Obesity

Question 1

Obesity

Answer 1

-Accumulation of fat to the extent that it compromises health

Question 2

BMI

Answer 2

Limitations:

1) Does not consider location of fats
2) Does not differentiate between muscle and fats
3) Inaccurate in different ethnic groups
4) Less accurate for elderly

Question 3

Waist circumference

Answer 3

Strengths:
1) Consider location of fat (central obesity most dangerous)

Limitations:
1) Does not take into account skeletal size

Question 4

Waist : Hip ratio

Waist : Height ratio

Answer 4

Strengths:
1) Better predictors of morbidty than waist circumference

Limitations:

1) Difficult to assess
2) Lack reference data, standard measurement protocols and accuracy in severe obese

Question 5

Physical consequences

Answer 5

1) Diabetes (high morbidity/mortality)
2) Cardiovascular problems (High BMI correlates with increase risk for CVDs)
3) Cancer
- Overweight and obesity increase risk of ovarian, breast, kidney, colorectal cancers in females
- Obesity is associated with increase risk of oesophageal cancer in males

Question 6

Pathways linking obesity and ill-health

Answer 6

Direct pathway:
1) Abdominal fat release adpokines into circulation
Adpokines are associated with:
-Inflammation
-Dyslipidaemia
-Insulin resistance

Indirect pathway:
1) Unhealthy behaviours (e.g. smoking, eating habits, alcohol)

Question 7

Psychological consequences

Answer 7

1) Depression
2) Lower self-esteem
3) Body dissatisfaction

Question 8

Social Consequences

Answer 8

1) Education
- Lower attendance
- Lower teacher ratings
- Bullying and teasing
2) Marriage and social position
- Less likely to get married
- Downward socio-economic trajectory for obese women
3) Less likely to get employed or get promoted
4) Social stereotypes
- Weak-willed
- Unattractive

Question 9

Causes of obesity – Biology

Answer 9

• Predicted by parental obesity
• Includes:
  1) Fat cell theory
  2) Metabolic theory
  3) Inherited less leptin

Question 10

Causes of obesity – Activity environment

Answer 10

-Influence that the environment has on an individual’s activity behaviour
E.g. if it is raining today, I will not go for a run

Question 11

Causes of obesity – Physical activity

Answer 11

• Frequency
• Intensity
• Type

Question 12

Causes of obesity – Societal influences

Answer 12

• Media
• Peer pressure
• Culture

Question 13

Causes of obesity – Individual psychology

Answer 13

-Individual’s psychology drive for particular food and consumption patterns or physical activity patterns/preferences

Question 14

Causes of obesity – Food consumption

Answer 14

• Frequency
• Quantity
• Quality

Question 15

Causes of obesity – Food environment

Answer 15

• Food advertisement (more money spent on advertising unhealthy food options)
• Availability
• Cost (healthy food options are more expensive)
• High fat
• Portion size
• Variety
• Nutrition labelling (time-consuming and difficult to understand)

Question 16

Developmental model

Answer 16

• Emphasis on learning
• Includes:
  1) Exposure
  2) Social Learning (via modelling and observation)
  3) Association

Question 17

Cognitive model

Answer 17

• Emphasis on beliefs and attitudes
• Attitude includes:
  1) Perceived behavioural control
  2) Social norms
  3) Attitude (self)

Limitations:
-Intention-behaviour gap

Question 18

Weight concern and body dissatisfaction

Answer 18

-Emphasis on the meaning of food and weight

Body dissatisfaction:

1) Research on size estimation
2) Perception of ideal vs reality
3) Can lead to dieting (restraint theory)
4) Can lead to overeating by:
- ‘What the hell’ effect
- Motivational collapse
- Mood modification

Question 19

UK Public Health Initiatives

Answer 19

1) Public Health Responsibility (2011) – Private sectors pledge to attempt to improve public health
2) Change 4 life campaign
3) ‘Eatwell guide’ (2016)
4) ‘Tackling obesity’ strategy (2020) includes:
- Improve access to weight loss programmes through primary care (incentives + increase services)
- Change to food environment by:
1) Ban food adverts on high fat, salt and sugar on TV and online after 9pm
2) Calorie labelling in restaurants, cafes and takeaways
3) End promotion of high fat, sugar and salt products in stores and online
4) Consultation on ‘traffic light’ nutritional info and calorie labelling on alcohol

Question 20

Treatments

Answer 20

1) Pharmacology
2) Surgery (e.g. gastric bypass, gastric banding, etc.)
3) Behavioural intentions

Question 21

Behavioural intention – Lifestyle intervention

Answer 21

1) Promote healthy lifestyle habits
2) Dietary counselling
3) Physical exercise training
4) Behavioural change targets

Participants lost about 3.5kg on average, which is maintained for 3 years

Question 22

Behavioural intention – Behavioural therapy

Answer 22

1) Advice on modifying energy balance
2) Increase control over energy balance behaviours:
- Functional analysis of behaviour – classical conditioning (e.g. eating a snack whilst watching TV)
- Goal setting in terms of behaviour change
- Self-monitoring of eating and activity
- Stimulus control over food and activity choices (Avoidance, Distraction, Resistance)
-Self-reinforcement of behaviour change
-Reward for good behaviours
-Evaluation of positive and negative cognitions (stop ‘what the hell’ effect)
-Relapse prevention
3) Cognitive restructuring
-aims to modify thoughts that undermine weight loss
-can be classified into 3 categories:
>Impossible to lose weight – previous failed attempts
>Unrealistic goals
> Self-criticism regarding eating and weight gain

Participants lose about 10.7kg in 30 weeks of treatment
80% of participants complete treatment