Obesity 2 Flashcards
obesity/readiness to change (3)
- appropriate timing
- ask if it is ok to discuss, if they want to lose weight
- meet patients where they are
stages of change
- Pre-contemplation
- contemplation
- preparation
- action
- maintenance; stages are cyclical and dynamic.
lookAHEAD study: 5-10% of weight loss improves:
- blood pressure
- blood glucose
- triglycerides
diabetes prevention program
intensive lifestyle intervention can reduce progreassion from prediabetes to diabetes
weight bias/stigma: care of patients with obesity vs. normal weight peers:
Providers spend less time in the room
Providers refer for routine screenings at lower rates
effect of weight bias on patients with obesity
Depression
Decreased physical activity
Decreased patient engagement and follow-up
steps for providers/educators
Be aware of our own attitudes and not let it affect patient management
Be aware that weight stigma is not an effective motivator for patients
Be aware of the example we set for healthcare trainees
Weight History includes (9)
- Length of overweight?
- Highest weight?
- Why do they want to lose weight?
- Precipitating factors?
- History of unexplained rapid weight gain?
- History of weight loss attempts and efficacy?
- Current dietary intake, home cooking environment
- PMHx: weight-related comorbidities
- Family Hx: overweight, diabetes, thyroid dz
supportive office environment: speech
- “People-first” language: “patient with obesity” not “obese patient”
- Avoid hurtful comments or jokes
- Terminology
supportive office environment: space
- Sturdy, armless chairs/high firm sofas/sturdy, wide exam tables
- Extra-large patient gowns
- Reading materials focusing on healthy habits, not looks or being “thin”
supportive office environment: equipment
- scales to measure over 400 pounds
- Large adult or thigh blood pressure cuffs
kcal/gram:
fat
ETOH
protein
carb
sugar alcohols
artificial sweeteners
Fat=9 kcal/gram
ETOH=7 kcal/gram
Protein= 4 kcal/gram
Carb/Sugar/Starch= 4 kcal/gram
Sugar Alcohols= ~2.6 kcal/gram
Artificial Sweeteners= ~1 kcal/gram
carbs
- Preferred source of fuel for the brain and muscles; spares protein.
- Examples: starches, starchy vegetables, beans/legumes, fruit, milk and
yogurt products, sugar
white vs whole wheat carbs
similar calories, whole wheat has more fiber and nutrients
milk variation in carbs
all same carbs, protein and calcium
fat content changes total calories
protein
- Necessary for building and maintaining muscle and bone mass.
- Some research suggests consuming 20-30 gm/meal is beneficial for satiety, bones and muscle mass.
fats
- Necessary for providing essential fatty acids, absorption of fat-soluble vitamins (A, D, E, K), important for brain function, growth and cushioning for organs.
- Hidden sources: Fast foods, prepared foods
partially hydrogenated fats =
trans fats
gold standard for weight loss
caloric deficit
diets for comorbidities
DASH diet (dietary approaches to stop hypertension)
Mediterranean diet: decreased LDL-C and CV mortality
Low glycemic index diet: prediabetes or diabetes
does type of diet matter for weight loss?
no, just adherence
calorie goal =
TEE - (500-750 kcal/day)
1 lb = _ calories
1 lb = 3,500 calories
weight < 250 lbs should consume _
weight > 250 lbs should consume _
weight < 250 lbs should consume 1200-1500 kcal/day
weight > 250 lbs should consume 1500-1800 kcal/day
5 dietary plans for weight control
- Meal replacements
- Meal delivery services
- Very low calorie diets (VLCD): < 800 kcal/day
- Elimination or decrease liquid calories (juice, soda, alcohol)
- My plate/healthy eating plate: macronutrient portions
comparing atkins, zone, weight watchers, and ornish diets at 1 year
each modestly reduced weight and cardiac risk factors
increased adherence = greater weight loss
intermittent (IER) vs continuous energy restriction (CER) with weight loss
both reduced frequency of food consumption and overall energy intake
no difference in weight loss
IER vs. CER: insulin resistance
IER had greater decrease in insulin/insulin resistance
IER vs. cER A1c, cholesterol
no sig diff
energy density/calorie density (ED/CD)
number of calories (energy) in a specific amount of food per gram
4 key components that affect ED:
- Water (raisins vs. grapes)
- Fat (ice cream vs. lowfat yogurt)
- Fiber (broccoli vs. white rice)
- Air (popcorn vs. pretzels)
high ED = __ calories per gram
high ED = a lot of calories per gram
low ED = __ calories per gram
low ED = a few calories per gram
grapes vs raisin energy density
grapes are low, raisins are medium
nutirent density (ND)
how many nutrients per 100 calories
9 healthy nutrients considered in ND
protein, fiber, vitamins A, C, and E, calcium, magnesium, iron, and potassium
high nutrient dense (HND) foods
whole grains, fruits, vegetables, dairy, lean proteins
non-nutrient dense (NND) foods
potato chips, white bread/starch, soda, non-fruit juice, high fat proteins
glycemic index (GI)
how quickly and how much a food increases blood sugar (0-100)
100 GI indicates
how much a 50 g carb raises glucose over 2 hours
lower GI means, carb is digested/absorbed at a __ rate, __ rise in blood sugar
lower GI means, carb is digested/absorbed at a slower rate, slower rise in blood sugar
higher GI means, carb is digested/absorbed at a __ rate, __ rise in blood sugar
higher GI means, carb is digested/absorbed at a quicker rate, rapid rise in blood sugar
glycemic load (GL)
measure of foods that takes into account impact of carb on blood sugar (GI) AND amount of carb in a typical serving of the food
GL =
glycemic index x amount of carb/100
3 categories of glycemic load
Low (10 or under)
Med (11-19)
High (20+)
eating low GL foods can reduce __ and promote __
eating low GL foods can reduce calories and promote fullness
addition of fat __ digestion and absorption of carbs, __ GL, but __ calories
addition of fat slows digestion and absorption of carbs, decreases GL, but increases calories
GI of apple, watermelon baked potato (and GL)
apple < watermelon < baked potato
insoluble fiber
increases the water-holding capacity of undigested food, which leads to increased bulk and frequency of defecation
insoluble fiber __ constipation
insoluble fiber improves constipation
insoluble fiber examples
leafy greens
berries
Fiber One
soluble fiber
forms gels, slows GI transit time
soluble fiber is helpful for (3)
constipation, diarrhea, and high cholesterol
soluble fiber examples
apples, oatmeal, legumes
resistant starch
unable to be digested, reduces number of calories absorbed
resistant starch examples
raw oats
some legumes
