Obesity and Hypertension (Week 12) Flashcards
Key messages for people living with obesity
Focus on co-morbid problems first and how nutrition will help that
* focus on improving food quality
What are some changes that can be suggested to imrpove eating habits?
- mindful eating
- Eating at home
- Wary of food marketing
- Eat protein foods
- Water choice beverage
- Eating more fruits and veggies
- Understand hunger cues
- Enjoy cultural foods
Anthropometric measurements to take for obesity
Assess degree of overweight or % body fat (e.g. skin folds, waist hip circumferences, bioelectrical impedance, DXA)
BMI
* Measures degree of overweight/obesity
* No special technical requirements
* Allows measurements over time by different individuals
* better as a screening tool then for individual body comp
WC
* In conjunction with BMI can help assess risk CAD/type 2 diabetes
* >88 for for women
* >102 for men
Obesity risk factors Associated with mortality
- CHD
- atherosclerotic diseases (PVD, CVD)
- Type 2 Diabetes
- sleep apnea
Obesity risk factors
- gynecological
- osteoarthritis
- gallstones
- stress incontinence
- elevated triglycerides
- Other CVD risk factors (e.g hypertension, hypercholesterolemia)
- NAFLD
- PCOS
Obesity treatment planning
Include all information gathered in assessment and in addition:
* Client’s point of view (etiology, desired outcomes)
* Attempt to understand client’s perspective
* Treatment plan agreeable to both (client and health care provider)
* Flexibility, evaluation, modification
FAD diets
Very often are not adequate
* entire food groups omitted
* overall calories not sufficient for micronutrients
* ↑Fat ↓CHO diets: low in vitamin E and A, thiamin, B6, folate, Ca, Mg, Fe, K, and fibre
* Very ↓Fat diets: low in vitamin E, B12, Zn
* May not be medically sound (e.g. very low CHO diet may lead to ketosis)
* Initial weight loss but difficult to maintain
Common FAD diets
- calorie reduced diets
- prepackaged meal plans
- Atkins/ PSMF
- Zone
- South Beach
- Weight watchers
Calories reduced diets
Usually prescribed when weight loss is desired outcome of nutrition counseling
* Reduction in fat and total calories (500-1000kcals/d; 1-2 lbs/wk)
* severely restricting calories for extended time
* Food choices high in fibre
What is PSMF?
protein sparing modified fast
* high protein diet (2-3g/kg) with limited CHO (1-2% w/v max). No dairy, fruits/vegetables or grains, particularly in the initial stages
* Low CHO facilitates a metabolic state of increasing ketosis (not ketoacidosis), rapid weight loss, and appetite suppression, “sparing of lean mass’.
* Goal is to protect lean body stores and promote fat loss of fat mass
* NUTRITIONALLY INCOMPLETE; requires close monitoring of electrolytes, fluid status.
* DEFICIENT in potassium and many other nutrients. Patients have to be medically monitored.
* Rarely utilized due to the dangers related to electrolyte disturbances; risk for cardiac arrythmias.
* Other Fad diets:allow higher amount of CHO
Popular diets at a glance
Obesity and being active
National health messages have shifted from promoting exercise to promoting physical activity
* Health benefits regardless of mode, intensity or duration.
* Overall goal for Canadians to accumulate at least 60 minutes of physical activity every day (in periods of at least 10 minutes each).
obesity behavioural modification
- Generation of permanent change of lifestyle habits
- Decrease, change, or eradicate those habits that have caused or contributed to weight gain
- Self-understanding, monitoring is vital to be aware of habits
What causes hypertension?
Primary or Essential Hypertension
* No obvious cause
* Related to combination of genetics and lifestyle factors (diet)
Secondary Hypertension
* Caused by other medical conditions such as: CVD, DM or renal disease (#1), Endocrine disorders
What is hypertension?
High Blood Pressure
* one of the leading causes of death (largely asymptomatic and may go undiagnosed for years)
* 95% primary/essential hypertension
* 5% secondary hypertension
hypertension diagnosis
DBP is defining feature of increased risk for stroke
Basic lab tests for primary HT
- fasting blood glucose (cardiometabolic disregulation)
- CBC (BP can go up with infection)
- lipid profile (metabolic disregulation)
- serum creatinine with eGFR (renal disease)
- Serum Na, K, Ca (influence BP)
- TSH (indrect impact of BP)
Medication treatment for HTN
- ACE inhibitors
- ARB
- Beta blockers
- thiazide & thiazide like-diuretics
- calcium channel blockers
Know functions
HTN lifestyle treatment
- Physical Activity
- Weight Reduction
- Alcohol Consumption (reduce ox stress to vessels)
- Stress Management (reduce chronic levels of cortisol)
- Diet (Dietary Patterns, Sodium, Potassium)
Diet therapies for HTN
- DASH diet
- MED diet
- Portfolio diet
DASH diet
Very good evidence for prevention and anagement and with meds improved outcomes
* More emphasis on eating foods higher in potassium
* High quality plant based sources
* Healthy fats
* Similar to mediteranean
* Different from CFG where not filled with 1/2 grains + F/V
MED diet
Less evidece for HT alone but CVD prevention
* Emphasis on fish and seafood compared to DASH (omega 3 and healthy fats)
* Anti oxidant and anti inflammatory focused diet (full of polyphenols)
* Makes you think about types of oils consuming as well choosing extra virgin olive oil
* See more commonality with CFG in focusing on plant based diet but CFG does not talk about polyphenols and does not focus on fish intake
* Similar to DASH in that it tries to reduce sodium intake
Diet Comparisons between Diet
Approaches
Diets compared to population actual intake
portfolio diet
More about improving CVD over obesity with 4 foods
* nuts
* soluble viscous fibre
* soy protein
* plant sterols
