Obesity 1 Flashcards
1
Q
Obesity
A
- complex, chronic disease
- excessive accumulation of fat in the body and is associated with numerous health problems (coronary heart disease, insulin resistance, T2D, hypertension, NAFLD, and certain cancers)
2
Q
guidlines for body mass
A
BMI = 25-29.9 is overweight
BMI >30 is obese for adults 19-65
abdominal / waste circumference
women >88 cm
men >102 cm
3
Q
etiology
A
multifacotrial
- genetics
- environmental
- metabolic/physiological
- biochemical
- psychological
- cultural (drive to eat is strong bc it represents survival)
4
Q
genetics
A
- obesity gene map
- leptin ~ obesity gene
- genes involved in body composition, RMR, appetitie, neuroedocrine signals
5
Q
environment
A
- factors influencing overeating - variety, palatabilty, convenience, cost
- factors influencing under-activity - technology, urbanization, safety, convenience
6
Q
metabolic/physiological
A
- low metabolism?
- low lean body mass?
- less regulation of appetite? (pressure for kids to eat big meals when they want to “graze”
7
Q
biochemical
A
- thyroid metabolism
- CNS impairment
- huge bolus overpower signals back from the gut to brain
- biochemical signals get distorted by the quality, frequency, and volume of what we eat
8
Q
psychological
A
- behavioural factors
- peer pressure
- societal pressure
- depression, anxiety
9
Q
cultural
A
- cultures that value high body fat, high food intake and low activity levels
- starting to change due to awareness
- acculturation of food intake
10
Q
struggle of definition
A
- imbalance between energy intake and energy output – overtime will lead to weight gain
- specific periods of growth and development
- increase in general population - decline in energy expenditure not matched by energy intake
- can’t place all responsibility on pt
11
Q
treatment controversies
A
- needing to weigh
- outcome depends on client attitudes, motivation and behaviours ~ work with pt to set goals , approach nutrition quality not weight outcomes
- focus endpoint should be eating patterns, activities, normalizing eating, motivation not weight loss
12
Q
successful treatment is usually lifelong
A
- health practices
- food choices
- exercise programs ~ doesn’t have to be working out
- support systems
- behavioral modification (not just education)
13
Q
cost of obesity
A
- financial
- person ~ peer problems, social isolation
- improve existing health problems
- decrease future health risks
14
Q
Rationale Against weight loss
A
- no effective, long-term safe treatment for obesity
- pressure to be thin
- weight cycling ~ it is better to stay the same weight
15
Q
nutrition assessment
A
- general guidelines eg BMI
- lifestyle practices
- PA hx
- unhealthy eating patterns
- resources and abilities
- motivation
- long term weight hx
16
Q
risk factors (Nutrition assessment)
A
- associated with mortality ~ CAD, atherosclerotic diease, type 2 diabetes, sleep apnea
- other risks ~ gallstones, high TAG, infertility, osteoarthritis, stress incontinence (urinary)
17
Q
obesity treatment
A
- surgery
- medication
- lifestyle management ~ nutrition therapy, PA, behavioural modification
18
Q
Bariatric Surgery
A
- not for ppl at risk of gaining weight back
- BMI > 40 or >35 with comobidities
- impaired Q of L
- only when all non-surgical treatments have failed
- includes: gastroplasty (stapling), gastric banding, gastric bypass
19
Q
Bariatric Surgery cont
A
- benefits outweigh potential hazards
- reduction of weight
- resolution of hypertension, T2D, back pain, dyslipidemia, osteoarthritis, sleep apnea, non-alcoholic steatohepatitis
- vitamin deficiency, electrolyte problems, intestine failure
- gradual weight regain and return of comorbidities may occur
20
Q
After Bariatric Surgery
A
- diet progresses from NPO to clear fluids to DAT
- long term vit and mineral supplementation (iron, calcium, D, B12, folic acid, and C)
- bleeds may be common
21
Q
Obesity Treatment - Pharmacotherapy
A
- suprpess appetite
- causes malabsorption
- questionable long term effects
- only for BMI >30 or BMI >27 with comorbidities
- used with low energy diet, low fat diet, PA and behavioural therapy
22
Q
Pharmacotherapy - Sibutramine (meridia)
A
- selective serotonin and noradrenaline re-uptake inhibitor *
- 5-10% weight loss maintained for up to 12 months
- side effect: cardiovascular symptomologies (increase heart rate and blood pressure)
- not for pt with CAD, HTN, stroke, CHF, or pt taking anorexiant drugs
23
Q
Pharmacotherapy - Olistate (Xenical) * main drug
A
- lipase inhibitor, causes fat malabsorption
- prevents <30%
- monitor level of fat soluble vitamins
- side effects which resolve in 1-5 weeks: oily diarrhea, fecal urgency, gastric cramping, large stools, steatorrhea
24
Q
Pharmacotherapy - Lorcaserin (Belviq)
A
- approved by FDA in 2012
- selective serotonin receptor agonist
- enhanced satiety after a meal and reduce pre-meal appetite and food intake
- side effects: anything regarding the CNS, heart disease, depression, hypoglycemia if diabetic, headache, fatigue, dizziness, dry mouth, constipation
25
Q
treatment - diet therapy
A
- don’t know how to apply Canada’s Food Guide; feel as though the issue is beyond this
- emphasize cereals, breads, grain products, vegetables and fruits
- choose low fat dairy products , lean meats
- PA
- limit salt, alcohol, and caffeine
- variety of foods
- Food Guide should be incorporated in combination with weight loss, lifestyle mod
26
Q
Composition of Diet for Diet therapy
A
50-60% CHO
<10% saturated fat)
10-20% protein
27
Q
Diet Therapy - Calorie Reduced Diets
A
- not able to prove this helps long term
- prescribed when weight loss is desired
- calorie deficit of 500-1000 kcal/d –> lose 1-2 lbs per week
- min intake of 1200 kcal/d for wt loss; may decrease RMR (weight gain again after normalization)
- food choices high in fibre ** longer to eat, slow gastric emptying, promote satiety
28
Q
Diet therapy - Prepackaged Meal Programs
A
- effective for short term weight loss
- should have counseling component ~ take responsibility off the client
- include PA
- support and education required for long term maintenance
29
Q
Diet Therapy - Fad Diets
A
- may not be medically sound (very low CHO diet may lead to ketosis)
- initial weight loss attracts people but is hard to maintain
- plan for fat stores to be used
30
Q
Protein Sparing Modified Fast
A
- protect lean body mass stores
- high protein diet (2-3 g/kg) with low CHO (102% w/v)
- no dairy, fruits, veg, or grains
- increases ketosis (not ketoacidosis), rapid weight loss, appetite suppression (caused by ketosis)
- more vit and mineral deficiency, low K levels
- if diet is liquid protein ~ provide electrolytes
31
Q
More on the PSMD
A
- goal is to protect the lean body mass stores and promote fat mass loss
- nutritionally incomplete ~ close monitor of electrolytes and fluid status
- deficient in K and other nutrients
- rarely used bc of dangers of electrolyte disturbances ~ risk for cardiac arrythmias
32
Q
Atkins Diet
A
- involves 4 phases, staring with lowest amount of CHO intake
- controlled, individualized CHO intake
- high protein
33
Q
CHO addicts Diet
A
- begins with restricted 2 week phase
- has a list of foods that cannot be eaten
34
Q
Zone Diet
A
- suggests a CHO/Protein/Fat ratio ~ 40/30/30
- sorts CHOs into favourable and nonfavourable
- considers portion size and GI
35
Q
South Beach Diet
A
- includes GI, types of CHO, allows “good fats”
- involves 3 phases, neither “low CHO” or “low fat”
- consume the “right carbs” and “right fats”
36
Q
Weight Watchers Diet
A
- involves a point system
- healthy eating and PA
- does not prohibit any food types
37
Q
Treatment - Size Acceptance Approach
A
- approach for lifestyle not weight
- health beyond weight losss
- positive body image
- avoid client feeling blamed
- knowledge vs coping skills
- before 12 yrs old assist changing lifestyle and behaviours
38
Q
Treatment - PA, Exercise
A
- PA ~ any modify movement produced by skeletal muscle that results in energy expenditure = more promotion for * (overall goal for 60 min a day in periods of 10 min each)
- exercise ~ specific, planned, structured activity
- both behaviors are directly related to energy expenditure
39
Q
Regular PA considered predictor of Weight Loss Success
Why?
A
- contributes to overall weight loss
- may decrease abdominal fat
- increase cardio-respiratory fitness
- maintain weight loss
- increase metabolic rate
- changes in WC
40
Q
success of PA
A
- include family
- tailored to each person (1 30 minute bout vs 3 10 minutes)
- usually require guidance
- more successful when simple (walking vs going to the gym)
- positive social interaction
- be achievable within resources
41
Q
Treatment - Behavioral Modification
A
- permanent change of lifestyle habits over generations
- decrease, change, or eliminate these habits that contribute to weight loss
- self-understanding, monitoring
- translate self-awareness to behavioral change
- ID and change env factors that may lead to unhealthy behaviors
- develop coping mechanisms *
42
Q
Alternative Weight Loss Products
A
- consider drug-drug interactions, drug-nutrient interactions
- amount of active ingredient, contamination and mis-identification
