Obesity Flashcards
What lifestyle factors impact health
- drug use
- diet
- exercise
- use of sunscreens
- use of condoms
- attendance at screening/health checks
- hygiene
- use of safety belts and helmets
Why is it hard to change behaviour
- giving up something pleasurable can be difficult
- changing routines is usually difficult
- habits and addictions are hard to modify
- motivation to change fluctuates
What is locus of control
- generalised expectancy that rewards are controlled by external forces or by ones own behaviour (internal (you can control it) vs external (you cannot control it))
What is the health belief model
action is a function of perceived likelihood of illness, its seriousness and costs and benefits of action
what are the stages of change that people go across when thinking of changing behaviour
- Pre -contemplation
- contemplation
- preparation
- action
- maintenance or relapse
What is the efficacy of lifestyle interventions determined by
- strength of the drive for the unhealthy behaviour
- effort required
- target population - motivation, social factors, personal characteristics ,biological factors
- efficacy of supportive medication
list some complications of obesity
- pulmonary disease - abnormal function, obstructive sleep apnea, hypoventilation syndrome
Nonalcoholic fatty liver disease
- steatosis
- steatohepatiits
- cirrhosis
Gallbladder disease
gynaecological abnormalities
- abnormal menses
- infertility
- PCOS
Osteoarthritis
stroke
cataracts
coronary heart disease
- diabetes
- dyslipidaemia
- hypertension
Severe pancreatitis
Cancer
What are the benefits of weight loss
- Can reduce blood pressure
- can prevent onset of T2DM
- reduce blood glucose and LDL cholesterol
- improve sleep apnoea
- benefits start to accrue when 5-10% of initial body weight is lost
What is the cause of obesity
- more energy in and less energy out leads to more energy stored and converted to fats
What is the basal metabolic rate for women
1200-1600kCal per day
what is the resting metabolic rate
the energy you use when you don’t do anything
Describe what happens to the resting metabolic rate
- increases with increased muscle mass
- declines with age
- declines during restriction of energy intake
What determines our body weight
Interaction of
- behaviour
- genes
- environment
What are some strategies for weight loosing
1, Self-monitoring 2, Stimulus control 3, Goal setting 4, Cognitive restructuring 5, Incentives
How do you self monitor in weight loosing
- food diaries - record type and amount of food eaton and times, places and feelings associated with eating
- pedometers to monitor physical activity
- scales to monitor body weight regularly - essential for any progress
How can you use stimulus control in weight loosing
Identify and modifying environmental cues to eating
- limit eating to kitchen
- remove snacks from TV room
- keep tempting food out of sight
How does goal setting work in weight loss
- 5% weight loss over 6 months
- loose a 1lb a week is a realistic goal
How does cognitive restructuring work in weight loss
identifying and challenging self defeating thoughts and counterproductive beliefs
how do incentives help weight loss
- agreements with HPs, friends, slimming group
- rewards and praise for achieving goals
What are the predictors of success of weight loss
- diet and activity
- 400kcal/day in activity
- average 5 eating episodes day including breakfast
- weighing yourself at least once a week
What are the physical activity recommendations
- 30 minutes moderate activity on 5 or more days a week
- up to an hourly may be needed to prevent obesity
- up to 90 minutes/day to maintain weight reduction
Who can have orlistat
- greater than 12 years old
- BMI over 30 years old
- or BMI >27 with risk factors such as hypertension, diabetes, dyslipidemia
How do you take orlistat
120mg TDS with meals containing fat
Whats another version of orilstat
Alli
Who can take Alli
- 18 years old
- for weight loss when used with rescued calorie and low fat diet
What is the dosage of Alli
- 60mg TID with meals containing fat
What are the side effects of orlistat
- Diarrhoea
- Steatorrhoea
- reduce intake of fat soluble vitamins in a small proportion of users
What fat is good
- subcutaneous fat seems protective
- internal fat e.g. liver fat is a problem
What is the Atkins diet
- max 20 grams of carbohydrates a day
- protein and fat as much as you like
What are some other dietary approaches to weight loss
- Low glycemic index diets
- low calorie diets with and without meal replacement
- intermittent fasting
What is a low GI index diet
- GI is the effect of carbohydrates on postprandial glycaemia
Who is the low GI index diet used for
- suggested for CHD and diabetes risk reduction but the evidence is weak
Why does the glycemic index have a mixed result
- Large individual difference in triglyceride, glucose and insulin response to indentical meals
- gut microbiome affected lipemia (more than food content) but not glycemic
- genes play some role for glucose but not for lipids and C-Peptide
What is the 5:2 diet
2 non consecutive days on 500/600 kcal
- then rest of the day can eat food
- seems to make Intermittent fasting easier
Name some appetite suppressant medication used for weight loss
- Mehtylcellulus
- Amphetamine derivatives - withdrawal
- Sibutramine - Withdrawn
- Rimonabant - Withdrawn - risk of suicide
- GLP-1 agonists are successful in diabetes and effective in weight loss
What is Liraglutide
- GLP-1 agonist
- have to be injected
- recommended by NICE as part of a tripe therapy for diabetes and has been used for weight loss
How do GLP-1 agonists work
- daily subcutaneous injection
- makes patients fell more full and delays the speed that the stomach empties
What are the side effects for GLP-1 agonists
- some nausea and vomiting but not bad enough to make them stop taking the medication
- reports of pancreatitis
who is gastric surgery considered in
- Considered in BMI of greater than 40 or greater than 35 with co-morbidities
- e.g. T2DM, sleep apnoea, high blood pressure or arthritis requiring joint replacement
What are the two types of surgical procedures for weight loss
- restrictive
- restrictive and malabsorption
Name a restrictive and malabsorption procedure
- Roux-en Y bypass
Name a restrictive procedure
- gastric band
What are the possible aftermath to a surgical weight loss procedure
- Skin flaps reducing aesthetic gain
- suicides
- post surgery addictions to gambling, alcohol and narcotics - but this is rare
What is a gastric aspiration
- tube in stomach, button in abdomen, apparatus to carry along
- chew slowly
- 1/3 of stomach contents flushed into loo after meal over 5-10 minutes
