Obesity and weight control Flashcards
Clinically severe obesity BMI Canada vs US
Canada: >35 (class 2)
US: >40 (class 3)
conclusion of Biggest Loser TV series
metabolic adaptations persists over time:
weight regained super easily –> metabolic adaption will continuously act to counter efforts fo reduce body weight –> set point theory!
Set point theory for fat storage levels defines what?
levels of energy reserves considered adequate or normal
What limits conscious effort to lose weight?
self-preservation processes
- Stigma and bias like what?
- impact on culture?
- negative cycle –> leads to ?
- 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
Graphs: overweight vs obesity –> which increases/stays constant? why?
Overweight: stable
Obesity –> increases: genetic/emotional vulnerability
Obesity definition –> consequences
complex disease characterized by abnormal/excessive body fat –> decreases health, quality of life and lifespan
Obesity management should focus on_______ and not ______
on improved health and well-being! not on weight loss
control of appetite involves (3)
hypothalamus (homeostatic control), mesolimbic system (hedonic control, reward system) and frontal lobe (executive control)
Patient journey in obesity management (5)
- ask permission recognize obesity as chronic disease
- assess story. root causes, what is involved
- advise on management –> focus on lifestyle changes!
- agree on goals: personalized and sustainable action plan
- assist with drivers and barriers: follow-ups and assessments
Core treatment methods for obesity
medical nutrition therapy (dietician) + exercise
adjunctive therapies for obesity
psychological (sleep, time, stress, psychotherapy, behavior change) + medications + bariatric surgery
What did the Canadian Clinical practice guidelines miss?
Food environment! link between socioeconomics status and obesity
Realistic goals –> improve ________ vs numbers on scale –> examples
improve health measures! improve blood glucose, high blood pressure, blood lipids, physical fitness
Realistic weight loss goal
5-10% of starting weight
why is gradual weight loss preferred? (3)
preserve lean body mass + less metabolic adaptation + more sustainable
is higher protein better than restricting calories?
protein more satiating + protects lean tissue BUT ANY DIET: need to adhere to it + caloric deficit for weight loss
Carbohydrate-insulin model?
increase ultraprocessed food = excess caloric intake = higher glycemic index + fat - increase fat deposition in body bc hormonal responses to high glycemic load diet
Advantages of physical activity for weight loss (5)
increase metabolism, improve body composition, increase health, reduced/better controlled appetite after exercising, stress reduction
What is a fad diet? what are some signs of fad diets?
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…
Sleeve gastrectomy (4)
- irreversible
- 2/3 stomach removed, leaving sleeve/tube behind
- reduce size of stomach = patients feel fuller soon
- hormonal circuit changed = metabolic response
Gastric bypass (3)
- reversible
- reduce stomach size to size of egg + bypass first section of small intestine
- restrictive + malabsorptive
Duodenal switch (2). reserved for who?
- irreversible
- sleeve gastrectomy + bypass 80% of small intestine
- reserved for BMI >70 –> lack of nutrients could be a concern
Adjustable gastric band
- 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
Complications of bariatric surgeries (6)
- infections, nausea/vomiting, dehydration, deficiencies, psychological problems
- alters expression of gut and adipose tissue hormones
“Benefit” of bariatric surgeries
We don’t see compensatory decrease in metabolic rate!
Bariatric surgeries reserved for ?
BMI > 40 (class 3)
OR BMI >35 (class 2) with at least one obesity related disease (diabetes, hypertension)
only 1 prescribed medication in Canada is approved:
Orlistat (Xenical): inhibits pancreatic lipase –> blocks fat absorption by about 30%
