Lifestyle and disease: Advising patients on obesity Flashcards
What is meant by ‘locus of control’?
Generalised expectancy that rewards are controlled by external forces or by one’s own behaviour (internal vs. external)
What is the health belief model?
Action is a function of perceived likelihood of illness, its
seriousness, and costs and benefits of action
What is self-efficacy?
Belief in ability to succeed, task specific
What are the stages of change? (5)
Pre-contemplation (happy with status quo)
Contemplation (thinks about change)
Preparation (getting ready)
Action (attempting change)
Maintenance (doing well) or Relapse (back to old ways – the typical outcome)
List three things that can be done to help people change their behaviours (in order of increasing intensity and decreasing population impact).
Health promotion (schools, mass media, leaflets) Advice by doctors Specialist treatments - e.g. drug clinics (smoking, alcohol, hard drugs), obesity treatments
What is the efficacy of lifestyle interventions determined by? (4)
Strength of the drive for the unhealthy behaviour
Effort required
Target population - motivation, social factors, personal characteristics, biological factors
Efficacy of supportive medication
Explain why the lifestyle interventions in obesity are limited.
Strength of drive - STRONG, hunger is the prototype of other drives e.g. when addicted to drugs. This force is difficult to modify.
Effort required - adhering to exercise regime isn’t as easy as putting on sunscreen for example
Target population - well motivated but varied resources and varied barriers
Efficacy of supportive medication - still waiting for a breakthrough in obesity, e.g. with smoking medication is more effective than for alcohol
Name some pulmonary and cardiovascular complications of obesity.
Idiopathic intracranial hypertension Stroke Coronary heart disease Diabetes Dyslipidemia Hypertension Phlebitis - venous stasis Pulmonary disease - abnormal function, obstructive sleep apnea, hypoventilation syndrome
Name some gastrointestinal/hepatic complications of obesity.
Nonalcoholic fatty liver disease - steatosis, steatohepatitis, cirrhosis
Gall bladder disease
Severe pancreatitis
What cancers are linked to obesity? (8)
Breast, uterus, cervix, colon, esophagus, pancreas, kidney, prostate
What gynaecologic abnormalities are complications of obesity?
Abnormal menses, infertility, polycystic ovarian syndrome
Other complications of obesity.
Cataracts
Osteoarthritis
Gout
How does BMI relate to hazard ratio for death from any cause in healthy never-smokers?
Increased if BMI over 25, and continues to increase
Also increased if BMI under 20
What is interesting about the Flegal et al. JAMA 2013 meta-analysis?
It showed that BMI>34 is associated with increased all-cause mortality compared to normal weight, but ‘grade 1 obesity’ (BMI=30-35) is not. It showed that being overweight (BMI=25-30) is associated with lower mortality.
What are the benefits of weight loss?
Can reduce blood pressure
Can prevent the onset of type 2 diabetes
Can reduce blood glucose and LDL cholesterol
Can improve sleep apnoea
When do benefits of weight loss start to accrue?
When 5-10% of initial body weight is lost
Explain the energy equation.
A – B = C
A = Energy in (food), B = Energy out (burned, metabolism), C = Energy stored (as fat)
i.e. if energy in is more than energy burned, you gain weight
How much weight gain does 1% energy over-consumption cause over 10 years?
~50 kg of weight gain per decade
What is the basal metabolic rate for women?
1200-1600 kCal per day
What is the total energy expenditure for most women (office work)? What does this include?
2000-2500
Exercise, NEAT (non-exercise activities, e.g. fidgeting), thermal work (shivering, sweating), effect of eating and digestion
What influences resting metabolic rate?
Increases with increased muscle mass
Declines with age
Declines during restriction of energy intake
What increases/decreases resting metabolic rate?
Increases with increased muscle mass
Declines with age
Declines during restriction of energy intake
What determines our body weight?
Interaction of behaviour, genes and environment
How heritable is BMI?
Around 50%
What environmental factors contribute to obesity?
Unrestricted access to food
Advertising of and easy access to fattening food
Sedentary lifestyle
Lack of opportunity to exercise
Describe different measures of success in terms of weight loss.
Patient wants to lose weight very quickly and maintain it
NICE vs OECD - gradual weight loss and maintain, or allowed to slowly creep back up
Lecturer - take 10 year approach, ups and downs but gradual decrease over 10 years
What rate of weight loss is achievable?
Websites claim 8lbs/week
Patient wants 2-4 lbs/week
Weight Watchers, British Dietetic Association - says 1 lb/week
In reality… patients manage 0.5 lb/week
Behaviour Modification in weight management - three steps?
1) developing specific and realistic goals that can be easily monitored
2) developing a plan of action
3) making manageable incremental changes to provide an experience of progress and success
Give some examples of self-monitoring strategies. (3)
Food diaries to record type and amount of food eaten, and times, place, and feelings associated with eating. This by itself generates a small weight loss.
Pedometers to monitor physical activity
Scales to monitor body weight regularly – essential for any progress.
Give some examples of stimulus control strategies. (3)
Identifying and modifying environmental cues to eating, e.g. limit eating to kitchen, with no TV on to raise awareness of what and how much is eaten.
Remove snacks from TV room
Keep tempting food out of sight
Give an example of a goal setting strategy.
e.g. 5% weight loss over 6 M/losing 1lb a week = REALISTIC