Obesity and weight control

Question 1

Clinically severe obesity BMI Canada vs US

Answer 1

Canada: >35 (class 2)
US: >40 (class 3)

Question 2

conclusion of Biggest Loser TV series

Answer 2

metabolic adaptations persists over time:
weight regained super easily –> metabolic adaption will continuously act to counter efforts fo reduce body weight –> set point theory!

Question 3

Set point theory for fat storage levels defines what?

Answer 3

levels of energy reserves considered adequate or normal

Question 4

What limits conscious effort to lose weight?

Answer 4

self-preservation processes

Question 5

1. Stigma and bias like what?
2. impact on culture?
3. negative cycle –> leads to ?

Answer 5

• negative attitudes, judgments, stereotypes
• stigmatizes individuals, media, healthcare professionals, workplace prejudice
• obesity/weight based stigma –> stress –> increased eating and increased cortisol –> weight gain –> repeat
• leads to poor self-esteem

Question 6

Graphs: overweight vs obesity –> which increases/stays constant? why?

Answer 6

Overweight: stable
Obesity –> increases: genetic/emotional vulnerability

Question 7

Obesity definition –> consequences

Answer 7

complex disease characterized by abnormal/excessive body fat –> decreases health, quality of life and lifespan

Question 8

Obesity management should focus on_______ and not ______

Answer 8

on improved health and well-being! not on weight loss

Question 9

control of appetite involves (3)

Answer 9

hypothalamus (homeostatic control), mesolimbic system (hedonic control, reward system) and frontal lobe (executive control)

Question 10

Patient journey in obesity management (5)

Answer 10

1. ask permission recognize obesity as chronic disease
2. assess story. root causes, what is involved
3. advise on management –> focus on lifestyle changes!
4. agree on goals: personalized and sustainable action plan
5. assist with drivers and barriers: follow-ups and assessments

Question 11

Core treatment methods for obesity

Answer 11

medical nutrition therapy (dietician) + exercise

Question 12

adjunctive therapies for obesity

Answer 12

psychological (sleep, time, stress, psychotherapy, behavior change) + medications + bariatric surgery

Question 13

What did the Canadian Clinical practice guidelines miss?

Answer 13

Food environment! link between socioeconomics status and obesity

Question 14

Realistic goals –> improve ________ vs numbers on scale –> examples

Answer 14

improve health measures! improve blood glucose, high blood pressure, blood lipids, physical fitness

Question 15

Realistic weight loss goal

Answer 15

5-10% of starting weight

Question 16

why is gradual weight loss preferred? (3)

Answer 16

preserve lean body mass + less metabolic adaptation + more sustainable

Question 17

is higher protein better than restricting calories?

Answer 17

protein more satiating + protects lean tissue BUT ANY DIET: need to adhere to it + caloric deficit for weight loss

Question 18

Carbohydrate-insulin model?

Answer 18

increase ultraprocessed food = excess caloric intake = higher glycemic index + fat - increase fat deposition in body bc hormonal responses to high glycemic load diet

Question 19

Advantages of physical activity for weight loss (5)

Answer 19

increase metabolism, improve body composition, increase health, reduced/better controlled appetite after exercising, stress reduction

Question 20

What is a fad diet? what are some signs of fad diets?

Answer 20

Give rapid results but difficult to sustain –> often extreme: cutting off entire food groups.
testimonials, fails to mention risks, reset metabolism, single food = key to success, unrealistic…

Question 21

Sleeve gastrectomy (4)

Answer 21

• irreversible
• 2/3 stomach removed, leaving sleeve/tube behind
• reduce size of stomach = patients feel fuller soon
• hormonal circuit changed = metabolic response

Question 22

Gastric bypass (3)

Answer 22

• reversible
• reduce stomach size to size of egg + bypass first section of small intestine
• restrictive + malabsorptive

Question 23

Duodenal switch (2). reserved for who?

Answer 23

• irreversible
• sleeve gastrectomy + bypass 80% of small intestine
• reserved for BMI >70 –> lack of nutrients could be a concern

Question 24

Adjustable gastric band

Answer 24

• band restricts size of stomach –> food is limited, passes through digestive track more slowly
• not recommended by Canadian guideline
• band can fall apart + not good for long term

Question 25

Complications of bariatric surgeries (6)

Answer 25

• infections, nausea/vomiting, dehydration, deficiencies, psychological problems
• alters expression of gut and adipose tissue hormones

Question 26

“Benefit” of bariatric surgeries

Answer 26

We don’t see compensatory decrease in metabolic rate!

Question 27

Bariatric surgeries reserved for ?

Answer 27

BMI > 40 (class 3)
OR BMI >35 (class 2) with at least one obesity related disease (diabetes, hypertension)

Question 28

only 1 prescribed medication in Canada is approved:

Answer 28

Orlistat (Xenical): inhibits pancreatic lipase –> blocks fat absorption by about 30%