obesity symposium Flashcards
describe gut hormones for energy intake? 2
- Satiety= anorexigenic gut hormones (cholecystokinin (CCK), pancreatic polypeptide, peptide YY, glucagon-like peptide, oxyntomodulin)
- Hunger= orexigenic hormones (ghrelin)
how does the CNA drive energy intake?
- Interplay between gut hormones and the hypothalamus via the vagus nerve
how does adipose drive energy intake? 3
- Leptin is anorexigenic
- Reduces adiposity in rodents but not in humans
- Signaller for satiety in deficiency- signals starvation
name 2 stress hormones?
- adrenaline
- cortisol
describe genetics and obesity? 3
- MC4R mutation found in up to 5% of kids leading hyperphagia
- Leptin deficient individuals can be treated with leptin to treat obesity
- Appetite is genetically determining with a growing number of genetic mutations associated with small increases in appetite and higher prevalence of obesity
describe microbiomes and obesity?
- People at higher weight have less variety and quantity of microbes in their gut
describe external drivers for energy intake? 5
- Environment
- Economic
- Social
- Cultural
- Education
describe from idealism to pragmatism? 5
- People are often desperate to lose weight
- Weight gain is easy, weight loss is hard and maintaining weight loss is even harder
- Learning to listen and guide behaviour is more effective than giving advice
- Diet of starvation= binge is driven by and creates low self esteem
- Fat shaming is real and can lead to worse health outcomes
give examples of fear inducing statements? 4
- You ought
- You need
- You should
- I want
give examples of weight discussing questions? 5
- What’s been happening with your weight
- What are you planning to do?
- What are your thoughts?
- How is it working for you?
how will you fit that into your life? - What might get in the way?
describe the weight stigma and the effect on health? 4
- Fear of stigma can lead to avoidance of seeking medical care which creates barriers to obesity prevention
- Weight stigma is correlated with a variety of disordered eating patterns such as binge eating, emotional eating, restrictive eating and eating anxiety
- Plays a fundamental role in the development of metabolic syndrome
- In some cases, can cause suicidal acts
describe energy expenditure? 4
- BMR increases as you gain weight and decreases as you lose weight
- Muscle is more metabolically active
- Influenced by age and genetics
- Body protects from weight loss through metabolic adaptations to weight loss, and hunger in response to weight loss
describe the slowing of weight loss? 2
- Energy out= as we lose weight, the body’s metabolism slows, therefore we burn less calories at rest
- Energy in= feedback to regulation of body weight. The body will resist weight loss by increasing appetite
describe some important considerations when advising on dietary approaches for weight loss? 5
- Nutritionally adequacy
- Cultural acceptance
- Economic affordability
- Safety
- Efficacy
describe general healthy diet and lifestyle principles? 6
- Rich in high fibre foods
- Low in added sugar, refined grains and ultra-processed foods
- Increased physical activity
- High quality protein foods
- Realistic goal setting
- Healthcare professional support may be useful
describe low fat diets? 3
- Fat is the densest macronutrient; high fat foods may promote consumption of excess calories due to being highly palatable and poorly satiating
- Focus on the replacement of fat with fruit and vegetables as a method of ensuring nutritional adequacy
- Application of low-fat dietary guidelines and weight loss intervention have not led to a reduction of obesity prevalence in the UK
describe the Mediterranean diet? 3
- Fish, whole grains, fruit, vegetables, nuts, mono-unsaturated fats
- Moderate in alcohol
- Low in red meat and processed meat and sugary foods
describe meal replacements and low energy diets? 4
- 800 calories a day via liquid only
- Food reintroduction
- Weight maintenance support
- Can lead to constipation and weight regain
what is intermittent fasting? 2
- Restriction of overall energy intake via periods of restricted and unrestricted food intake
- May provide metabolic benefit
describe long term weight maintenance? 6
- Essential and often overlooked
- Diet quality
- Developing behavioural and self-monitoring skills
- Support
- Physical activity
- Individualisation
what is obesity?
a disorder in which excess body fat has accumulated to an extent that health may be adversely affected
what is general obesity?
fat distributed over the whole body
what is central abdominal obesity? 2
- fat is distributed mainly in chest and abdomen
- associated with higher risks of diabetes, raised blood lipids and greater cardiovascular morbidity
what is the health impact of obesity? 6
- Increased mass of fat causes changes at cellular and metabolic levels
- Increased weight causes increased wear and tear in joints
- Increased fat around the airway provokes asthma and sleep apnoea
- Increased fat in blood alters the insulin response
- Associated inactivity has independent effects including mental health
- Body self-image changes and there is an impact from the perception and reality of wider cultural and societal attitudes
what are the health risks of obesity in adults? 12
- Increased hypertension risk
- Weight on joints
- Low back pain
- Type 2 diabetes
- Atherosclerosis
- Cancer
- Stress incontinence
- Sleep apnoea
- Asthma
- Liver disease
- Gall stones
- Pancreatsis
- Depression
what are the health risks of obesity in children? 6
- Type 2 diabetes
- Asthma
- Sleep apnoea
- Hypertension in adulthood
- Bowlegs- tibia vara
- Emotional and behavioural problems
describe the assessment of obesity in primary care? 10
- Assess eating behaviour and lifestyle
- Risk factors
- Advise on management
- Consider drugs
- Referral to surgery
- Counselling
- Appetite suppressants?
- Vitamin D supplements
- Type 2 diabetes treatments
- Weekly subcutaneous injection?
describe the requirements for bariatric surgery? 4
- When other interventions fail
- BMI>40
- BMI 35-40 with co-morbidity
- Obese Asian patients with type 2 diabetes
describe bariatric surgery intervantions? 3
outcomes? 4
- Laparoscopic adjustable band
- Sleeve gastrectomy
- Roux-en-Y-Y/laparoscopic gastric bypass
- 65% type 2 DM remission
- Reduces total cholesterol
- 85% of sleep apnoea will resolve
- Over 10 years 25% will regain weight
