Obesity Flashcards
When was obesity recognized as a major health problem?
In the US surgeon general report of 2001
What did WHO say about obesity in 2011?
WHO stated that obesity had more than doubled from 1980-2011
What % of the world’s population live in countries where obesity kills more than being underweight?
65%
Who created the BMI formula?
Belgium statistician Adolphe Quelet
When was Adolphe Quelet alive?
1796-1874
What is BMI
Body mass indicator used to measure obesity
Who does BMI not work for?
- Muscular people
2. Kids
What is the ratio for BMI?
Weight to height
What is the metric BMI formula?
Weight in kg / height in m ^2
What are the units for the metric BMI formula?
Kg / m^2
What is the imperial BMI formula?
Weight in lbs x 703 / height in inches ^2
What are the units for the imperial BMI formula?
Lbs / inches ^2
What is the conversion factor of inches to m?
1m = 39.37 inches
What is the conversion factor of kg to lbs?
1kg = 2.2lbs
What is the ponderal index?
A more fair comparison between individuals of different stature
How do you calculate the ponderal index?
Weight in kg / height in m ^3
What are the units for the ponderal index?
Kg / m^3
What is a BMI healthy range?
Approximately 19 - 25
What is BMI higher risk?
Approximately 26 - 40
Who uses the BMI chart?
Pediatricans and PE teachers use BMI charts
Who created BMI charts?
WHO and Centers for Disease Control
What does it mean if a child is in the 95th percentile of weight for a given age?
It means that they have increased risk of obesity due to the fact that 95% of people lie below their weight and only 5% of people lie above
What would a typical BMI be for a short child who weighs more than normal?
They would have a high risk BMI
What would be a typical BMI for a tall child with the same weight as the short child?
They would have a normal BMI - body parts are proportional
What is underweight classified as?
<18.5
What percentile is underweight in?
Less than the 5th percentile
What is normal range classified as?
18.5 - 24.9
What percentile is normal range in?
Between 5th and 85th percentile
What is overweight range classified as?
> 25.0
What percentile is overweight in?
Between 85th and 95th percentile
What is pre-obese range classified as?
25.0 - 29.9
What is obese range classified as?
> 30.0
What percentile is obesity in?
Greater than the 95th percentile
What is obese class I range classified as?
30.0 - 34.9
What is obese class II range classified as?
35.0 - 39.9
What is obese class III range classified as?
> 40.0
What is severe thinness range classified as?
> 16.0
What is moderate thinness range classified as?
16.0 - 16.9
What is mild thinness range classified as?
17.0 - 18.49
What is a protective factor for a population in regards to BMI?
Being within a healthy range of weight to height
What BMI constitutes bariatric surgery candidates?
> 40.0
Who is Herschel Walker?
- World champ at 100m
2. Fullback for the Eagles
What is Herschel Walker’s height and weight?
6’2” and 240lbs
What is Herschel Walker’s BMI?
32.5
What would HW’s BMI imply about his life?
It implies that he is in the obese class I category
How much body fat does HW have?
4%
What is the discrepancy between BMI and HW?
He is technically considered in a high risk, obese class I range but when you look at his muscle vs. fat mass, he is nowhere near being too fat
Do women or men tend to have higher BMI’s when looking at the same age category?
Women - more BF generally
Explain the trend of the BMI curve in men and women between 2-20 years old.
It starts off at a higher BMI because children tend to have more BF, and then it dips as they grow out of baby fat, and then it continually increases as age increases due to height, adipose tissue, and muscle changes
What kind of relationship exists between obesity and all cause mortality?
A U or J shaped curve
What does the U or J shaped curve indicate?
It implies that as BMI is on the lower range (underweight) and on the higher range (overweight), there is more of a chance for premature death/all cause mortality
What is the nadir of the curve?
Lowest level of something being measured
What is the nadir of the curve in obesity vs. all cause mortality?
The people who have the lowest risk of mortality because they have a normal range of BMI
What do the U and J shape curves already account for?
Smokers - with or without history of disease
Non smokers - with or without history of disease
What does it mean if smokers and non smokers including their family histories are taken into account?
It means that despite whether someone smokes or does not or has a family history of disease or does not, their own individual BMI still correlates to a certain depiction of mortality rate
Do men tend to have all cause mortality rates higher at underweight or overweight end?
Overweight end
Do women tend to have all cause mortality rates higher at underweight or overweight end?
It is about equal
What kind of trend has been noticed in media coverage regarding obesity?
Media coverage on obesity epidemic has escalated as shown from 2000-2003 in a 4000 case increase
How much BF do men normally have?
12-20%
How much BF do obese men have?
Over 25%
How much BF does a man need to survive?
At least 4%
How much BF do women normally have?
20-30%
How much BF do obese women have?
Over 30%
How much BF does a woman need to survive?
8-9%
What kind of profession would someone with the minimum amount of BF be doing?
Elite running
What is overweight defined as?
Too much body weight for a given height and frame
What is obesity defined as?
An overeat level that brings with it an increased risk of serious and fatal disease
Can a person be overweight without being obese?
Yes
Give 2 examples of when someone can be overweight but not obese
- Muscle mass is greater than adipose mass
2. Low waist circumference but has a high BMI
Who is an example of being overweight but not obese?
Herschel Walker
What do you typically see in older people?
Someone who is not overweight but is overfat
What is it called when someone is not overweight but is overfat?
Sarcopenic obesity
What is sarcopenia?
Loss of muscle
What is sarcopenic obesity?
Losing a lot of muscle which procures a larger amount of adipose tissue/fat
Are people with sarcopenic obesity overweight?
No they are not overweight but they do have an over abundancy of fat
What kind of characteristics does someone with sarcopenic obesity have?
Fat and frail
What are the greatest health risks to sarcopenic obesity?
- Osteoporosis and falls
2. Metabolic syndrome and HD
What are the symptoms of frailty?
Osteoporosis
Are older people generally advised to retain some body fat?
Yes for BMR purposes but not when the fat becomes in excess
What % of people over 20 are overweight in the US?
67%
What % of youth between 2-19 are overweight?
16.3%
What % increase has the prevalence of overweightness been seen in 2-5yo?
5 to 12.4%
What % increase has the prevalence of overweightness been seen in 6-11yo?
6.5 to 17%
What % increase has the prevalence of overweightness seen in 12-19yo?
5 to 17.6%
What 3 things does PIA and excess weight when combined do to revenue in society?
- Increases health care medical costs
- Increases worker compensation
- Increases a loss of productivity
What other diseases are you at an increased risk for if you have obesity?
- CHD
- Type II diabetes
- Certain cancers
- HT
- High cholesterol
- Stroke
- Liver and gall bladder diseases
- Sleep apnea and respiratory problems
- OA
- Gynaecological problems
What kinds of cancers do you have increases risks for when you are obese?
- Endometrium
- Colon
- Breast
What constitutes a gynaecological problem?
Issues with menses and fertility
What is type I diabetes?
An auto-immune disorder where the body cannot produce insulin in the pancreas
What is type I diabetes also known as?
Juvenile diabetes
What is type II diabetes?
A metabolic disorder where the body can create insulin but there is too much glucose and so little space to bind that the body becomes insulin resistant and you retain glucose
What is type II diabetes also known as?
Adult diabetes
Is type II diabetes becoming prevalent in children nowadays?
Yes
What are modifiable risk factors for obesity?
- PIA
- Excess caloric intake
- Low socio-economic status
What are non modifiable risk factors for obesity?
- Age
- Heredity
- Ethnicity
- Culture
- Metabolism
What kind of PA best targets weight maintenance?
Aerobic activity is preferred over resistance training
What is the volume of PA needed for weight maintenance?
13 to 26 MET hours per week
What does 13 to 26 MET hours equate to?
- Walking 4 mph for 150 minutes of the week
2. Jogging 6mph for 75 minutes of the week
What is the best combination for weight maintenance?
Diet and exercise
What volume is needed to prevent weight regain?
30 MET hours or more per week
What is 30 MET hours equating to?
Walking 4 miles per hour for 50 minutes daily
How much PA should children acquire to prevent the risk of obesity?
At least 30 minutes of MVPA
What is an epidemiological measure?
The frequency at which an event occurs in terms of injury, disease, and cause of death
What was the issue with Grow Up Fertilizer?
Farmers had an increased prevalence to get ill due to toxins inside the fertilizer
What is an incident case?
New occurrences of these events during a time period of interest
What is a prevalent case?
Diseases that are developed and diagnosed already during a time period of interest
What are 2 examples of incident cases?
- Deaths from a certain disease
2. Not injured becoming injured
What trend is seen in adult overweight and obese categories at greater than 20yo in 1988 to 2003?
Overweight: 55% to 65%
Obesity: 22% to 32%
Are obese people categorized into the overweight portion?
Yes - because obese people also have >25 BMI alike overweight
Are overweight people categorized into the obese portion?
No - because overweight people do not have >30 BMI
Which group has a higher total % - overweight + obese or just obese?
Overweight + obese
What trend is seen in adult overweight and obese categories at greater than 20yo between specifically 1999 and 2003?
A smaller increase in the prevalence of overweightness and obesity compared to the increase from 1988 - 2003
Where is the prevalence of metabolic syndrome noted?
- Italy
- US
- Omani
- Porto
- Indian Americas
What typically occurs when people have arthritis or other rheumatic conditions?
They have reduced levels of leisure time PA due to these disabilities
How many people does arthritis and rheumatic conditions affect in the USA as of 1995?
About 40 million
How many people are arthritis and rheumatic conditions projected to affect in the USA as of 2020?
About 60 million
Are arthritis and rheumatic conditions the leading cause of disability in the US?
Yes
Why is PA leisure time down in people with arthritic disabilities?
They become less likely to do PA
What is a rate in epidemiology?
Number of events, cases, or deaths per population of interest across some period of time
What is a rate also described as in epidemiology?
The progression of disease statistics in terms of numbers in a specific population
What amount of children <12yo had medically attended injuries?
3835 - 8% of their population
What amount of children between 12-17yo had medically attended injuries?
2889 - about 12% of their population
How many people in Canada are obese?
7.6 million
What percentage of Canadians is this total?
7.6/33 = 0.231 = 23.1%
What is the approximate fraction of obesity in Canada?
About 1 in 4
What is the BRFSS?
Behavioural Risk Factor Surveillance System
What was considered as the obesity epidemic in America?
People with a BMI over 30 or people who were 30lbs overweight for a person at 5’4”
What is the typical trend of obesity in America between 1985-1990?
- A lot of states were not surveyed
- Most states began in the <10%
- As the years went on, the ratio of states went closer to most being in the 10-14% range
What happened in 1991 with the obesity epidemic in America?
An addition of a new colour was founded for mapping out states with 15-19% obesity rates
What is the typical trend of obesity from 1990-1995?
- Colorado was the last state to move to 10-14%
- All states are at 10-14% or higher
- Increasing proportion of 15-19%
What happened in 1997 with the obesity epidemic in America?
An addition of a new colour was founded for mapping out states with >20% obesity rates
What is the typical trend of obesity from 1995-2000?
- Increasing amount of 15-19%
- After 1997, most states are now at >20%
- Colorado was the last state to move out of 10-14%
What happened in 2001 with the obesity epidemic in America?
An addition of a new colour was founded for mapping out states with >25% obesity rates
What is the typical trend of obesity from 2000-2005?
- Most states sit at >25% obesity
2. 1 in 4 Americans have obesity
What happened in 2005 with the obesity epidemic in America?
An addition of a new colour was founded for mapping out states with >30% obesity rates
What is the typical trend from 2005-2010?
- Most states are at 25-29% of obesity rates
- The South is sitting primarily at >30%
- Colorado is the last state to change to 25-29%
What is the age adjusted obesity rate as of 2015?
USA is >26% obese
What is the age adjusted diabetes rate as of 2015?
USA in >9.0% diabetic in cases where obese is prevalent
What kind of obesity trend did Canada see in 1990?
Most provinces sat between 10-14% except for AB, BC, and QC
What kind of obesity trend did Canada see in 1994?
All provinces were at 10-14% obesity but now SK, MB, and the Maritimes were at 15-19% obese
What kind of obesity trend did Canada see in 1998?
All provinces were at 15-19% obese except for BC and QC
What kind of obesity trend did Canada see in 2000?
- BC and QC at 10-14%
- Yukon and central provinces are at 15-19%
- NW, NU, and Maritimes are >20% obese
When CDC measured the prevalence of BMI at 30+ in Canada between 1978 and 2010, what techniques did they use?
- Self reporting - telephone survey
2. Measuring - bringing people in
What was the general trend of BMI being at 30+ between 1978-2010 in Canada?
There was a steep almost doubling in the prevalence of obesity
Is self reporting accurate?
No
How does CDC’s study on BMI of over 30+ prove that self reporting is not accurate?
Measured BMI over 30 at 25% of people
Self reported BMI over 30 at 17% of people
Why is self reporting inaccurate?
- Non reliance of survey
2. Under/over reporting
What do men tend to over report?
Height
What do women tend to under report?
Weight
What do seriously obese people tend to not do?
Weigh themselves because they are fearful of what they might see
What are the trends of changing Canadian obesity rates between 1978-2004 in young adults (25-34)?
A tripling of obesity
What are the trends of changing Canadian obesity rates between 1978-2004 in children (12-17)?
A doubling of obesity
What are the trends of changing Canadian obesity rates between 1978-2004 in elderly (75+)?
A more than doubling of obesity
What percentage of elderly have sarcopenic obesity as of 2004?
About 30-40% of elderly people
What is a common trend seen in obese young adults?
They are likely to become obese older adults
Were genetic influences hard to measure 30 years ago?
Yes
What do they use to measure genes nowadays?
Genomic readers
Who is Dr. Stuntgart?
Father of Psychiatry
What did Dr. Stuntgart do?
He found separated identical twins and that the circumference of the children had identical profiles to a BMI closer related to their birth parents and to each other than their adoptive parents
What is a typical comparison between Canadian and American obesity rates?
Canadian women and men tend to be less obese
By what % are Canadian men less obese than American men?
About 5%
By what % are Canadian women less obese than American women?
About 10%
Who accounts for a large proportion of obese women in America?
African American women
What is the ratio of AA women who are obese in USA?
About 1 in 2
When looking at the % distribution of household population above 18 in Canada, where do most people sit?
In the normal weight range between 18.5 - 24.9 BMI
When looking at the % distribution of household population above 18 in Canada in 2004, who is included in the underweight group?
- Cancer patients
- Anorectic individuals
- Lean athletes
When looking at the % distribution of household population above 18 in Canada in 2004, are men more overweight and obese class I than women?
Yes
When looking at the % distribution of household population above 18 in Canada in 2004, are women more obese class II and III than men?
Yes
When looking at the % distribution of household population above 18 in Canada in 2004, are there more women or men at a normal weight?
There are more women sitting at a normal weight than men are
When looking at the % distribution of household population above 18 in Canada in 2004, what could the high number of overweight men be due to?
It could be due to discrepancies of muscle mass exclusion in the BMI ratio
In which country, outside of Canada and US, are female obesity rates the highest as of 1992?
England
What problem do developed countries have similar to USA and Canada?
Increasing obesity rate
What 3 countries have increased female obesity rates as of 1980 to 1992?
- Australia
- Brazil
- England
Has the prevalence of female obesity gone down in Brazil since the study of female obesity rates done in 1980 to 1992?
Yes - they have created better promotions of PA including Move for Health on World Health Day
What happened to Japanese female obesity rates in 1980-1992?
They maintained and even decreased slightly in the amount of female obesity
What happened to Swedish female obesity rates in 1980-1992?
They maintained and only slightly increased in the amount of female obesity
Why would Japan and Sweden have lower female obesity rates?
- Diet of F/V
2. Active commuters
What kinds of modifiable factors contribute to less obesity?
- Higher level education
2. Socio-economic status
At what age does the obesity epidemic start as seen in Canada in 2004?
It moves the greatest amount for men from 18-24 into 25-34 and it moves the greatest amount for women from 35-44 into 45-54
What happens to the rate and numbers of obesity as you age?
- Rate will drop off
2. Numbers continue to increase
When does the numbers of obesity stop increasing and start decreasing on the age spectrum?
After the age of 64 for both men and women
Why would the prevalence of obesity start to decrease after the age of 64?
- Obese people get sick and die early
- Older people do not get the same enjoyment of food due to a loss of smell and taste buds which causes minimized intake
What could be 1 reason why 35-44yo men have lower risks of obesity than 25-34yo men?
Plainly due to their age - most men between 25 and 34 are finishing university and starting to live life on their own again
What race did CDC find to have the least prevalence of obesity?
White non hispanics
What race did CDC find to have the second most prevalence of obesity?
Hispanics
What race did CDC find to have the most prevalence of obesity?
AA non hispanics
Of these AA non hispanics that are obese, what gender is it mainly?
Women
At the current rate of increase in obesity, what is the stat said to be by 2059?
All Americans will be overweight
According to the races that are most likely to become obese, who is most likely to become diabetic?
- AA non hispanics and Native Americans
- Hispanics
- White non Hispanics
Are people obsessed with weight?
Yes
Is thin waist and high BMI ideal?
No
What gender has the most problems with optimal BW?
Women - typically Caucasian women
Why are AA women more realistic with their weight than Caucasian women?
There is not as much of a stigma on weight in the AA population
What is the magnitude of obesity in accordance with?
The prevalence of obesity in society
Which age category has the worst magnitude of obesity?
45 to 54 year olds and 55 to 64 year olds
What causes decreases in the magnitude of obesity at 75+?
- Death
- Decrease in enjoyment of food
- Decrease in intake of food
- Sarcopenic obesity (appearing to be over fat but do not have a high BMI)
What is the optimal BW?
BMI at 18.5 - 24.9
What is a weight optimal for appearances?
- Individually decided
2. Based largely on beauty standards
What is a weight optimal for peak performances?
Based on the sport or performance that the individual is looking for
What 3 layers of the body are there?
- Outer- skin and fat
- Middle - muscles
- Inner - bones
What are the 2 typical body composition changes in Canadian people from 25 to 55 years old?
- Gaining 1 pound per year = 30lb increase
2. Losing 1/2 pound per year = 15lb decrease
What is the total increase of weight for the average Canadian between 25 to 55 years old?
If you lose 15lbs but gain a net 30lbs, you have actually gained 45lbs
What is it called when you think you are losing weight every year due to muscles but are actually gaining it back through mass and lifestyle choices?
Creeping obesity
What comprises of lean tissue?
- Muscle
- Bone
- Connective tissue
- Organs
What comprises of fat tissue?
- Sub cutaneous fat
2. Internal fat - android obesity over abdominal region
What are lab methods of determining body composition?
Tests done within the lab with specialized equipment
What is underwater weighing?
A lab method of determining % fat by weighing a person on land, underwater, and then estimating their body density of mass/volume which is correlated to their % of fat
What is bioelectrical impedance?
A lab method where current enters the body and measures the resistance drop throughout the body
Where are electrodes placed in bioelectrical impedance?
- Attachment of wrist to machine and other wrist to an electrode
- Attachment of foot to machine and other foot to an electrode
What happens to the resistance if you have a lot of muscle?
Muscle is 70-73% water so there will be a smaller resistance drop as the current travels through
What happens to the resistance if you have a lot of fat?
Fat is 10% water so there will be a greater resistance drop as the current travels through
What is wrong with bioelectrical impedance?
It has a fancy output but it is not a great measure of the % fat
What are examples of bioelectrical impedance?
- Taneda scales
2. Ultrasound wounds
What are 2 other lab methods used to determine percent of fat?
- Ultrasounds
2. X rays
What is an MRI?
A lab method to determine fat by producing images of organs
What is a DEXA machine?
A lab method used to determine bone, fat, and muscles by dual energy and x ray absorptiometry
What is a CT scan?
A lab method used to determine visceral adiposity
What is a downfall of a CT scan?
It’s dose of radiation is fairly high
What are field method measurements in assessing body composition?
Tests that can be done by any odd person and does not require use of extensive equipment
What are 3 examples of field methods?
- BMI
- Skinfold measurements
- Circumference measurements
What margin of error do field methods have?
+/- 4%
What is the bod pod?
A pressurized cage that measures body volume and assesses alike underwater weighing
What is the bod pod used to do?
Determining density and thus, % of fat and muscle
Who is the bod pod good to use on?
Children
What did Dr. King do a study on?
The effects of maternal adversity on the birth of children when the pregnant mother had to survive an ice storm
Where do men normally accumulate adiposity?
Abdomen - android obesity - apple shape
Where do women normally accumulate adiposity?
Hips - gynoid obesity - pear shape
What is the waist/hip ratio?
It is the waist circumference divided by the hip circumference
What is the waist/hip ratio related to?
Android obesity and internal body fat
What are the AHA standards for waist/hip ratio?
Males - less than 1.0
Females - less than 0.8
Where is the most hazardous place for fat to be stored?
Upper body
What is visceral fat?
Interior fat that is hard on touch and more difficult to lose
What is subcutaneous fat?
Exterior fat that is jiggly
What did Dr. Despres study?
The effects of VPA on decreasing visceral body fat
What happens as fat cells enlarge?
They push up against the skin
What happens when muscle is surrounded by too much fat?
The fat becomes marbled into the muscle
While the fat is pushing up against the skin, what is also happening?
Tough, long connective cords are pulling the fat down
What is this up-down tension in fat cells called?
Cellulite
What does cellulite do?
It creates an uneven surface or dimpling
How much does the cellulite industry make per year?
$3 billion
How many people are estimated to have metabolic syndrome in the USA?
About 47 million people
What are contributing factors to MS?
Genetics and environment
What are resulting factors of MS?
CVD and type II diabetes
What are characteristics of MS?
- Inflammation
- High BP
- High triglyceride levels
- High glucose or insulin levels
- Visceral/abdominal adiposity
- High LDL
- Abnormal vascular responses - prothrombotic
- Low HDL-C levels
What does it mean to be prothrombotic?
Increased risk of blood clots
What is MS a consequence of?
Obesity
What is the trend for the prevalence of MS among US adults?
As age increases, so does the chances for MS
Are younger or older bodies better at handling the assault of their body?
Younger bodies can sustain unhealthy functioning better than older bodies
Who has the highest risk of MS in the US?
Women above the age of 70 and men + women in the age range of 60-69
Who has the lowest risk of MS in the US?
Women between 20-29 years old
What is a normal blood sugar?
80-100mg/dl
What is pre-diabetic blood sugar?
100-120mg/dl
What is high blood sugar/hyperglycemic?
> 120mg/dl
What is low blood sugar/hypoglycemic?
<70mg/dl
What is very low blood sugar?
<40mg/dl
What can you occur at very low blood sugars?
Unconsciousness
What amount of Canadians had diagnosed diabetes in 2008 and 2009?
Approximately 2.4 million - 6% overall
Are there chances for unreported cases of diabetes?
Yes - at least a million
Where is the highest prevalence of diabetes in Canada?
Ontario and the Maritimes
Where is the lowest prevalence of diabetes in Canada?
Nunavut and Alberta
What are other names to MS?
- Syndrome X
2. Insulin Resistant Syndrome
What are the 2 main RF’s for MS?
- CVD
2. Type II diabetes
What is the progression of obesity?
Obesity - MS - diabetes - CVD
What are acknowledged as important causative factors in MS?
- Central obesity
2. Insulin resistance
Is MS well understood?
Not yet - too complex
What are the 5 RF’s associated with MS as stated by NCEP ATP III?
- Abdominal obesity
- Triglyceride level
- HDL
- BP
- Fasting plasma glucose
How many of the RF’s do you need to have to be described as having MS?
3 of the 5
Does diabetes follow the same criterion as MS?
Yes
What 4 other factors are included when assessing diabetes?
- Family history
- Ethnicity or race
- Sedentary lifestyle
- History of CVD (high risk of HD and stroke)
What are the 3 ways to diagnose diabetes?
- Fasting Plasma Glucose Test - after 8 hours
- Oral Glucose Tolerance Test - after 8 hours and ingestion of glucose 2 hours before
- Random Plasma Glucose Test - diabetic symptoms present
What test is normally used for gestational diabetes?
Oral glucose tolerance test
What is the indicator that someone has diabetes?
When one of these tests has a highly increased glucose level?
What are the guidelines for abdominal obesity as an RF for MS?
Men - >102 cm
Women - >88 cm
What are the guidelines for triglycerides as an RF for MS?
> 150 mg/dl
What are the guidelines for HDL as an RF for MS?
Men - <40mg/dl
Women - <50mg/dl
What are the guidelines for blood pressure as an RF for MS?
> 130/>85 mmHg - could be equal to these numbers
What are the guidelines for fasting plasma glucose as an RF for MS?
> 110mg/dl - could be equal to this number
What 2 changes are there to RF’s for MS in terms of the IDF organization?
- Men >94cm abdominal obesity
- Women >80cm abdominal obesity
- > 100mg/dl for fasting plasma glucose
What are the 5 major health problems with regards to obesity?
- Risk for type II diabetes
- RF for some kinds of cancers
- High total cholesterol
- High BP linked to RF for CHD
- Social, psychological, financial, and health care problems
What is the risk factor of MS in regards to PA?
When there is self reported high PA levels, there is a lower risk of MS yet when there is self reported low PA levels, there is a higher risk of MS
What is the risk factor of developing MS in regards to fitness level?
As the level of fitness increases, the risk of MS decreases yet as level of fitness decreases, the risk of MS increases
What is the age adjusted prevalence of metabolic syndrome in Canada?
About 1 in every 4 people:
Women - 25.2%
Men - 26.8%
Which group in Canada experiences the least MS?
Chinese
Which women are less likely to experience MS than men?
- Chinese
2. European
Which women are more likely to experience MS than men?
- South Asian
2. Aboriginal
Which group in Canada experiences the most MS?
Aboriginals at 40-45%
How does PA help MS?
- Increased TEE
- Increased protein synthesis
- Increased AA uptake into skeletal muscle
- Reduced LDL
- Reduced triglyceride levels
- Increased HDL
- Improved glucose tolerance
What is the paradox in the USA regarding obesity and PA?
- Dollars spent on diets and diet products in 2017 in the US was equal to 50 billion
- Number of US Health Club members rose to 39.4 million in Jan 2004
- 2003 US industry revenues received 14.1 billion
Why is MS so prevalent if diet products and PA are supposedly being advertised so much?
- Not sticking to training plan
- Poor choices
- Location and availability
What is the Mark Eden Developer?
A fad concerning a small exercise mechanism that says it will improve bust line in a short period of time
Did the Mark Eden Developer work?
It was claimed to work for a few people but the results mainly indicated that it did not work for most people
What was the Dr. Oz Green Coffee Extract study?
Randomized, double blind, placebo controlled, linear dose, crossover study to evaluate efficacy and safety of a green coffee bean extract in overweight subjects
What were the results of the study?
Inaccurate and it was later retracted
Should you be wary around some weight loss products?
Yes
Are weight loss skin patches or shoe inserts reliable?
No
What 3 products should you avoid in weight loss products?
- Ephedra
- Ephedrine
- Ma Huang
What do fat blockers or shrinkers do?
- Do not absorb or bind fat
2. Interfere with fat digestion
What do fat absorbers or magnets do?
- Flush fat out before being absorbed
What kind of tea should you avoid?
Diet teas that only cause a loss of bodily fluids
Are fiber tablets, bee pollen, or laxatives recommended for weight loss?
No
Should you use electrical muscle stimulators for WL or body toning?
No
What are the 4 main things accounting for a sudden increase in the prevalence of obesity?
- Western diet
- Increased sodium
- Portion size
- Media
What is positive energy balance?
Caloric consumption > caloric expenditure
What is positive energy balance linked to?
Weight gain
Where does the population sit in terms of energy balance?
Positive energy balance
What is neutral energy balance?
Caloric consumption = caloric expenditure
What is neutral energy balance linked to?
Weight maintenance
What is negative energy balance?
Caloric consumption < caloric expenditure
What is negative energy balance linked to?
Weight loss
What are some plausible factors explaining the development of obesity?
- Genetics
- Body responses
- Learned behaviour
- Lack of discipline
- Work hours
- Portion sizes
- Snack foods
- Depression
- TV
- Physical disability
What study was conducted regarding twins?
Testers added a surplus of 1000 kcals to the twin’s normal diets to see its affect
What was the initial variability between Twin A and Twin B?
They were at different body sizes - 4kg or 14kg - tremendous variability
What was the results of the twin study?
Weight gain was relatively similar in terms of patterns despite the starting point
What is the typical BMI for PIMA Indians in Arizona?
Women - 36
Men - 30
What is the typical BMI for PIMA Indians in Mexico?
Women - 25
Men - 25
What is causing the discrepancy between Arizona and Mexico PIMA Indians?
Mexicans live rural with increased PA and healthy food whereas Arizona lives on a reservation with a Western diet and decreased PA
What is the overview of the PIMA Indian study?
They have the exact same kind of culture/DNA but vary largely in BMI due to different environments
Can identical twins look different in body composition?
Yes - but that will be due to training - i.e. runner vs. body builder
What are the 2 main factors related to the onset of obesity?
- Altered dietary intake
2. Easy to access inexpensive food
Where is there the most amount of KFC?
China
Which park has 4 McDonald’s in it?
Stratford Olympic Park
How many customers does the McDonald’s at Stratford seat?
1500
How common is McDonald’s in the US?
It is speckled everywhere, especially on the East and South Coasts
What is the trend in energy intake from 1977 to 1994?
There was an increase of 200 calories, accounting for a few pound increase each month
What is the trend in snacks consumed from 1977 to 1994?
There is a gradual increase of snacks consumed
What is the trend in the percentage of kcal consumed at home from 1977 to 1994?
It has decreased because fewer women were in the workforce in 1977/1978 and would always make meals for their family but now people work a lot more at >10 hours per day and only want readily available food that they do not have to cook
What is the trend in the amount of Mexican food eaten at home from 1977 to 1994?
It has slightly increased
What is the trend in the amount of Mexican food eaten in fast foods from 1977 to 1994?
It has significantly increased
What is the trend in the amount of Mexican food eaten in restaurants from 1977 to 1994?
It has slightly increased
By approximately how much have soft drinks increased their portion sizes from 1978 to 1998?
By about 8oz or 200mL
By approximately how much have fruit drinks increased their portion sizes from 1978 to 1998?
By about 3oz
By approximately how much have hamburgers increased their portion sizes from 1978 to 1998?
A couple ounces more
By approximately how much have french fries increased their portion sizes from 1978 to 1998?
A couple ounces more
In general, what is trend in portion sizes?
Most things given out today are in much higher portion sizes than they were 40 years ago
Which range of years did portion size change most drastically?
Between 1965 and 2005
What kind of trend do you see in calories per capita per day between 1965 and 2005?
It has gradually increased
What kind of trend do you see in the % of overweight and obese people from 1965-2005?
It has increased
What does increased calories per day and larger portion sizes link to?
They link to an increased prevalence of obesity and overweightness in society
In who does portion size of food affect energy intake and how?
In normal weight and overweight men and women, larger portions contribute to excess energy intake and greater obesity levels
Why is a large plate affecting energy intake?
People do not realize how much more food they put on a larger plate than a smaller plate
Has food intake increased increased in both men and women?
Yes - in terms of portion size and energy intake
What are 6 shifts in food practices in North America?
- Fast food consumption
- Reduced frequency of family meals
- Restrained eating and meal skipping
- Consumption of soft drinks changing from 27 gallons in 1972 to 44 gallons in 1992
- 30 000 more products in the supermarket
- Increased portion sizes
What will rats do if food is readily available to them all the time?
They will overeat until they die
When and why was McDonald’s Supersize phased out?
It was phased out on March 3rd, 2004 because many lawsuits on over consumption were becoming a detriment to the company
What is the Complete Scarsdale Medical Diet?
High protein diet
What is the Pritikin principle?
Calorie dense diet that is high carb and low fat
What is the Atkin’s Essentials diet?
High protein and high fat with low carbs
What happens when you exclude one or more of the food groups?
You put someone into negative energy balance
What is RMR?
Resting Metabolic Rate
What is RMR dependent on?
Body mass composition and amount of lean tissue
How is RMR measured?
- Sleep at home
- Come to lab
- -> slightly elevated
What is BMR?
Basal metabolic rate
Who is BMR useful for?
Dieticians
How is BMR measured?
- Sleep at lab
- Measure in lab
- -> Lower than RMR and more accurate
What is TEF?
The total thermic effect of food
What constitutes TEF?
Chewing, breakdown, and excretion of food throughout the day
What is PAL?
Physical activity levels varying by person
What is NEAT?
Non exercise activity thermogenesis - fidgeting factor
What is exercise?
Purposeful PA
What is TEE?
Adding up TEF, RMR, and PAL
What does TEA/PAL take up in EE over 24 hours?
About 15-30%
Is TEA variable?
Yes - you have control over this part of your TEE and it can vary up and down dependent on own activity levels
What does TEF take up in EE over 24 hours?
About 10%
What does RMR take up in EE over 24 hours?
About 60 to 75%
What is the disuse affect on EE?
Body goes into disuse and decreases RMR, TEF, and TEE
What is the PA/exercise effect on EE?
Body increases RMR, TEF, and TEE
What happens when you are highly active in terms of your viscera?
You have a quicker GI transit for the TEF
What happens when you are highly active in terms of your viscera?
You have a quicker GI transit for the TEF
How much muscle tissue is lost during weight loss in obese patients?
25%
How much muscle tissue is lost during weight loss in bariatric surgery candidates?
35 to 40%
How much of a calorie drop in RMR does a kg of body weight lost amount to?
20 cal/d drop in RMR
If you lose 20kg, how much will your RMR be reduced by each day?
400cals/day
Why does the RMR go down in general post obesity?
There is less of the person to sustain after losing weight so RMR drops to account for the weight lost
What effect does exercise have on RMR?
More muscle creates a higher RMR
Why is there an increased RMR during exercise?
The body has a greater ability to burn and use metabolic rate when there are more muscles to help out
Why do older people have slower metabolisms?
You lose muscle as you age
What reduces RMR?
Prolonged caloric restriction
When you are prolonging calories, what kind of energy balance does that put you in?
Negative energy balance for a long time period
Why does prolonged caloric restriction decrease RMR?
There is nothing to burn inside the body so the RMR will try not to burn anything
If you have severe caloric restriction, how much is your RMR reduced?
By 45%
What kind of response do you see in regular exercise that is similar to prolonged caloric restriction?
Self preservation type of stress reponse
Is a more muscular person or a more fatty person have a faster RMR?
A muscular person
If you are severely obese, what is your RMR like?
It is not fast
Why do obese people have slow RMR?
There is little blood flow to the fat so it does not metabolize calories as easily which put all the stress on the skeletal region
Why would obese people when losing weight decrease their RMR further?
There is less SA to use energy on
What is a secular trend?
Remaining consistent over the long term (1960-1970-1980-1990)
What has been the secular trend in diet from 1950 to 1990?
Energy and fat intake have maintained the same or slightly decreased
What has been the secular obesity trend from 1950 to 1990?
Obesity has increased
What has been the secular trend in cars per household from 1950 to 1990?
It has increased
What has been the secular trend in TV viewing hours from 1950 to 1990?
It has increased
What does the increase in obesity most probably mirror?
It mirrors the prevalence of inactivity and sedentarism over one’s diet
Do patterns in activity better explain obesity?
Yes
What study did NHANES do in 1998 that attracted a lot of media attention?
Skinfolds in relation to TV watching
What were the results of the NHANES 1998 study on Skinfolds relating to TV watching?
As the amount of TV watching increases to over 4 hours, the amount of skin folds also increases
What gender is an increase in skin folds more prevalent in?
Female
How much TV are children currently watching?
Approximately 4+ hours every day OR they are spending 4+ hours on their screens/TV total every day
Is the TV a cue to eat?
Watching more TV causes an increase in caloric intake for US children
Which gender does the relationship between hours of TV watched and caloric intake affect most?
Boys
What % of US adults over 18+ are doing irregular activity?
45% - almost every 1 in 2
What constitutes irregular activity?
Weekend exercisers
What % of US adults over 18+ are doing regular sustained activity?
25% - every 1 in 4
What % of US adults over 18+ are doing no activity?
30% - every 1 in 3
What kind of exercise prescription has the greatest effect in fitness but can be very time consuming?
- Vigorous
- Sustained and uninterrupted
- Done on 3-5 days of the week
- Sophisticated by receiving advice from an exercise professional
What is exercise known as in current times?
The art of converting big meals and fattening snacks into back strains and pulled muscles by lifting heavy weights that do not need to be moved or running when no one is chasing you
What are the reactions of people who have not exercised in 30-40 years?
They are typically less excited than someone who does exercise normally
Who receives the greatest health benefits?
More active active people
Who receives the greatest gains of health benefits?
Couch potatoes who are made to be more active
What kind of relationship exists between health benefits and PA?
A parabolic curve that increases health benefits as PA goes up - not necessarily dose response yet
What is the order of who receives the most initial gains of health benefits?
Sedentary –> moderately active –> active
What kind of theoretical pattern of PA would a sedentary individual have over 24 hours?
They would never hit above 2 METS the whole day
What kind of theoretical pattern of PA would a leisure time exerciser have over 24 hours?
They would expend about 10-11 METS for 30 to 40 minutes but then live the same sedentary lifestyle for the rest of the day around 2-3 METS
What kind of theoretical pattern of PA would a lifestyle exerciser have over 24 hours?
They would be participating in activities all throughout the day by walking to bus stop, jogging, taking stairs, walking after dinner etc.
What kind of study did Dr. Andersen hold in terms of treating obesity?
He looked at how lifestyle vs. programmed exercise affected the WL of obese people
Who were the subjects of Dr. Andersen’s study on treating obesity?
- 40 obese women assigned to either a diet plus programmed aerobic exercise or diet plus increased lifestyle activity
- Diet consisted of 1200kcal/d on BCD diet
How long did Dr. Andersen’s study last on treating obesity?
16 weeks
What did all subjects of Dr. Andersen’s study on treating obesity receive?
Weekly behavioural counselling from a clinical psychologist
What were the results of WL in Dr. Andersen’s study on treating obesity?
Both groups lost approximately the same weight with aerobic exercises losing slightly more
What were the results of serum cholesterol changes in Dr. Andersen’s study on treating obesity?
Both experienced decreases in the amount of cholesterol - aerobic group did start with less to begin with so they ended with less than the aerobic group
What were the results of total treadmill time in Dr. Andersen’s study on treating obesity?
Both groups improved their fitness in clinically meaningful and significant ways over the 16 weeks
What was the overview after week 16 and to a year later at week 68 in Dr. Andersen’s study on treating obesity?
- Women continued to attend the aerobic workouts because they had 95% turnouts on 3 days of the week during the study and continued to like their teacher and program
- Aerobic group had regained slightly more weight than the lifestyle group
- Lifestyle group had acquired new habits relevant to lifelong sustainability
What are the Surgeon General Report Guidelines critical for?
Long term weight control
What does the SGR suggest for activity during the week?
About 30 minutes of moderate intensity every day or 30 minutes of vigorous intensity every week
What occurred 12 weeks post treatment weight change in Dr. Andersen’s study on treating obesity?
- Control group - increased weight
- Lifestyle group - managed to stay at a 0 balance difference between weight change
- Aerobic group - managed to continue losing weight
What were these post treatment weight changes in Dr. Andersen’s study on treating obesity in accordance with?
The percentage of weeks that met or exceed SGR guidelines
What is the Harris and Benedict equation and when did they patent it?
It is a BMR equation based on weight, height, and age and was founded in 1919
What is the metric BMR formula for women?
BMR = 655 + (9.6 x kg) + (1.8 x cm) - (4.7 x years)
What is the metric formula for men?
BMR = 66 + (13.7 x kg) + (5 x cm) - (6.8 x years)
What happens to BMR as height and weight goes up?
BMR goes up
Why does metabolism go down as you age?
Less lean body mass
What happens to BMR as age goes up?
BMR goes down
How many pounds of tissue do you lose between 25 and 55?
1/2 lb each year - 15lbs total
Why is the Harris and Benedict formula accurate?
It calculates caloric needs based on height, weight, and age rather than just BW alone
What is the only factor that Harris and Benedict omit?
Lean body mass and thus the ratio of muscle to fat the body has
Do leaner bodies need more calories than bodies that are not as lean?
Yes
Why is the HB formula not accurate in very muscular people?
It will underestimate muscular people’s caloric needs
Why is the HB formula not accurate for very fat people?
It will overestimate fat people’s caloric needs
How can you determine daily total caloric needs from the HB formula?
Multiply the BMR by the appropriate activity factor
What is the activity factor for a sedentary person?
Little to no exercise = 1.2
What is the AF for a lightly active person?
Light activity on 1 to 3 days of the week = 1.375
What is the AF for a moderately active person?
Moderate activity on 3 to 5 days of the week = 1.55
What is the AF for a very active person?
High intensity activity on 6 to 7 days of the week = 1.725
What is the AF for an extra active person?
2x regular high intensity training = 1.9
What does the calculation of BMR x AF mean?
It shows the total number of calories needed in order to maintain current weight
What can you do once you know the number of calories needed to maintain your weight?
You can evaluate the number of calories needed to eat in order to gain or lose weight
What does caloric surplus indicate?
Weight gain
What does a 500 cal deficit indicate?
Weight loss
What 3 things that occur when you reduce caloric intake only by diet?
- Lose more body weight than just exercise
- Lose body fat but not as much as with exercise
- Lose some fat free body mass
What are 3 things that occur when you reduce caloric intake by exercise?
- Lose body weight but not as much as with diet
- Lose more body fat than just diet
- Gain most fat free body mass
What are 3 things that occur when you reduce caloric intake by a combination of exercise and diet?
- Lose most body weight
- Lost most body fat
- Gain some fat free body mass
What is lean tissue?
Metabolically active tissue
What period is most difficult for lean tissue to thrive?
After treatment
What do individual studies show?
Large variability in results
When were the most major research review studies?
In the 70’s/80’s/90’s
What did Epstein and Wing find out about weight change with exercise alone?
- Body mass kg/week = -0.09
2. Fat mass kg/week = NA
What did Wilmore find out about weight change with exercise alone?
- Body mass kg/week = -0.06
2. Fat mass kg/week = -0.13
What did Ballor/Keesey find out about weight change with exercise alone?
- Body mass kg/week = -0.06
2. Fat mass kg/week = -0.09
What happens to BMR over time?
- Children have very high BMR
2. Decreases due to a loss of lean tissue
Who has a higher BMR?
Men
What is a typical change in body mass through exercise?
-2.0kg
What is a typical change in body mass through diet?
-9.0kg
What is a typical change in body mass as a combination of diet and exercise?
-11.0kg
What prescription is best for losing weight?
- Exercise and diet
- Diet
- Exercise
If someone is running at 12km/h at 7.46miles/h and 8:02 mins/mile, what will happen as he keeps running?
He will continue to lose a greater net EE per the hour of his horizontal running as he continues to do more miles
If a 70kg man was running at 7.46miles/h, and was losing 112 kcal every mile, how much kcal would he lose in an hour?
7.46x112 = 835 total kcals
What is Hardee’s 1420 Calorie Burger called?
Monster Thickburger
Describe the Monster Thickburger
2 and 1/3 pound slabs of angus beef, bacon, cheese, and mayo, on a buttered bun
How much does the Monster Thickburger cost?
$5.49 alone or $7.09 with fries + drink
How many calories are in a Big Mac?
540 kcals
What is the net expenditure of a 70kg man on a 3 mile walk?
- Gross expenditure = 300 cals
- RMR = -50 cals
- Exercise he would have been in had he not walked = -50 cals
TOTAL = 200 cals
What is the single most important key point for PA?
Maintenance
What happens when you maintain PA?
You maintain a consistent and desirable body composition
If you golf 2 rounds per week burning 700 kcals each time by walking without a cart, and continue to do this for 5 weeks and then a year, how many calories and how much weight would you lose?
- 5 weeks - 3500 calories which is 1lb
2. 1 year - 35 000 calories which is 10lbs
How many calories equates to 1 pound?
3500 cals
How could you lose 1 pound in a week?
By restricting 500 calories each day
If you combine losing weight with exercise, what modifications do you make to your diet?
- Much less restriction
2. No restriction at all
What are 4 guidelines for managing weight?
- Lifestyle behaviour changes in diet and PA
- Psychological and behavioural considerations
- Caloric intake
- Caloric expenditure
Which consideration has the most effect on WL?
Long term behavioural changes
How can you modify your behaviour?
- Self monitoring in diaries
- Stimulus control by identifying circumstances that stimulate eating
- Reward reinforcement by formal rewards
- Nutrition education
- PA
- Cognitive restructuring where you counter negative thoughts and set reasonable goals
How do you lose weight?
Expending more calories than consuming
How can you expend more calories than you consume?
- Consume fewer
- Combine exercise and diet
- Caloric intake < caloric expenditure
What will do the best job at increasing caloric expenditure?
Weight control mechanism habits paired with other healthy habits
What happens to BMR in WL?
It decreases
What happens to RMR in WL?
It increases or boost during exercise
What are 4 WL misconceptions?
- Quick fixes
- Fad diets
- Cellulite
- Spot reduction
What is spot reduction?
Local, contracting skeletal muscle believed to burn fat only in this area
Is spot reduction valid?
No - you burn fat in several other areas than just the target spot
What are 6 reasons why Freshmen gain 15 pounds in university?
- On your own and free to eat whenever
- Pile on portions of unhealthy foods
- Adapting to stress and overeating
- Using sodas and lattes to say awake
- Meal skipping
- More alcohol consumption
How can you gain weight?
Must eat about 400 to 500 more cals per day than being expended to gain at least 1lb per week
What should you do while trying to gain weight?
- Exercise regularly
2. Include weight training to ensure that WG is lean weight
What has happened to ideal body weight perceptions since the 1950?
As weight increases, it becomes less ideal and there is a larger difference between actual and ideal BW
What is disordered eating?
Not being able to eat properly
What are 2 examples of disordered eating?
- Bulimia
2. AN
What have some people proposed as a mechanism to stop eating and lose weight?
Water
Who is disordered eating more prominent in?
Women
What are the 3 components contributing to disordered eating?
- Genetics
- Environmental
- Psychological
What study did Beavers et. Al do in 2017?
They studied the effect of exercise type during intentional weight loss on body composition in older adults with obesity
What was the objective of the Beavers et. Al study in 2017?
To maximize fat loss at 5 to 10% and minimize lean mass loss at 10 to 50%
Who were the subjects in the Beavers et. Al study of 2017?
60 to 79 year olds with a BMI of >28 but <42 and who were maintaining less than 60 minutes of moderate PA per week
What was the 1st effect found in Beavers et. Al study?
- Superior ability of WL and RT vs. WL and AT when trying to conserve lean body mass
How much lean body mass was lost under all 3 conditions in effect #1 of Beavers et. Al study?
WL and RT = 10%
WL = 16%
WL and RT = 0.8kg
WL and AT = 1.6kg
What was the 2nd effect found in Beavers et. Al study?
- WL and RT or AT resulted in greater overall reductions in total fat mass loss than WL alone
What was the 3rd effect found in Beavers et. Al study?
- Fat mass loss is primarily responsible for WL associated improvements in mobility whereas lean mass lass is primarily responsible for WL associated with declines in strength
What was the conclusion of the Beavers et. Al study?
WL and RT yield the greatest weight loss and most favourable shift in body composition because you are conserving lean mass and getting rid of fat mass
