obesity Flashcards
what’s new？Obesity Canada: New Obesity Clinical
Practice Guidelines: Why And How We Did Them And What’s New?
our vision was:
“To develop a non-biased, scientifically valid and trustworthy set of clinical practice guidelines with specific recommendations on the management of obesity to inform clinical decision-making that is patient-centered and to support shared decision-making in order to optimize patient care.”制定一套无偏见的、科学有效的、值得信赖的临床实践指南，包括针对肥胖管理的具体建议，为以患者为中心的临床决策提供信息，并支持共同决策，以优化患者护理
2. more comprehensive definition is needed to address obesity misconceptions and to better guide clinical care。
This is why in the new Canadian Adult Obesity Clinical Practice Guidelines we define obesity as “a chronic disease characterized by excessive or abnormal body fat that impairs health”. 需要更全面的定义来解决对肥胖的误解，并更好地指导临床护理。
这就是为什么在新的加拿大成人肥胖临床实践指南中，我们将肥胖定义为“一种以身体脂肪过多或异常为特征的慢性疾病，损害健康”。
3.Research also indicates that individuals can experience good health at different BMI levels and by defining obesity based on BMI alone, we may under and over diagnose individuals with obesity. 研究还表明，个体在不同的身体质量指数水平下也能经历良好的健康状况，如果仅仅根据身体质量指数来定义肥胖，我们可能会对肥胖个体进行过低或过高的诊断。
4.Finally, the guidelines recommend that obesity treatment should focus on improving health, not weight loss alone.
REQUIRED READING (Pg. 1-5):Canadian Adult Obesity Clinical Practice Guidelines: Assessment of people living with obesity
该文件是《加拿大成人肥胖临床实践指南》，特别侧重于对肥胖人群的评估。 该文件的要点和关键论点如下：
- 肥胖是一种慢性、进行性和复发性疾病，会损害健康和社会福祉。
- 应定期使用体重指数 (BMI) 和腰围测量值进行肥胖筛查。
- 肥胖症的临床评估应旨在建立诊断，确定异常肥胖的原因和后果，并评估患者的身体、心理和功能健康。
- 参与肥胖评估的医疗保健提供者应重点关注建立治疗的价值观和目标，确定必要的资源和工具，并培养自我效能以实现长期成功。
- 对于肥胖患者的有效评估，非评判性、无耻辱感的环境是必要的。
该文件的主要建议包括：
- 医疗保健提供者应使用 5As 框架（询问、评估、建议、同意、协助）来发起有关肥胖管理的讨论。
- 所有成年人均应测量身高、体重和BMI，BMI为25-35 kg/m2的个体应测量腰围。
- 应全面了解病史，以确定体重增加的根本原因、肥胖并发症以及治疗的潜在障碍。
- 应测量血压、空腹血糖或糖化血红蛋白、血脂和 ALT，以确定肥胖人群的心脏代谢风险并筛查非酒精性脂肪肝。
- 埃德蒙顿肥胖分期系统可用于确定肥胖的严重程度并指导临床决策。
此外，该文件强调了医疗保健提供者在评估肥胖患者时采取支持性和非评判性方法的重要性。 它还强调需要解决临床环境中的体重偏差和耻辱感。
给肥胖症患者的关键信息：
- 肥胖是一种慢性疾病，会对身心健康产生负面影响。
- 需要进行临床评估来确定体重如何影响健康和福祉。
- 医疗保健提供者应以敏感和非判断性的方式进行肥胖评估，以避免体重偏见和耻辱。
The document is the Canadian Adult Obesity Clinical Practice Guidelines, specifically focusing on the assessment of people living with obesity. The main points and key arguments of the document are as follows:
- Obesity is a chronic, progressive, and relapsing disease that impairs health and social well-being.
- Screening for obesity should be performed regularly using body mass index (BMI) and waist circumference measurements.
- The clinical assessment of obesity should aim to establish the diagnosis, identify the causes and consequences of abnormal adiposity, and assess the patient’s physical, mental, and functional health.
- Healthcare providers involved in the assessment of obesity should focus on establishing values and goals of treatment, identifying necessary resources and tools, and fostering self-efficacy for long-term success.
- A non-judgmental, stigma-free environment is necessary for an effective assessment of patients living with obesity.
Key recommendations from the document include:
- Healthcare providers should use the 5As framework (Ask, Assess, Advise, Agree, Assist) to initiate discussions about obesity management.
- Height, weight, and BMI should be measured in all adults, and waist circumference should be measured in individuals with a BMI of 25-35 kg/m2.
- A comprehensive history should be taken to identify the root causes of weight gain, complications of obesity, and potential barriers to treatment.
- Blood pressure, fasting glucose or glycated hemoglobin, lipid profile, and ALT should be measured to determine cardiometabolic risk and screen for nonalcoholic fatty liver disease in people living with obesity.
- The Edmonton Obesity Staging System can be used to determine the severity of obesity and guide clinical decision-making.
In addition, the document emphasizes the importance of a supportive and non-judgmental approach by healthcare providers when assessing patients with obesity. It also highlights the need to address weight bias and stigma in clinical settings.
Key Messages for People Living with Obesity:
- Obesity is a chronic disease that can have a negative impact on physical and mental health.
- A clinical evaluation is needed to determine how weight impacts health and well-being.
- Healthcare providers should conduct obesity assessments in a sensitive and non-judgmental way to avoid weight bias and stigma.
FACTORS THAT DRIVE OBESITY
genetics
metabolic considerations
gut microbiome
1.Diseases (eg. Cushings)
2.Medications (eg. antidepressant medications called SSRIs, antipsychotics, steroid hormones, others抗抑郁药物SSRIs，抗精神病药物，类固醇激素)
3.Socioeconomics (eg. lack of safe areas to exercise, lack of availability of local grocery stores, inability or unwillingness to cook, affordability of food缺乏安全的运动场所，缺乏当地的杂货店，不能或不愿意做饭，食物的可负担性)
4.Stress (eg. eating of comfort foods, increased production of hormone cortisol)
5.Behaviour (eg. overeating with respect to portion sizes, calories in liquid form, low intake of fruit and veg, with or without physical inactivity/sedentary behaviour暴饮暴食，液体形式的卡路里，水果和蔬菜的摄入量低，有或没有身体活动/久坐行为)
6.Hormonal (eg. estrogen, androgens, thyroid雌激素，雄激素，甲状腺)
7.Food Literacy (lack of food knowledge and food skills)
Fat Cell Development when energy in > energy out
Stored in fat cells of adipose tissue
how is body fat reflected in the number and size of fat cells?
1.In growing years, fat cells grow most rapidly
2.Obese individuals have more and larger fat cells
Fat Cell Development when energy in < energy out
Fat cell size decreases; no change in number of fat cells
what is LPL
lipoprotein lipase
Fat Cell Metabolism—>lipoprotein what would LPL do?
Uptake of triglycerides into tissues
how would LPL level change with obesity?
higher
why LPL Activity in varying body regions
Sex hormone dependent
how would LPL activity change when having a weight loss
increase activity
body weight Set-Point Theory
Body likes to maintain homeostasis
Role of hypothalamus and other regulatory centres
The body tries to adjust to original weight
Leptin is coded by what gene
obesity gene
leptin binding location
hormone in hypothalamus
leptin function
Promotes negative energy balance, which means
▪ Suppresses appetite
▪ Increases energy expenditure能量花费
