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BPK 417 > Quest 1 > Flashcards

Quest 1 Flashcards

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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

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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
Which macronutrient is the best for weight loss
protein, the rest dont really matter, total calorie count is the most important
26
What is the microbiome and microbiota
microbiome: genetic material of all non-human microbes microbiota: the microbes themselves
27
How are microbiota and obesity linked
increased energy harvesting from carbs that otherwise would be indigestible - more calories extracted from food increased inflammation
28
What are the components of total energy expenditure
basal metabolic rate (60-75% of TEE) Thermic effect of food (10-15% of TEE) activity thermogenesis (NEAT=20%, EAT = 10%)
29
What is basal metabolic rate
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
What is NEAT
non exercise movements, very variable, low levels of neat associated with obesity
31
Does TEE increase linearly with physical activity
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
What is the thermic effect of food
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
What is a fat depot
accumulation of fat in specific area of the body
34
compare subcutaneous adipose tissue and visceral adipose tissue
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
What is White adipose tissue
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
What is brown adipose tissue
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
How do did brown and white adipocytes develop?
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
What are beige adipocytes
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
How are beige adipocytes formed?
Transdifferentiating of mature WAs to BAs induction of differentiation of BA progenitors
40
What are adipokines
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
What is adipokine secretion associated with in obesity
pro inflammatory morbidity increasing pattern non obesity adipokines are overall more protective
42
What is leptin?
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
How does leptin affect energy balance?
binding to hypothalamus inhibits orexigenic NPY/AgRP (appetite stimulators) and stimulates anorexigenic POMC/CART (appetite suppressors)
44
How does leptin affect the immune system
upregulates phagocytosis and mediates proinflammatory cytokines such as TNF-alpha and IL-6 activates T-cell/B-cell proliferation
45
What is adiponectin
adipocyte complement related protein released from WAT antihyperglycemic, antiatherogenic, and anti-inflammatory inverse relationship between adiponectin and obesity
46
What does adiponectin do
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
What is PAI-1
Plasminogen activator inhibitor inhibits plasminogen activators elevated levels promote thrombosis and atherosclerosis inhibits blood clot breakdown
48
What is IL6
Interleukin 6 regulator of immune system increased production during obesity mediators of inflammation in obesity
49
What is TNF alpha
proiflammatory cytokine that increases in obesity
50
What is the inflammation response
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
How is the inflammation response altered with obesity?
immune response normally for host defence remains triggered, causing low grade chronic inflammation increased M1 concentration causes damage in obesity (M2 in lean)
52
What are 4 potential mechanisms towards infammation
adipocyte hypertrophy leading to rupture oxidative stress of overfeeding (esp pro-inflammatory foods) microbiota promoted inflammation increases in reactive oxygen species
53
How are diabetes and obesity related
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
how is atherosclerosis promoted in obesity?
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
WHat is the obesity paradox
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
How does obesity influence cancer
tumots invade areas rich in adipose tissue (WAT) increase pro inflammatory adipokines makes tumors more aggressive
57
WHat is the relation between obesity and polycystic ovarian syndrome
more androgen production, causes menstrual irregularities 40-80% of women with this are obese
58

BPK 417 (2 decks)

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