OBESITY Flashcards
1
Q
Current Obesity Statistics in Wales
A
- 58% classified as overweight (25-29.9kg/m2) or obese
- 22% classified as obese (>30kg/m2)
- 36% of men and 23% of women have PA levels to convey good health
2
Q
CMO Guidelines, 2012 - Benefits of PA for Adults and Older Adults
A
- benefits health
- improves sleep
- maintains health weight
- manages stress
- improves quality of life
3
Q
Following CMO Guideline Reduces
A
- T2D - 40%
- CVD - 35%
- Falls, depression and dementia - 30%
- joint and back pain - 25%
- Cancers (colon and breast) - 20%
4
Q
Morton et al., 2010 - Walking and Lipid Burning
A
- walking improves lipid burning
- 19% lipid contribution pre-train, 26% post-train
5
Q
Sources of Lipids in the Body
A
- plasma; NEFA ~0.4g; TG ~4g
- intramuscular TG; IMTG ~300g
- adipose tissue
- humans have a fuel reserve to complete between 43 (female elite) - 195 (female obese) marathons on lipids alone
6
Q
Goodpaster et al., 2000 - Athlete Paradox
A
- lipid accumulation within muscle fibres is significantly increased in obesity and is reduced by weight loss
7
Q
Goodpaster et al., 2001 - Athlete Paradox
A
- skeletal muscle of trained endurance athletes is markedly insulin sensitive and has a high oxidative capacity, despite having an elevated lipid content
8
Q
Coen et al., 2015 - Lipid Metabolites Interfere with GLUT-4 Mobilisation
A
- Fat/CD36 is increased in human IR skeletal muscles
- existing skeletal muscle can decrease intramuscular ceramides and sphingolipids
- ceramide content in muscle decreases with RYGB surgery - induced weight loss
9
Q
Bariatric Surgery
A
- derived from Greek words baros = weight and iatrokos = medicine
- currently referred to as metabolic surgery
- results in weight loss
- improves metabolic consequences of obesity
10
Q
All Wales Obesity Pathway: PA Component
A
- tier 1 - community based prevention early intervention
- tier 2 - community and primary weight management service
- tier 3 - specialist, multi-disciplinary weight management services; specialist dietary, PA and behavioural elements delivered through primary and secondary care; sometimes w drug therapy
- tier 4 - specialist medical and surgical services
11
Q
NICE (National Institute for Health Care and Excellence) Guidelines State
A
- BMI of 40kg/m2 or more
- all appropriate non-surgical measures have been tried but the person has not achieved or maintained adequate, clinically beneficial weight loss
- person has been or will be receiving intensive managements in a tier 3 service
- person is generally fit for anaesthesia and surgery
- person commits to the need for the long-term follow-up
12
Q
Types of Bariatric Surgery
A
- laparoscopic adjustable gastric bonding (LAGB)
- laparoscopic biliopancreatic diversion with duodenal switch
- laparoscopic sleeve gastrectomy (LSG)
- laparoscopic roux-en-Y gastric bypass (LRYGB)
13
Q
Wu et al., 2016 - Bariatric Surgery vs Exercise
A
- bariatric surgery results in significantly greater percentage loss of excessive fat deposits except for epicardial adipose tissue (EAT)
- EAT but not paracardial adipose tissue (PAT) was relatively preserved despite weight reduction in both groups
14
Q
ASMBS, 2012 - Pre-Surgical PA
A
- evidence of pre-surgical PA markers is poor but advocated
- mild ex for 20mins/day on 3/4days/week before surgery
- pre-surgery PA engagement may improve cardiorespiratory fitness, reduce risk of surgical complications, facilitate healing and enhance post-operative recovery
15
Q
Marcon et al., 2016 - Pre-Surgical PA
A
- pre-surgery ex programme significantly improved functional capacity and cardio-metabolic parameters in intervention group and worsened in control
- exercise adherence above 78%
16
Q
ASMBS, 2012 - Post-Operative Exercise
A
- exercise after surgery is imperative, and may be the most important factor that can achieve long-standing and successful weight loss
- start walking from day 1
- increase walking each day; add other aerobic activities as surgeon permits
- start light weight training and sit ups as surgeon allows
- consider using a PT to educate about exercise, improve motivation and ensure correct techniques
17
Q
Mechanick et al., 2009 - Post-Surgery PA
A
- increase their PA to a minimum of 30 min per day as well as increase PA throughout the day as tolerated
18
Q
Peacock and Zizzi, 2012 - Post-Surgery PA
A
- only 22% of patients in American college of surgeons bariatric surgery centre network accredited bariatric centres received post-surgery exercise counselling
19
Q
Effects of PA Following Bariatric Surgery
A
- weight; loss vs regain
- metabolic control (glucose, lipids)
- functional capacity: VO2, PA, CVD risk
- psychological changes: QoL, readiness to exercise
20
Q
Weight Loss
A
- bariatric surgery induces weight loss but isn’t and infallible treatment
- 10-30% of bariatric patients experience sub-optimal weight loss and long-term effectiveness is less clear
- exercise may be an important adjunct therapy
21
Q
Coen et al., 2015 - Weight Loss
A
- walking (2h/week over 6month period) didn’t impact RYGB surgery induced weight loss or fat mass
22
Q
Rothwell et al., 2015 - Weight Loss
A
- excess weight loss was improved at 12months but not 36 post-op by attending semi-structures exercise education classes
23
Q
Chaston et al., 2007 - Weight Loss
A
- loss of FFM accounted for 31.3% of weight loss with RYGB surgery
24
Q
Janssen et al., 2002 - Weight Loss
A
- RE excellent way to maintain muscle mass
- supervised ex reduced loss of FFM in patients undergoing 16 weeks of weight loss on low calorie diet
25
Q
Wing, 2002 - Weight Regain
A
- 12-18 months after weight loss, 33-50% of initial weight loss may be regained
26
Q
National Weight Control Registry (NWCR), 2001 - Weight Regain
A
- moderate intensity-ex critical for maintaining weight loss
- addition of 275min/week in combination with a reduction in energy intake was necessary for maintenance of 10% weight loss in obese women
27
Q
Campos et al., 2010 - Metabolic Control
A
- caloric restriction improves hepatic insulin sensitivity after RYGB surgery
28
Q
Dunn et al., 2012 - Metabolic Control
A
- peripheral tissue insulin sensitivity 1 month after RYGB surgery and 11% weight loss didn’t change
29
Q
Olbers et al., 2006 - Metabolic Control
A
- long-term improvements in peripheral tissue insulin sensitivity after bariatric surgery do occur after ~50% reduced whole body fat mass and a ~60% decrease in visceral adipose tissue after a year
30
Q
Camastra et al., 2011 - Metabolic Control
A
- peripheral insulin sensitivity remains low compared with that in lean, metabolically healthy individuals
31
Q
Best et al., 1996 - Metabolic Control
A
- exercise may be beneficial to improve peripheral tissue insulin sensitivity after surgery induced weight loss
32
Q
Coen et al., 2015 - Functional Capacity
A
- 6 months walking improved fitness in obese patients without diabetes who underwent bariatric surgery
33
Q
Stegen et al., 2011 - Functional Capacity
A
- 4 months strength/endurance programme improved cardio-respiratory fitness and physical function
34
Q
Huck, 2015 - Functional Capacity
A
- Resistance training can improve cardiorespiratory fitness and muscle strength in patients who have undergone bariatric surgery
35
Q
Directions for Clinical Practice
A
- implement pre-surgery diet and exercise programmes
- post-surgery PA programme; begin day 1progressively increasing to CMO guidelines and beyond
- introduce pedometers/trackers and characterise baseline activity, then increase week by week
- upskill more practice HCPs involved in tier 3 and 4 provision using number of exercise in medicine initiatives
- empower patient to exercise and lead to a change in behaviour for life
