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Patients, Populations and Society > PPS Obesity Outcomes > Flashcards

PPS Obesity Outcomes Flashcards

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1
Q

What is obesity

A

Accumulation of fat stores to an extent that compromises health

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2
Q

BMI formula

A

Weight kg/height metres squared

below 18.5 = underweight, 25 or above = overweight, 30 or above = obese

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3
Q

Problems with BMI

A

Doesn’t allow for difference in weight between muscle and fat

Doesn’t consider location of fat

Visceral (Abdominal) fat is most harmful

Inaccurate in different ethnic groups

Less accurate in elderly with lost muscle mass.

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4
Q

Waist circumference

A

Considers location of fat

Men: Low<94cm, high 94-102cm, very high >102cm

Women: low<80cm, high 80-88cm, very high >88cm

Doesn’t take account of skeletal size

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5
Q

waist:hip or waist:height ratios

A

Complex to assess, lacks reference data and standardised measurement protocols

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6
Q

BMI and risk of CVD

A

A high body-mass index was most predictive of death from cardiovascular disease, especially in men

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7
Q

Link between body weight and cancer

A

Meta-analysis 89 prospective studies:

  • Overweight and obesity associated with increased risk of breast, colorectal, endometrial, kidney, and ovarian cancers
  • Association between weight and oesophageal cancer in men only
  • Mixed associations for pancreatic and prostate cancer
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8
Q

” pathways linking obesity and ill-health

A

DIRECT PATHWAY
Obesity directly impacts physiology

INDIRECT PATHWAY
Obesity associated with poo health behaviours which in turn impacts health (eg smoking, eating behaviour, alcohol consumption)

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9
Q

Emotional consequences of obesity

A

Body dissatisfaction

Lower self-esteem in community samples

Higher rates of depression at the higher grades of obesity

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10
Q

Obesity: discrimination and social exclusion

A

Educational access

  • Lower college attendance
  • Lower teacher ratings of ability for obese girls
  • Bullying and teasing at school

Marriage and social position

  • Less likely to get married
  • Downward socioeconomic trajectory for obese women

Employment

  • Employers less willing to take obese people as employees
  • Obese employees earn less and are less likely to get a promotion

Social stereotyping

  • Unattractive
  • Weak-willed
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11
Q

Causes of obesity

A
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12
Q

Are genes related to obesity?

A

Predicted by parental obesity

  • One obese parent – 40% chance
  • Two parents – 80% chance
  • Healthy BMI parents - 7% chance

Twin studies
-Obesity far more similar in identical twins reared apart than in non-identical twins reared together

Adoptee studies
- Adoptee’s weight far more strongly related biological parents

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13
Q

What theories explain genetic vulnerability?

A
  1. Metabolic theory
    - Low resting metabolic rate is heritable and is associated with weight gain
  2. Fat cell theory
    - Cell number mainly genetically determined
    - Severely obese have larger and more cells
    - Can increase number of cells, especially in childhood
  3. Appetite theory
    - Leptin regulates appetite
    - Lack of evidence to show that obese individuals produce less leptin
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14
Q

‘Obesogenic environment’ as a cause of obesity

A

Food environment and activity environment

Food environment
 Availability
 Cost
 Variety
 Portion sizes
 High energy density (kcal/g)
 High fat
 Low fibre (not filling)
 Food advertising
Activity environment
 High cost of activity
 Labour saving devices
 Sedentary travel
 Enjoyable sedentary pastimes
 High ambient temperatures
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15
Q

MArketing and costs

A

Junk food targeted to children- marketing dollars spend a lot on advertising junk food to children compared to barely anything for healthy food messages

Junk food is also cheaper per calories compared to fresh fruits and vegetables

Increased portion sizes sold in US

Higher density of fast food outlets, in deprived areas

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16
Q

Models of eating behaviour

A
  1. Developmental model
  2. Cognitive model
  3. Weight concern and body dissatisfaction
17
Q

Developmental model of eating behaviour

A

Emphasis on learning

Exposure
- People show neophobia but this reduces after exposure

Social learning

  • Importance of modelling and observation
  • Parental feeding styles and practices are important!

Association

  • Food as the reward
  • Food and control- overt & covert differ
18
Q

Cognitive model of eating behaviour

A

Emphasis on beliefs and attitudes

  • Framework for explaining, predicting and changing behaviour
  • Many different ones  most eating research uses social cognition models
  • Theory of planned behaviour
19
Q

Cognitive model of eating behaviour 2

A
20
Q

Weight concern and body dissatisfaction

A

Emphasis on the meaning of food and weight

Body dissatisfaction
- Research on size estimation, perceptions of reality vs. ideal and negative emotions

Dieting and overeating

  • Body dissatisfaction related to dieting as well as overeating!
  • Dieting ->Restraint theory
  • Overeating in dieters -> Motivational collapse
  • Overeating in dieters ->‘What the hell effect’
  • Overeating in dieters -> Mood modification
21
Q

UK Tackling Obesity strategy

A

Improving access to weight loss programmes through Primary
care

Changes to the ‘Food Environment’
- Banning adverts for high fat, salt or sugar products on TV and online before 9pm.

  • Calorie labelling in large restaurants, cafes and takeaways.
  • Ending promotion of high fat, sugar or salt products in store and online.
  • Consultation on ‘traffic lights’ nutritional information and calorie labelling on alcohol
22
Q

Treatment options for obesity

A

Behavioural interventions (diet & activity)

  • ‘Lifestyle interventions’
  • Behavioural Therapy

Pharmacology

Surgery

  • Gastric banding
  • Vertical banded gastroplasty
  • Gastric bypass
23
Q

Meta analysis of lifestyle interventions

A

Analysis of 17 interventions that had a minimum observation period of 1 year

  • Lifestyle interventions resulted in significant reductions in weight compared with standard care
  • On average participants lose about 3.5 kg which is maintained for 3 years
24
Q

Behavioural therapy for obesity

A

Advice on behaviours to modify energy balance -> Nutrition and Exercise advice

Strategies to increase control over energy balance behaviours

  • Functional analysis of behaviour
  • Goal-setting in relation to behaviour change
  • Self-monitoring of eating and activity
  • Stimulus control in relation to food and activity choices
  • Self-reinforcement of behaviour change
  • Evaluation of positive and negative cognitions
  • Reward good behaviour
  • Relapse prevention
25
Q

What is central to obesity behaviours?

A

Classical conditioning

Two stimuli repeatedly paired will become linked

  • Eating cookies whilst watching TV -> turning on TV triggers craving for cookies
  • Goal of behavioural therapy is to identify and distinguish cues
26
Q

Self monitoring

A

Most important component of behavioural treatment

People can underestimate calorie intake by 40-50% per day
• Detailed records of 
• Food intake
• Physical activity
• Weight
• Mood (positive and negative)

Reveals patterns such as calories from soft drinks -> targets for intervention in the behaviour chain

27
Q

Strategies to increase control over energy balance behaviours

A

Stimulus control in relation to food and activity choices
1. Avoidance
E.g. environment, situation
2. Distraction
e.g. brushing teeth instead
3. Resistance
e.g. exposure to stimulus and active control -> willpower is important!

Evaluation of positive and negative cognitions

  • Thought Diary- monitor internal ‘triggers’
  • Stop ‘what the hell effect’ and using food for mood modification

Reward good behaviour
- Reward but not with food

28
Q

Cognitive restructuring

A

Aim is to modify thoughts that undermine weight loss

  • Typically three categories:
  • The impossibility of weight loss – previous failed attempts
  • Unrealistic eating and weight loss goals
  • Self-criticism regarding over eating or weight gain

“ I’ve blown my diet so I might as well eat what ever I want”

versus

“I’ve over eaten today, but only by about 400 kcals. If I stop now, I can easily make up the difference by cutting back over the next couple of days”

29
Q

Effectiveness of behavioural therapy

A

Review of studies 1996-2002
• Patients treated with a comprehensive group behavioural approach lose approximately 10.7kg (approx. 10% of initial weight) in 30 weeks of treatment
• Importantly 80% of patients who begin treatment complete it

30
Q

” pathways linking obesity and ill-health

A

DIRECT PATHWAY
Obesity directly impacts physiology

INDIRECT PATHWAY
Obesity associated with poo health behaviours which in turn impacts health (eg smoking, eating behaviour, alcohol consumption)

Patients, Populations and Society (12 decks)

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