obesity management Flashcards
what does obesity management include
obesity management targets health-related improvements
1. dietary/ nutrition intervention
2. medical nutrition therapy
3. physical activity
4. behavioural approaches
5. pharmacological agents
6. surgery, psychotherapy
what are the 5As of obesity management for adults
- ask for permission to discuss weight and explore readiness
- assess obesity related risk and root causes of obesity
- advise on health risks and treatment options
- agree on health outcomes and behavioural goals
- assist in accessing appropriate resources and providers
5as guiding principle
- obesity is a chronic condition
- obesity management is about improving health and well-being, not simply reducing weight on a scale
- early intervention means addressing root causes and removing roadblocks
- a patient’s “best” weight may never be an “ideal” weight
what are some key messages for healthcare providers?
- healthy eating for all
- no single “one size fits all” eating pattern
- emphasize food quality, healthy relationship with food
- goal is to improve health outcomes and quality of life
- energy restriction is often not sustainable long term
- increased risk for micronutrient deficiencies
- refer/collaborae with RDs
medical nutrition therapy. Why a person come to see you (their objectifs)
- changes in eating behaviours
- weight loss/ weight stabilization/ prevention of weight regain
- reduction in risk factors (diabetes, hyperlipidemia, hypertension)
- reduction in complications, medication
- eligibility for surgery
- psychosocial adjustment
what are the benefits of weight loss
- Diabetes control: high glucose tolerance, high insulin sensitivity, decrease need for glucose lowering medications
- cardiovascular risk/diseases : decrease triglycerides, LDL, raises HDL
- hypertension : decrease systolic blood pressure, blood volume, cardiac output, sympathetic act and antihypertensive medication
what is the benefit of a 10 kg weight loss in mortality
mortality :
20-25% fall in total mortality
30-40% fall in diabetes related deaths
40-50% fall in obesity-related cancer deaths
what is the benefit of a 10 kg weight loss in bp
blood pressure:
fall of systolic and diastolic
what is the benefit of a 10 kg weight loss in angina
angina:
91% reduction symptoms
33% increase in exercise tolerance
what is the benefit of a 10 kg weight loss in lipids
lipids:
10% fall in total cholesterol
15% fall in LDL cholesterol
30% fall in triglycerides
8% increase in HDL
what is the benefit of a 10 kg weight loss in diabetes
> 50% reduction in risk of developing diabetes
30-50% fall in fasting blood glucose
15% fall in HbA
what is the difference in the diet when you want to loose weight vc maintain
loose weight : hypocaloric diet
maintain weight: isocaloric diet
what are the limitation when you are calculating the amount of time that a person will loose weight
there is a plateau (forbes equation) that it does not take into consideration, meaning that the person will take more time to loose that weight because of the lean body mass
how do we estimate target weight
- need to put a realistic goal
-Aim to reach a heathy BMI upper range or even more if a person in really obese (changing the BMI quadrant is good) - for people with obesity aim for a more modest weight loss (5-10%)
- if more weight is to be lost, could be stepwise ( loss -> stable -> loss -> stable)
what is the % of weight that a person with obesity needs to lose that will be modest
5-10%
What will the stepwise approach allow?
Allow the patient to adjust to behavioural modifications, readjust energy expenditure and energy metabolism.
what is the protein needed to take in weight reduction
25-30% during weight loss
what is the protein needed to take in weight reduction g/kg/d
<800 cal
800-1200 cal
>1200
<800 cal : more than 1.5g/kg/d
800-1200 cal: 1.2-1.5 g/kg/d
>1200: 1.0-1.2
what are the priorities in a balanced diet
increase diet quality
create energy defecit
avoid nutritional deficiencies
preserve lean mass
promote long term adherence (avoid hunger)
In weight management for obesity we want to __
change behavioral and dietary habits for life
what are the results in a study about high protein diet during weight loss
REDUCTION in body weight, fat mass, serum triglycerides
LESS loss in fat free mass
NO DIFF in total cholesterol, HDL, LDL, BP, fasting glucose and insullin
in 4 groups of study ( LP - HGI), (HP-HGI), (HP-LGI), (HP,LGI) which of these groups maintained their weight and how it was their N losses
High protein a low glycemic index maintained their weight loss and their N losses were +
what is the diff between high and low protein weight maintenance
high protein : less dropout, less weight regain
in a national weight control registry what was their criteria for people to register
they needed to have lost 30lbs (13.6kg) and maintained for over a year
the majority of the people who achieved losing 13kg for one year had the … method
diet + pa
what was the common features of those participants
- continue low energy, low fat, minimal variation
- eat breakfast
- exercise on average 1h/day
- weigh themselves once a week
- watch less than 10h of tv per week
how much protein do you need for maintenance
15-20%
how can you educate people
- content of a healthy plate
- normale portion sizes
- read food labels
- limit highly processed foods
- be aware of food marketing
- healthy eating habits
(take time to eat, notice when you are hungry and when you are full. Cook more often, enjoy your food, eat with others)
are people physically active in canada
half of people is not
physically activity … with increasing age
increase
what are the new physical activity recommendation
150 min of moderate/vigorous aerobic per week
what is the evidence that it is good to do physical act
active adults have at least 20-30% reduced risk of premature mortality
true or false
even modest enhancement in fitness in sedentary people has a huge impact in health
true
what is the evidence of decrease risk with mortality in aerobic fitness
little physical activity will decrease by a lot the chance of morality (almost 30%)
what are some disease related health benefits by doing pa by fallowing the guidelines
decrease osteporosis, decretion diabetes, decrease stroke, decretion of weight gain
what are the canadian guidelines says
- physical activity
- light physical act
- sleep
- less sedentary behavior
physical activity and weight loss say if there is a strong evidence or not
- PA to prevent weight gain
- PA for weight loss
-PA for weight maintenance after weight loss
-lifestyle PA - PA and diet restriction
- resistance training for weight loss
- PA to prevent weight gain = strong
- PA for weight loss = not strong
-PA for weight maintenance after weight loss = not strong
-lifestyle PA = not strong - PA and diet restriction = strong
- resistance training for weight loss = not strong
physical activity in obese management
- aerobic physical activity (30-60) can decrease liver fat an heart fat even in the absence of weight loss
- regular physical activity with out without weight loss can improve many cardiometabolic risk factor in adults who have overweight and obesity
what are some behaviours modifications in weight management
increase awareness to change eating habits
increase physical activity
alter attitudes
develop support system
educate about nutritiom
how can you change your eating habits
enhance self-awareness
minimize constant exposure to food
interrupt negative behavior chains
what are the 4 medications indicated for long-term obesity
- liraglutide (saxenda)
- naltrexone (contrave)
- orlistat (xenical)
- semaglutide (wegovy)
what happen when you stop taking the obesity medication
you regain weight
orlistat function
lipase inhibitor
what is the efficacy of it
improve blood pressure, lipids and glycemia
what are the sides effects of orlistat
fatty stools, fecal urgency and incontinence, losses in vit A,D,E,K
Function of naltrexone
opiod receptor antagonist
what is the efficacy of naltrexone
improved lipds, glycemia but increased bp
what are the sides effects of naltrexone
nausea, constipation, headache, dry mouth, dizziness, diarrhea
liraflutide function
Injection
glucagon-like peptide analog - induces satiety. Increase insulin and decreasing glucagon
what is the efficacy of liraglutide
improved blood pressure, lpids, glucemia and more
wegovy medication diff than the others why
huge weight loss, more than the others
what is the problem of the semagluide:wegovy
people non obese are using to loose weight
what are the benefits of semaglutide
waist circ, BP, A1C, lipids, physical functioning.
84% of prediabtes reverted back to normoglycemia
