Obesity & Eating Disorders Flashcards
A BMI over what equals overweight or obese
Over 25 = overweight
Over 30 = obese
Obesity global epidemic stats
- Rates have tripled since 1975
- 38 million children under 5 were overweight or obese in 2019
- 39% of the world adult population was overweight with 13% obese in 2016
Why has obesity risen?
- Portion sizes
- Convenience food
- Food abundance/exposure
- Flavour enhancers
- Alcohol
- Snacking
- Speed of eating
Drivers of obesity:
How does a sedentary lifestyle add to this?
- Reduced energy expenditure
- Exercise increases glucose uptake and mitochondrial activity
Drivers of obesity:
Sleep
Sleep disruption creates hormonal imbalance that promotes overeating and weight gain
- Reduced glucose tolerance and insulin sensitivity
- Inflammatory pathways are activated
Work on sleep hygiene - epsom salts, stress, valerian, B6
Drivers of obesity:
Chronobiology (shift work, sleep deprivation, exposure to light at night increase adiposity)
Irregular eating patterns affect circadian rhythm and glucose control
Drivers of obesity: processed foods - palatability
Strong dopamine stimulators - fat, starch, alcohol, caffeine
Bliss point - combining fat, sugar and salt to maximise dopamine release
Artificially sweetened drinks have a 47% higher risk of increased BMI
Drivers of obesity:
High cortisol
An overactive HPA axis includes high GI consumption, stress, pain, alcohol, sleep deprivation
Stress can equal eating 50% more food and eating energy dense comfort foods
Drivers of obesity: Microbiome
E.g Lack of akkermansia munciniphilia
Drivers of obesity:
Genes
E.g A SNP on FTO is a strong predictor of obesity
Insulin resistance causes and risk factors:
Reduced physical activity
Chronic stress
Poor methylation
Dysbiosis
Signs and symptoms of insulin resistance
Lethargy
Hunger
Brain fog
Overweight
High blood pressure
High blood glucose
Naturopatic approach to insulin resistance
- Stabilise blood glucose levels
Increase fibre - it slows gastric emptying and a slower release of glucose
Restrict calories
Increase protein especially at breakfast as it helps normalise insulin secretion
Avoid processed food
B vits, chromium, magnesium
Naturopathic approach to insulin resistance
- Reduce inflammation
- Avoid inflammatory foods e.g damaged fats and refined carbs
- Increase antioxidants
- Prioritise sleep
- Green tea polyphenols help HBA1C
- Prebiotic foods e.g leeks, onions, chicory
Naturopathic approach to insulin sensitivity
Optimise insulin sensitivity
- Time restricted eating
- Increase exercise
- Vit D, zinc, chromium
Fasting glucose should be this for the lowest mortality
4.4-5.2mmol/l
How to reduce obesity
Chew well - 30 times
Palm sized protein with every meal
Fasting 16:8
Smaller portions
Exercise daily: 35 mins low intensity
Always have breakfast
5HTP obesity function
Increase satiety
Promotes sleep (enhances melatonin production)
50-100mg twice daily
Green tea obesity function
Polyphenols may stimulate thermogenesis and far oxidation
600-900mg daily
(3-4 cups of green tea)
L- carnitine obesity function
Improves leptin resistance
Reduces BMI and fat mass
Up to 2000mg daily
Chromium obesity function
Increases insulin sensitivity
Reduces carb cravings
Increases lean body mass
200-1000mcg chromoum picolinate
Breaking habits
Identify the cue
Change the routine
Change the reward
Repetition is key
Eating disorder environmental risk factors
Bullying and abuse
Difficult family relationships
Media - body image
Sports e.g ballet, dancing
Eating disorder genetics
SNPs
Family history
Deficiencies e.g efa, zinc
Perfectionism
Anorexia Nervosa characteristics
Low body weight
Fear of gaining weight
Distorted perception
10% of all eating disorder
Adolescence/early adulthood onset
Males 25%
50% recover
Anorexia signs and symptoms (behavioural)
Excessive calorie counting
Avoiding all fats
Vegan/vegetarian
Overexercising
Excessive water intake/appetite supressants
Socially isolated esp around mealtimes
Anorexia symptoms physical
Lack of energy
Poor stress resilience
Dizzy spells
Amenorrhoea
Constipation
Poor concentration
Anoreixa concomitanr symptoms and complications
Anxiety and depression
Poor skin, hair and nails
Poor immunity
Food intolerances
Menstrual irregularities
Diagnosing anorexia
Intense fear of gaining weight
BMI 17.5 and under
Body dysmorphia
Denies weight is an issue
Dark circles under eyes
Low mood due to less tryptophan
Baggy clothing
Anorexia nutrient deficiencies
Zinc
Confusion
Depression
Low stomach acid
Recurrent infections
Loss of motivation
Anorexia symptom deficiencies (magnesium)
Irritability
Constipation
Depression
Insomnia
Anorexia tryptophan symptoms
Anxiety
Low mood
Bow irregularity
Anorexia protein deficiency
Fatigue and weakness
Poor hair, skin and nails
Anorexia Omega 3 deficiency
Depression
Dry skin
Anorexia B vits symptoms
Anxiety
Confusion
Poor stress resilience
Anorexia naturopathic nutrition aims
Redefine relationship with food
Build a rapport and gain trust
Emphasis on nutrients and health not kcal and weight
Correct deficiencies
Anorexia consultation
Keep focus on nutrients
Never recommend exclusions e.g gluten or dairy unless clear evidence ro help health
Contain own self beliefs
Avoid conversations about calories
Do not discourage foods e.g chocolate etc just focus on reintroducing foods
Anorexia therapeutics - weight gain
Focus on nutrient dense warming foods
Include bitters and probiotics
Introduce essential fats for reproductive function
Be empathetic but stay firm and consistent
Focus on health not BMI
Keep plans simple
Anorexia therapeutics re-establishing healthy eating
Focus on high energy, calorie and nutrient rich foods
Co create a plan
Acknowledge fear foods and try to expand safe foods list
Only ask for food diary if necessary
Negotiate how much willing to eat. It doesn’t need to be 3 meals and 2 snacks
Anorexia therapeutics - high calorie nutrient dense foods
Nut butters
Avocado
Quinoa
Eggs
Omega 3 fish
Natural yog
Anorexia therapeutics - supplements
Zinc - must always be included as it helps with weight gain and depression (plus B6 for absorption
Probiotics - yoghurt with certain strains increase immunity
L-arginine is cardioprotective
Anorexia bach flowers
White chestnut - obsessive thinking
Star of Bethlehem - past trauma
Rock water - perfection
Aspen - anxiety/impending doom
Bulimia characteristics
Bingeing followed by inappropriate methods of weight control
Subtypes - Purging (vomiting, laxatives, diuretics, enemas)
Non purging (fasting, excessive exercise)
Must happen 2x week for 3 months
Bulimia signs and symptoms
Normal to slightly overweight
Fasting/laxative abuse
Binge eating
Visiting toilet after meals
Frequent weight changes
Associated depression/anxiety
Tooth erosion
Bulimia causes/risk factors
Shift working
Alcohol consumption
Glucose/food intolerances
Jobs which require weight control
