Obesity 2015 Flashcards by ROGER ALONSO

During the past 20 years there has been a dramatic
increase in obesity in the United States
• In 2008, only 1 state (Colorado) had a prevalence
of obesity

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US has the highest rate of obesity among the
developed nations
Considered an ______ by most healthcare practitioners

EPIDEMIC

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All racial and ethnic groups, all regions of the country,
and all socioeconomic strata are affected
(Mokdad, et al. 2001)
The largest increases in obesity are occurring among
________&___________

children and minorities

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Estimated _____________ Americans die each year

because of obesity related diseases

30,000

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Waist Management

Increased abdominal fat* is associated with an increased
risk for type 2 diabetes, dyslipidemia, hypertension and
cardiovascular disease – National Institutes of Health

Men: WC > ____ inches
Women: WC > ____ inches

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The Secret Life of Fat Cells

Fat = Not _________ storage tissue, more appropriate to
consider it an Endocrine Organ
• Fat cells — particularly __________ fat cells — are biologically active
• Releases leptin, interleukin-6, tumor necrosis factor alpha, angiotensinogen, adiponectin, and resistin

Excessive Body Fat (Especially ____________ fat)
• Reduces cells sensitivity to insulin
• Triggers ___________
• Sends signals to cause vasoconstriction
• Sends signals to cause blood clot formation

passive

abdominal

visceral

inflammation

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Although associated with metabolic complications of
obesity, __________ fat tends to be more readily mobilized than______________ fat
– Since MEN are generally more subject to central obesity
NOTE: following __________ women are increasingly subject to central obesity
– Supports the frequently reported complaint that men lose weight quicker than women

central

peripheral

menopauses

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A World Health Organization expert committee defined
obesity as a body fat percentage:
≥\_\_\_\_% in men
≥\_\_\_\_% in women
(World Health Organization 1995)

***Research shows that 9 /10 young to middle-aged men
and 7 /10 women are likely to be or to become
overweight over a period of 30 years
• US obesity epidemic set to be worse than imagined

**Bottom line: There is no time point in life when you
can become complacent about your weight

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__________ = factors that contribute to weight
gain (Protects temptation to blame the victim)

Obesity develops as a result of many interwoven
factors
Lifestyle, physiologic, environmental, genetic, societal

Environmental Obesigenicity:
• Time demands that preclude ______ __________ at home
• Lack of ______, increased TV viewing/gaming, reliance on
cars, suburban sprawl, curtailed PE in schools
• Availability of energy dense, nutrient poor foods, larger
portion sizes, food marketing
• Endless variety of foods available at any time and at a
reasonable cost – people eat more when than when a single food item is present (think: all you can eat buffet)

Obesigenicity

food preparation

activity

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Chemical “__________”

_________ disrupting chemicals

May interfere with ___________ _________
Hypothesized to promote weight gain and OBESITY

Include:
• Select _________ found in food and water
• Chemicals found in common HOUSEHOLD products,
.• Some medications including select anti-diabetic and
anti-depressant DRUGS

Obesogens

Endocrine

human metabolism

pesticides

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________________ – Altered Gut Flora

Many studies have described an association between obesity and certain gut microbiota

• OBESE subjects have LESS diversity and different
proportions of intestinal bacteria than LEAN people

• Imbalances in the intestinal microbiome may contribute to obesity, systemic ___________, increased intestinal permeability and metabolic dysfunction

Dysbiosis

inflammation

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Obesity - Is it all in our Genes?

Cases of __________ (Pertaining to one gene) obesity do exist, but they are RARE
—____ genes have been identified as risk factors for obesity
—Only account for a small number of those who are
overweight and OBESE

***Simply having a genetic predisposition to obesity does NOT guarantee that an individual will develop the disease!!!

“The recent increases in weight observed in the
American population are NOT correlated with genetics”

“Increases in the incidence and prevalence rates of
obesity in the US are likely due to ________ or
_____________ factors, which have interacted with
genes, and not the effects of genetics alone”

monogenic

behavioral

environmental

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Genes may increase ___________ to obesity however,
• Other determinants must be present for obesity to occur
–Genes have NOT evolved within the past 20 years to account for the increased prevalence of obesity
—Mismatch between genetics and lifestyle

vulnerability

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Goal Setting

____% weight loss within 6 months .
• At schedule of 1 -2 pounds of fat loss per week

NOTE: More rapid weight loss (>3 to 4 lbs/wk) may
offer benefits…but may provoke formation of __________ and may lead to ketoacidosis, provoking gout attacks. so patients must be carefully monitored.

gallstones

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In general, more rapid initial weight loss = greater and
more rapid the subsequent weight gain
Possible explanation: EXTREME caloric restriction or
other means of extreme weight loss is simply unsustainable.

No evidence that most commercial weight loss
programs are successful in the ______ ______

long term

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Fad Diets – Concerns and Considerations
–_________ inaccuracies and misinformation –
may be nutritionally inadequate

—Failure to address ____ ____ habits – set person
up for failure to maintain healthy weight once
weight loss is achieved.

Specific macronutrient restriction
–Completely avoiding any food groups or
macronutrient as a means of weight loss is
_____________

–Also, too restrictive to maintain for extended
periods of time

—May carry health risks

Scientific

long term

unfounded

Studies evaluating different MACROnutrient diets:
• NO differences with regard to changes in body
composition, abdominal fat, or hepatic fat .

• Overall reduction in _________ resulted in meaningful
weight loss regardless of macronutrients emphasized

When considering co-morbidities in addition to weight
loss:

• Low-_________ diet may be more effective than a
low-__________ diet for overall cardiovascular risk factor reduction and as a first approach to
treating ___________

calories

carbohydrate

fat

type 2 diabetes mellitus

Increasing intake of plant based foods and fiber:

• Enhance feelings of ________
• Helps re-establish disturbed __________ balance in
obesity.
• Decreases levels of CRP in overweight and obese
adults

satiety

microbiota

Bariatric Surgery

Reserved for BMI ≥ ____ kg/m2 OR ≥ 35 kg/m2 with at
least one ________ related disorder who have NOT had
success with other weight loss methods.

_____ _______– is the most frequently performed
bariatric surgery in the United States

IMPORTANT:
Does NOT replace the need for healthy, controlled
diet and exercise!!
—In fact, the success of the surgery depends on it!!

Makes STOMACH smaller - allows food to bypass part of
the ______ ________.
–Feel full quicker - reduces the amount of food and calories consumed

obesity

Gastric bypass

small intestine

Gastric Bypass Surgery

Can result in:
• Mental and physical benefits.
• GREATER improvements in weight loss and weight
associated co-morbidities then lifestyle or
______________ interventions with significant weight
loss reported with up to ____ years of follow-up.

NOTE: Surgery is NOT without significant risk
• Safety of these procedures has improved but
perioperative complications and nutrition deficiencies
are common .
• Ongoing _______&__________ is critical

***LONG TERM total mortality after gastric bypass surgery was significantly reduced, particularly deaths from diabetes, heart disease, and cancer
–However, the rate of death from causes other than disease (______) was HIGHER in the surgery group than in the control group.

pharmaceutical

follow-up and monitoring

suicide

______ ________– has risks such as bleeding, infection and reactions to the anesthesia.

Possible complications include:
 Vitamin and mineral deficiency
 Dehydration
 Gallstones
 Bleeding stomach ulcer
 Hernia at the incision site
 Intolerance to certain foods
 Kidney stones
 Low blood sugar (hypoglycemia)
 \_\_\_\_\_\_\_\_\_\_\_  syndrome
• Condition where stomach contents move too quickly through small intestine causing nausea, vomiting, diarrhea, dizziness and sweating

Gastric bypass

Dumping

Laparoscopic Gastric Banding

Surgeon places a band around the UPPER part of stomach to create a small pouch to hold food
Limits the amount of food
Prolonging fullness
After surgery, doctor can adjust the band to make food pass more ______OR________ through digestive
system

slowly or quickly

Liposuction

Removal of large amounts of abdominal subcutaneous
adipose tissue (SAT) (~10 kg) did NOT improve CHD
risk factors or _______ _________ when subjects were
evaluated ~10 weeks after the liposuction procedure
was performed

**Criticism: Was suggested that liposuction-induced–adipose tissue ___________ could have obscured the detection of metabolic benefits

**Metabolic endpoints (oral glucose tolerance, homeostasis model assessment of insulin resistance, blood pressure and plasma triglyceride (TG),
high-density lipoprotein (HDL)-cholesterol, and low-density lipoprotein (LDL)-cholesterol concentrations) obtained at 10 through 208 weeks were not different from baseline and did NOT change over time

insulin sensitivity

inflammation

Pharmacotherapy

6 drugs with FDA approval for obesity management:

Lorcaserin
Phentermine/topiramate ER
Phentermine
Orlistat
Bupropion SR/Naltrexone SR
Liraglutide

KNOW

Complementary and Alternative Medicine (CAM) therapies Therapies including acupuncture, chiropractic, Ayurveda, hypnotherapy may provide benefits in weight loss but -- high quality _____ ______ are needed to establish the effectiveness for obesity treatment

clinical trials

Weight Loss Supplements --Current evidence of efficacy for most supplements is limited for the treatment of obesity --Some evidence for use of supplemental fiber, protein, probiotics, vitamin D, omega 3 fatty acids, calcium and _______ have been reported – best when used in conjunction with modified dietary intake rather than as standalone intervention • May only minimally impact weight loss but, • May improve _______ risk factors and obesity-related comorbidities

chromium * ***Increases calories burned,decreases appetite and builds muscle. ..Insufficient reliable evidence to rate...Likely safe FYI...Conjugated linoleic acid (CLA)--Reduces body fat and builds--muscle Possibly effective-- Possibly safe FYI--Green tea extract---Increases calorie and fat metabolism and decreases appetite--Insufficient reliable evidence to rate---Possibly safe cardiometabolic

Diet-induced FAT loss is recommended for obese patients who have cardiometabolic risk factors, because even moderate (e.g. ___% of body weight) weight loss improves ALL risk factors simultaneously and safely!

Encourage a _______ centered, rather than _________ centered approach • Emphasize ________ _______ instead of diet • Emphasize ____ _____ loss instead of WEIGHT loss --Focus on SLOW, steady, healthy weight loss ----Reasonable Goal: 1-2 lbs loss per _____ ***No single approach to weight loss will be effective for everyone!!!

health weight- LIFESTYLE CHANGE body fat week

Effective long term maintenance strategies MUST include _______ ______ Physical activity is the best predictor of LONG TERM weight maintenance! ----Weight loss without adequate physical activity results in ______ loss ---______ decreases rapidly during weight loss – up to 15% in 2 weeks

physical activity LBM RMR

``` Create an activity plan using the F.I.T.T.(E.) Principle: . F- ____________ I – ntensity T -___________ T - ime (duration) E -__________ ```

F requency T ype of activity E njoyment

Supporting Lifestyle Change One of the most common reasons for patients lacking motivation to change are _________ problems -- Including depression, stress, and co-dependency ------Referral for co-management likely indicated _____ _______ _________ (CBT) • Facilitate improvements in binge eating and emotional eating . • May improve anxiety and depression in obesity

psychological Cognitive Behavioral Therapy

AS A DC I CAN HELP WITH: Standard behavioral approaches include self-monitoring, self-care, social support, stress reduction, and stimulus control Emotional Eating Before eating, consider: “Is hunger coming from above or below the NECK?” • Is desire to eat coming from the mind or the gut? • Emotional hunger is NEVER satisfied through food consumption

KNOW

``` _________ Hunger • Builds gradually • Strikes below the neck • Occurs several hours after a meal • Goes away when full • Eating leads to feeling of satisfaction ``` ``` __________ Hunger • Develops suddenly • Above the neck • Unrelated to time • Persists despite fullness • Eating leads to guilt and shame ```

Physical Emotional

Timing of meals 1. Stop eating within ___-hours of bed time -- Often not eating at night to satisfy hunger – driven by habit, boredom etc. -- Late night eating often leads to skipping breakfast 2. Have a meal within ___-___ min of waking in AM 3. Do NOT go more than___-____ hours without eating a meal of healthful snack during the day

2 30-45 3-4

Those who kept daily food records lost TWICE as much weight as those who kept no records - -The simple act of writing down what you eat appears to encourage people to consume fewer calories - -The more food records they kept, the more weight the participants lost!

KNOW