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Clinical nutrition > obesity management > Flashcards

obesity management Flashcards

1
Q

what does obesity management include

A

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

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2
Q

what are the 5As of obesity management for adults

A
  1. ask for permission to discuss weight and explore readiness
  2. assess obesity related risk and root causes of obesity
  3. advise on health risks and treatment options
  4. agree on health outcomes and behavioural goals
  5. assist in accessing appropriate resources and providers
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3
Q

5as guiding principle

A
  • 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
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4
Q

what are some key messages for healthcare providers?

A
  • 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
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5
Q

medical nutrition therapy. Why a person come to see you (their objectifs)

A
  • 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
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6
Q

what are the benefits of weight loss

A
  • 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
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7
Q

what is the benefit of a 10 kg weight loss in mortality

A

mortality :
20-25% fall in total mortality
30-40% fall in diabetes related deaths
40-50% fall in obesity-related cancer deaths

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8
Q

what is the benefit of a 10 kg weight loss in bp

A

blood pressure:
fall of systolic and diastolic

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9
Q

what is the benefit of a 10 kg weight loss in angina

A

angina:
91% reduction symptoms
33% increase in exercise tolerance

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10
Q

what is the benefit of a 10 kg weight loss in lipids

A

lipids:
10% fall in total cholesterol
15% fall in LDL cholesterol
30% fall in triglycerides
8% increase in HDL

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11
Q

what is the benefit of a 10 kg weight loss in diabetes

A

> 50% reduction in risk of developing diabetes
30-50% fall in fasting blood glucose
15% fall in HbA

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12
Q

what is the difference in the diet when you want to loose weight vc maintain

A

loose weight : hypocaloric diet
maintain weight: isocaloric diet

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13
Q

what are the limitation when you are calculating the amount of time that a person will loose weight

A

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

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14
Q

how do we estimate target weight

A
  • 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)
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15
Q

what is the % of weight that a person with obesity needs to lose that will be modest

A

5-10%

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16
Q

What will the stepwise approach allow?

A

Allow the patient to adjust to behavioural modifications, readjust energy expenditure and energy metabolism.

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17
Q

what is the protein needed to take in weight reduction

A

25-30% during weight loss

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18
Q

what is the protein needed to take in weight reduction g/kg/d

<800 cal
800-1200 cal
>1200

A

<800 cal : more than 1.5g/kg/d
800-1200 cal: 1.2-1.5 g/kg/d
>1200: 1.0-1.2

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19
Q

what are the priorities in a balanced diet

A

increase diet quality
create energy defecit
avoid nutritional deficiencies
preserve lean mass
promote long term adherence (avoid hunger)

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20
Q

In weight management for obesity we want to __

A

change behavioral and dietary habits for life

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21
Q

what are the results in a study about high protein diet during weight loss

A

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

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22
Q

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

A

High protein a low glycemic index maintained their weight loss and their N losses were +

23
Q

what is the diff between high and low protein weight maintenance

A

high protein : less dropout, less weight regain

24
Q

in a national weight control registry what was their criteria for people to register

A

they needed to have lost 30lbs (13.6kg) and maintained for over a year

25
Q

the majority of the people who achieved losing 13kg for one year had the … method

A

diet + pa

26
Q

what was the common features of those participants

A
  • 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
27
Q

how much protein do you need for maintenance

A

15-20%

28
Q

how can you educate people

A
  • 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)
29
Q

are people physically active in canada

A

half of people is not

30
Q

physically activity … with increasing age

A

increase

31
Q

what are the new physical activity recommendation

A

150 min of moderate/vigorous aerobic per week

32
Q

what is the evidence that it is good to do physical act

A

active adults have at least 20-30% reduced risk of premature mortality

33
Q

true or false
even modest enhancement in fitness in sedentary people has a huge impact in health

A

true

34
Q

what is the evidence of decrease risk with mortality in aerobic fitness

A

little physical activity will decrease by a lot the chance of morality (almost 30%)

35
Q

what are some disease related health benefits by doing pa by fallowing the guidelines

A

decrease osteporosis, decretion diabetes, decrease stroke, decretion of weight gain

36
Q

what are the canadian guidelines says

A
  • physical activity
  • light physical act
  • sleep
  • less sedentary behavior
37
Q

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
A
  • 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
38
Q

physical activity in obese management

A
  1. aerobic physical activity (30-60) can decrease liver fat an heart fat even in the absence of weight loss
  2. regular physical activity with out without weight loss can improve many cardiometabolic risk factor in adults who have overweight and obesity
39
Q

what are some behaviours modifications in weight management

A

increase awareness to change eating habits
increase physical activity
alter attitudes
develop support system
educate about nutritiom

40
Q

how can you change your eating habits

A

enhance self-awareness
minimize constant exposure to food
interrupt negative behavior chains

41
Q

what are the 4 medications indicated for long-term obesity

A
  1. liraglutide (saxenda)
  2. naltrexone (contrave)
  3. orlistat (xenical)
  4. semaglutide (wegovy)
42
Q

what happen when you stop taking the obesity medication

A

you regain weight

43
Q

orlistat function

A

lipase inhibitor

44
Q

what is the efficacy of it

A

improve blood pressure, lipids and glycemia

45
Q

what are the sides effects of orlistat

A

fatty stools, fecal urgency and incontinence, losses in vit A,D,E,K

46
Q

Function of naltrexone

A

opiod receptor antagonist

47
Q

what is the efficacy of naltrexone

A

improved lipds, glycemia but increased bp

48
Q

what are the sides effects of naltrexone

A

nausea, constipation, headache, dry mouth, dizziness, diarrhea

49
Q

liraflutide function

A

Injection
glucagon-like peptide analog - induces satiety. Increase insulin and decreasing glucagon

50
Q

what is the efficacy of liraglutide

A

improved blood pressure, lpids, glucemia and more

51
Q

wegovy medication diff than the others why

A

huge weight loss, more than the others

52
Q

what is the problem of the semagluide:wegovy

A

people non obese are using to loose weight

53
Q

what are the benefits of semaglutide

A

waist circ, BP, A1C, lipids, physical functioning.

84% of prediabtes reverted back to normoglycemia

Clinical nutrition (11 decks)

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