Obesity II Flashcards
What are the 3 general goals related to weight management?
- Prevention of weight gain (~1 pound per year)
- Losing weight
- Maintaining weight loss
What is the natural course of weight gain with age?
Approximately 1 pound per year.
What defines clinically significant weight loss?
> 5% of baseline body weight.
What are the benefits of clinically significant weight loss?
Reduces risk factors for cardiovascular disease and type 2 diabetes.
What are the main strategies to achieve weight loss?
Diet, exercise, medications, surgery, or a combination of these.
Why is it hard to maintain energy balance in a state of low energy flux?
Low energy flux leads to issues with satiety signals, preference for sweet/high-fat foods, and social difficulties. The body tries to hold onto weight, especially when older.
What is the minimum recommended amount of moderate to vigorous physical activity per week to prevent weight gain?
150 minutes
What does FITT stand for in the context of exercise?
Frequency, Intensity, Time, and Type.
What two factors determine the total volume of physical activity?
Frequency x Time, which is also related to energy expenditure
How does increased energy expenditure (EE) help with weight loss?
Effect on energy balance is proportional to increase in EE; it increases fat and CHO oxidation which may lead to favorable health consequences.
What are some reasons why increasing EE for weight loss might not work?
Achievable exercise leads to small increases in EE, poor adherence, and possible compensatory increases in energy intake.
What is the STRRIDE trial and what were its findings?
An 8-month training study with a mean age of 52 and BMI of ~30 kg/m2 that examined the effects of exercise on body weight, fat mass, and lean mass.
What is the relationship between volume of physical activity and weight/fat loss?
There is a dose-response relationship: increased volume of PA is linked to increased weight loss and fat loss.
What is the difference between short bouts and long bouts of exercise for weight loss?
Initial weight loss is similar between short and long bouts if adherence is the same. Better adherence allows for maintenance and prevents regain.
What are the benefits of high-intensity exercise?
Same energy expenditure in less time, greater improvements in fitness and risk factors, greater preservation of fat-free mass, decreased appetite, and can be more enjoyable for some.
What are the drawbacks of high-intensity exercise?
Can be less enjoyable, less accessible, greater risks/safety concerns, and lower self-efficacy.
What are three debated intensities for weight loss?
1) Low intensity (maximizes fat oxidation)
2) High intensity (HIIT)
3) Intensity that leads to highest energy expenditure.
What is Fatmax?
Intensity that maximizes fat oxidation, approximately 65% of VO2 max.
According to the Romijn figure, what is the intensity for greatest absolute fat oxidation?
~ 65%
According to the Romijn figure, what is the intensity for greatest relative fat oxidation?
~25%
According to the Romijn figure, what is the intensity for greatest caloric expenditure, relative CHO oxidation and absolute CHO oxidation?
~85%
What is the effect of MICT/HIIT vs. MICT on weight loss over 24 weeks?
Similar EE, but 3kg greater weight loss in MICT/HIIT
MICT= moderate-intensity continuous training
What are some effects of high-intensity exercise?
Release of endorphins (better adherence) and suppression of appetite
What is key to a successful weight loss program?
Adherence
What is the role of resistance training for weight loss?
It is not very effective for weight loss alone but can contribute to changes in body composition
What are some of the reasons why resistance training may not be effective for weight loss?
The effect on FFM is small, especially during energy restriction, and the energy cost of resistance training is small.
How does resistance training affect muscle mass during diet-induced weight loss?
It can partially prevent the decrease in fat-free mass (FFM) and is critical for maintaining function, especially in older populations.
What is a key benefit of resistance training in older populations?
Attenuates muscle mass loss during weight loss and is critical to maintaining function.
What are the benefits of exercise for class II/III obesity?
Contributes to negative energy balance, improves health, quality of life, and response to bariatric surgery.
Why might exercise not work for class II/III obesity?
Low fitness, co-morbidities worsened by exercise, time/fatigue interferes with other activities
What did Marty, Chair of Obesity Canada Patient Engagement Committee, say about exercise for individuals with higher weights?
He noted that people with higher weights are not lazy and are getting exercise in daily activities by moving their bodies and performing normal tasks. He walks 2 hrs/day
In the Goodpaster study, what were the findings about initial vs delayed activity?
Both groups dieted for 12 months, but one group had activity from the start, while the other started after 6-12 months. Not everyone responds the same to these interventions.
What are some possible reasons for non-response to exercise in class II/III obesity?
Adherence, compensatory behaviors, and other factors related to energy intake and appetite.
What are some things to consider when designing exercise programs for individuals with obesity?
Access to facilities/equipment, adapted exercises, seating/changing facilities.
What are the recommendations for aerobic physical activity?
30-60 minutes of moderate to vigorous intensity most days of the week for fat/weight loss, visceral and ectopic fat reduction, weight maintenance, fat-free mass maintenance, and increased cardio-respiratory fitness.
What is the recommendation for resistance training in adults with overweight or obesity?
It may promote weight maintenance or modest increases in muscle/fat-free mass and mobility
What are the benefits of increasing exercise intensity?
Can achieve greater increases in cardiorespiratory fitness and reduce time needed for similar benefits as moderate-intensity activity
What are some cardiometabolic risk factors that can be improved with physical activity?
Hyperglycemia, insulin sensitivity, high blood pressure, and dyslipidemia
What are some other benefits of regular physical activity for adults with overweight or obesity?
Improved health-related quality of life, mood disorders, and body image.
What are some advantages of physical activity, beyond weight loss?
Fitness, quality of life/independence, improvements in risk factors, fat distribution/quality, and prevention of weight regain
What was the link between METs and risk of death?
Twice the risk of death in METS <5. Exercise capacity was the strongest predictor of death. 1 MET = 12% improvement in survival
What is the role of physical activity in preventing weight regain?
It plays an important role, but strong evidence from long-term RCTs is rare.
What amount of physical activity combined with diet allows for a >10% weight loss in overweight women?
275 mins/week of physical activity.
According to the lecture, what matters more when it comes to weight loss? How you lose the weight or how you prevent the regain?
How you prevent the regain
What is the definition of obesity according to the 2020 CMAJ guidelines?
A complex, progressive, and relapsing chronic disease characterized by abnormal or excessive body fat that impairs health
What are the screening tools for obesity?
BMI and waist circumference.
How should obesity be diagnosed?
Based on the presence of functional, medical, and/or psychosocial impairments related to excess body fat, rather than anthropometric measures alone
What should obesity management address, according to the guidelines?
It should use evidence-based chronic disease management principles, validate patients’ lived experiences, move beyond “eat less, move more,” and address root drivers of obesity
What are the recommended intervention areas for obesity?
Medical nutrition therapy, physical activity, psychological interventions, pharmacotherapy, and surgery
What is weight bias?
Prejudice or discrimination against people based on their weight
What is the 5-step approach for obesity management?
ASK, ASSESS, ADVISE, AGREE, ASSIST
What is the Edmonton Obesity Staging System (EOSS)?
A tool to determine the severity of obesity and guide clinical decision-making
