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BPK 417 > Quest 1 > Flashcards

Quest 1 Flashcards

1
Q

What are the advantages of classifying obesity as a disease?

A

changes the narrative about it (not a choice

forces medical community to respond

call to action to find solutions, causes, etc

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2
Q

WHat are the disadvantages to calling obesity a disease?

A

may promote despair

panic when moderate weight increase

promote stigma

external locus of control

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3
Q

WHat is the definition of obesity

A

chronic/progressive condition, characterized by excess body fat

commonly classified using BMI over 30, but not ideal as it doesnt take body comp into account

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4
Q

WHat is the edmonton staging system?

A

ranks severity of obesity based on clinical assessment of weight related health problems, mental health, and quality of life

uses a holistic view, used to assess if pt is candidate for bariatric surgery

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5
Q

What are the 5 stages of the edmonton staging system?

A

stage 0 - normal
stage 1 - subclinical risk factors with mild symptoms
stage 2 - begins meeting clinical criteria for admission, established obesity related co-morbidities
stage 3 - significant obesity related organ damage/limitations
stage 4 - severe damage and symptoms

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6
Q

What are the 3 strategic goals of obesity canada?

A
  • address the social stigma associated with obesity

-change the way policy makers and health professionals approach obesity

-Improving access to evidence-based prevention and treatment resources

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7
Q

What is weight bias

A

negative stereotyping of individuals with obesity

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8
Q

what is implicit vs explicit bias

A

implicit is bias that you arent consciously aware of

explicit is bias that you are aware you have

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9
Q

What kind of stigmas do health care providers have around weight?

A

bad patients

bad people

ill-equipped to treat them

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10
Q

What are some individual health consequences of weight stigma?

A

causes unhealthy eating/less activity

psychological disorders

stress-induced pathophysiology

substandard health care and lower health care utilization

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11
Q

what are some key messages about weight bias from the everyBODY matters summit

A

weight bias and obesity discrimination will not be tolerated in education, health care, and public policy

obesity should not be recognized and treated as a chronic disease in healthcare

weight and health need to be decoupled in education

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12
Q

what are some key strategies to reduce weight bias from the everyBODY matters summit

A

create resources to support policy makers

use personal narratives from people living with obesity to engage the audiences and communicate anti-discrimination messages

develop a better clinical definition for obesity

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13
Q

What are some strategies to address weight stigma in primary care providers

A

increase provider empathy

altered perceived norms around stigma

have providers examine their own biases

educate providers on complexity of obesity

reduce focus on weight

pt centered communication

welcoming environment that values diversity

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14
Q

WHat is people first language

A

saying people with obesity instead of saying obese people

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15
Q

What is reductionist thinking

A

thinking that complex systems can be explained by reducing em to a small number of variables

looking at components of a system instead of the system as a whole

applies a one size fits all approach

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16
Q

What is systems science

A

focuses on the connections between components rather than the components themselves

ie: a system is more than the sum of its parts

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17
Q

Why is a systems approach important

A

Allows you to focus on a higher level and understand the interactions and driving forces that cause the result

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18
Q

What are the benefits of using a reduced foresight map

A

shows the connections, but identifys the strongest connections with bolder lines

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19
Q

What are some solutions to complex problems

A

consider that individuals matter

match capacity to complexity

set functional goals and directions, distributing decision, action, and authority

understand the system and look for modifiable connections that can shift feedback loops to balance instead

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20
Q

What is energy balance

A

relation between energy intake and expenditure

energy cant be destroyed, just transfered

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21
Q

What happens with an energy surplus

A

weight gain and increase in fat mass

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22
Q

How is adipose tissue remodeled

A

differentiation of precursors into adipocytes (hyperplasia) and the increase of cell size of the adipocytes (hypertrophy)

hyperplasia is healthier as it can maintain proper vascularity, but hypertrophic tissue is associated with increased hypoxia and inflammation due to expansion

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23
Q

combination of what increases body weight

A

increase in adipose tissue mass (size or number)

increase in lean body mass (muscle hypertrophy)

increase in glycogen mass (max 1-2kg change)

increase in water mass

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24
Q

What are the 4 dietary macronutrients

A

carbs (fuel, 4kcal/g)

protein (growth/repair, 4kcal/g)

lipids (fuel/excess stored as lipid with adipose tissue, 9kcal/g)

alcohol (fuel, dysregulates lipid metabolism, 7kcal/g)

25
Q

Which macronutrient is the best for weight loss

A

protein, the rest dont really matter, total calorie count is the most important

26
Q

What is the microbiome and microbiota

A

microbiome: genetic material of all non-human microbes

microbiota: the microbes themselves

27
Q

How are microbiota and obesity linked

A

increased energy harvesting from carbs that otherwise would be indigestible - more calories extracted from food

increased inflammation

28
Q

What are the components of total energy expenditure

A

basal metabolic rate (60-75% of TEE)

Thermic effect of food (10-15% of TEE)

activity thermogenesis (NEAT=20%, EAT = 10%)

29
Q

What is basal metabolic rate

A

energy expended for homeostatic processes

mean rate of bmr is 0.863kcal/kg/hr

higher for men, lowers with age, and is less in overweight people.

obese people have lowest rate

positively correlated with muscle mass

genetically influenced

30
Q

What is NEAT

A

non exercise movements, very variable, low levels of neat associated with obesity

31
Q

Does TEE increase linearly with physical activity

A

no, in the constrained model of energy expenditure, the body adapts to increased physical activity by reducing energy spent on other physiological activity, maintaining the TEE within a narrow range of baseline

more not always better beyond a threshold

32
Q

What is the thermic effect of food

A

diet-induced thermogenesis

an increase in metabolism after food intake, energy needed to process and store the food, depends on the content of the food

decreases with age, and higher levels of activity are associated with higher TEF

TEF of protein>carbs>lipids

fiber rich diets and whole foods provide higher TEF

eating one large meal has higher TEF than multiple smaller meals

33
Q

What is a fat depot

A

accumulation of fat in specific area of the body

34
Q

compare subcutaneous adipose tissue and visceral adipose tissue

A

both have protective and pathogenic characteristics, but SAT is more benign

increase in visceral adiposity is a marker for dysfunction of SAT and global fat dysfunction, accounting for association with metabolic diseases

VAT has higher sensitivity to catecholamines, lower sensitivity to insulin, and direct portal access to liver

35
Q

What is White adipose tissue

A

95% of adipose tissue

functions are for energy/vitamin storage
insulation
protection
endocrine organ

unilocular, thin rim of cytoplasm, thickened perinuclear cytoplasm with small lipid droplets
flattened nucleus on periphery with visual nucleolus

composed of adipocytes, fibroblasts, smooth muscle cells, endothelial cells, and blood cells

36
Q

What is brown adipose tissue

A

main function is for thermogenesis

darker appearance due to higher population of mitochondria

multiocular (many lipid droplets)

in highly vasculated and innervated areas

develops from muscular progenitors

mitochondria has clear, ordered crista

UNIQUELY OVEREXPRESSES UNCOUPLING PROTEIN 1

UCP1 uncouples protein gradient from ATP synthase during oxidative phosphorylation, releasing heat

BAT is inversely correlated with BMI

37
Q

How do did brown and white adipocytes develop?

A

brown - developed from shared precursor of skeletal muscle that expresses Myf5 positive precursors

white - developed from shared precursor of skeletal muscle that expresses Myf5 negative precursors (some BAT also develops from these, creating beige adipose tissue)

38
Q

What are beige adipocytes

A

bright inducible/recruitable brown (rBAT)

inducible thermogenic cells from WAT

develop due to exposure to cold, cancer, bariatric surgery, adrenergic stress, etc

Beige fat is multilocular and thermogenic like brown fat, but has a lower expression of UCP1 compared to BAT

39
Q

How are beige adipocytes formed?

A

Transdifferentiating of mature WAs to BAs

induction of differentiation of BA progenitors

40
Q

What are adipokines

A

peptides secreted from adipose tissue that communicate with the brain, liver, etc

similar to hormones

become dysregulated when adipocytes reach critical level of adiposity

41
Q

What is adipokine secretion associated with in obesity

A

pro inflammatory morbidity increasing pattern

non obesity adipokines are overall more protective

42
Q

What is leptin?

A

Adipokine that promotes satiety

obese mice are unable to produce enough leptin (obesity gene is expressed in WAT), while diabetic mice produce it but cannot respond to it due to defective satiety center

expression is proportional to WAT mass

acts on LEPRb-expressing neurons on hypothalamus

43
Q

How does leptin affect energy balance?

A

binding to hypothalamus inhibits orexigenic NPY/AgRP (appetite stimulators) and stimulates anorexigenic POMC/CART (appetite suppressors)

44
Q

How does leptin affect the immune system

A

upregulates phagocytosis and mediates proinflammatory cytokines such as TNF-alpha and IL-6

activates T-cell/B-cell proliferation

45
Q

What is adiponectin

A

adipocyte complement related protein released from WAT

antihyperglycemic, antiatherogenic, and anti-inflammatory

inverse relationship between adiponectin and obesity

46
Q

What does adiponectin do

A

increases insulin sensitivity in muscle, promotes insulin secretion in pancreas, activates glucose transport and decreases inflammation in liver, and increases insulin stimulated glucose uptake in adipose tissue

47
Q

What is PAI-1

A

Plasminogen activator inhibitor

inhibits plasminogen activators

elevated levels promote thrombosis and atherosclerosis

inhibits blood clot breakdown

48
Q

What is IL6

A

Interleukin 6

regulator of immune system

increased production during obesity

mediators of inflammation in obesity

49
Q

What is TNF alpha

A

proiflammatory cytokine that increases in obesity

50
Q

What is the inflammation response

A

macrophages and mast cells release leukocytes

neutrophils are activated

macrophages phagocytose the activated leukocytes

if injury persists, different inflammation response agents are recruited, like t cells

51
Q

How is the inflammation response altered with obesity?

A

immune response normally for host defence remains triggered, causing low grade chronic inflammation

increased M1 concentration causes damage in obesity (M2 in lean)

52
Q

What are 4 potential mechanisms towards infammation

A

adipocyte hypertrophy leading to rupture

oxidative stress of overfeeding (esp pro-inflammatory foods)

microbiota promoted inflammation

increases in reactive oxygen species

53
Q

How are diabetes and obesity related

A

obesity is the best predictor of type 2 diabetes

risk rises with increased teenage weight gain

insulin resistance is part of early progression towards type 2

obesity strongly associated with insulin resistance, due to dysregulation of adipokines and more free fatty acids released into the blood in obesity compromising insulin receptor expression/function

54
Q

how is atherosclerosis promoted in obesity?

A

associated with higher C-reactive protein - a key inflammatory marker for CVD

pro-inflammatory adipokines increase adhesion molecules on endothelial surface

elevated insulin has proliferative effects on smooth muscle cells

55
Q

WHat is the obesity paradox

A

it increases the risk of heart failure, however it can also exert protective effects in patients with a confirmed heart failure diagnosis

half have reduced ejection fraction, while the other half have increased ejection fraction

possible due to preserved muscle mass, lower SVR, or increased lean mass

56
Q

How does obesity influence cancer

A

tumots invade areas rich in adipose tissue (WAT)

increase pro inflammatory adipokines

makes tumors more aggressive

57
Q

WHat is the relation between obesity and polycystic ovarian syndrome

A

more androgen production, causes menstrual irregularities

40-80% of women with this are obese

58
Q
A

BPK 417 (2 decks)

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