* Drug/nutrient interactions * Impaired absorption * Chronic disease * Recent hospitalization
39
What to look for with obesity-related health risk
* Biochemical data, comorbid conditions * Comparative standards (e.g. Framingham risk scores for cardiovascular risk) * BMI and waist circumference * Edmonton Obesity Staging System (EOSS) * Determine targets to measure outcomes
40
CPG recommendations for gathering anthropometrics
Healthcare providers can measure height, weight and calculate BMI in all adults, and measure WC in individuals with a BMI 25-35 kg/m2
41
Measuring BMI
42
How is BMI used?
Health risk tool
43
recommended classifications of BMI
44
Mortality Risk Ratio by BMI Category
45
Limitations of BMI
* Not a direct measure of body composition or distribution * Not a direct measure of health * Does not distinguish between sex or ethnicity * Less accurate in certain populations * No longer sufficient to diagnose obesity **Not to be used to set a weight loss goal “healthy”**
46
Language with BMI
47
Describe waist circumference
Waist circumference is a modifiable risk factor that can indicate cardiometabolic risk, morbidity and mortality. * Benefits associated with reductions in waist circumference might be observed with or without a change in BMI
48

NUTR 482 Dietetic Practice (5 decks)

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