Study Guide Flashcards
Current clinical guidelines to eval overweight peeps and should weight loss be recommended? 3 pieces of info needed to perform eval
- BMI (>/= 25)
- waist circumference
- Readiness for change
- Fasting glucose?
Importance of genetics and childhood dev’t for current understanding of obesity (3)
- Positive correlation between aging and weight gain (decreased PA, increased body comp, decreased metabolic activity)
- Darwinism (calorie conservation to prevent starving)
- Genetics (appetite, activity, metabolic rate, adipose cell development, hormones, psychological factors)
Percentage of adults currently overweight and change in last 30 years
Significant increase over last 30 years.
Changes in adulthood that increase weight gain risk
Decreased PA
Changes in metabolism
Genetics
Health risks of overweight and obesity (13)
Mortality Cardiovascular disease DM Type 2 Cancer M: renal, esophageal, colon, thyroid Cancer W: gallbladder, esophageal, renal, endometrial Dementia Biliary tract disease GERD Asthma Pregnancy complications Renal disease LBP OA (hip and knee)
Significance of learned eating behaviours and social environment in current understanding of obesity (4)
- Cues trigger habitual eating disorders and consequences.
- Food as entertainment
- Social eating opportunity and pressure
- Eating to reduce stress/satisfy unmet psychological/emotional needs
- Common psychological disorders
Food environment and understanding of obesity (2)
- Overconsumption of calories = abundance of high fat/high sugar foods available anywhere anytime
- Modern society and increasingly sedentary lifestyles.
How a clinician can better understand health risks of obese patient through history, physical and lab assessment process (8)
- BMI >/= 25
- WC >35-27 (M), >31”(W)
- Personal/family weight and disease hx
- Type 2 DM
- Metabolic syndrome
- HTN
- Dyslipidemia
- Obesity related conditions
What diet will decrease metabolic rate, thus = bad results and increased risk of weight regain
WEIGHT CYCLING YO! Aka yo yo dieting
Complications of weight cycling (4)
- Osteoporosis and related fractures
- Gallbladder disease
- HTN
- Some cancers
Complications associated with rapid weight loss (4)
- Increased risk of electrolyte and cardiac disturbance
- Loss of bone density and lean body mass
- Gallstones
- Reduced metabolic rate
What is metabolic fitness? How does it differ from traditional approaches for obesity treatment?
De-emphasize fitness and focus on risk factor reduction and healthy lifestyle (optimal diet and exercise balance).
Base outcomes on health risks rather than a number on scale = more tangible and long term results
Correct method for measuring waist circumference
Measure upright relaxed position @ iliac crests w/ min respiration
Pre-existing risk factors used to gauge potential impact of overweight or high waist circumference?
- Family history of obesity
- Personal health history (eating disorders, meds w/ weight gain side effects, endocrine disorders)
- Weight history (gains & losses, dieting attempts)
- Diet history (typical intake, eating habits, influences on eating)
- Exercise history
Important info about obstacles for patient’s attempts to lose weight discovered in family history or personal health history?
Family: cardiovascular disease, diabetes, obesity
Personal: eating disorders, meds with weight gain side effects, endocrine disorders, psychological health
Therapeutic objectives more important than weight loss considering how to manage overweight patient
Improve overall obesity-related health risks in manner consistent with good health practice
STOP SMOKING, drug dependency treatment, improve BP, blood lipids and glucose tolerance
Potential contraindications to recommending weight loss, even when supported by national guidelines? How can these contraindications be minimized?
- History of weight cycling. New weight loss attempts must be designed to overcome past obstacles to long-term success
- Presence of eating/psychological disorder
- Strong genetic, developmental, physiological, environmental or psychological obstacles to successful long-term weight loss
- History of gallbladder disease. Rapid weight loss can aggravate cholecystitis and must be avoided
- History of significant bone loss or osteoporosis
reasonable initial goal for weight losS? Alternative goals to be set instead of weight loss goal?
Percentage of overall weight
Inches
Eating goals
Decreasing risk factors
How would you decide which type of weight loss diet is most suitable for a patient?
Individual preferences
Partner with referrals in cummunity
As long as achievable
How beneficial is exercise as a strategy for weight-reduction and maintenance?
Improves results and exercise will prevent additional weight gain.
Improves heart risk factors.
Better when patient is compliant.
But not a good option if patient binge eats then expects to work it all off. Injuries! Unrealistic.
What is meant by self monitoring as a behaviour self-management term?
Eval how much/what they are eating, their PA, thoughts/feeling/concerns regarding eating, activity, weight, etc.
What is meant by portion control as a behaviour self-management term?
Triggers and conditions taht push you to overeat
What is meant by stimulus control as a behaviour self-management term?
ID conditions/triggers asociated with overeating and inactivity; includes food temptations, dining out challenges, portion control issues and screen time
joining a support group increases changes of successful weight loss. Why?
provides patient with lower cost resources
Support groups
Obesity has convincing evidence for which cancers
BEEPCK =
Breast, esophageal, endometrial, pancreatic, colorectal, kidney
Obesity has probable evidence for which cancers
Liver, gallbladder, ovary, prostate, lymphoma, leukemia and Multiple myeloma.
L3MOPG
Glenn Gaesser, PhD and his article Obesity, Health and Metabolic fitness suggests what
Metabolic fitness is an alternative health paradigm,
Weight loss is misdirected
BEING FIT IS MORE IMPORTANT THAN BEING THING,
Thinner = not healthier
Health and Every Size movement suggests what
Natural diversity in body shape and size
Importance in relaxed eating in response to internal body cues
Contribution of social, emotional and spiritual and physical facts to health and happiness
Advantages of low fat, high carb diet for achieving and maintaining weight loss
No calorie restriction on allowed foods
Chronic dz prevention
Reduce BP, improve blood lipids, improve heart function (w/ aerobic exercise)
Improve glucose tolerance
Reverse coronary atherosclerosis, reduce symptoms of CHD
Disadvantages of low fat high car diet for weight loss
Deficient in Vit E, B12 and zince
Increase plasma TG’s and lower HDL
Not so good for glucose control and insulin function
Advantages of high protein diet for weight loss
Increased satiety and metabolic energy expenditure
Faster initial weight loss (loss of body water)
Effective at 6months compared to low fat
Disadvantages of high protein diet for weight loss
Deficient in Vit A, E, thiamin, B6, folate, ca2+, mg2+, K+, fiber
Ketogenic: fatigue, nausea, dehydration, constipation, diarrhea
CVD
Renal = risk of stones and bone loss
DM = bad for glucose control or insulin sensitivity
Cancer risk: CPBL: colon, prostate, breast, lymphoma
Little compliance
Little long term efffects
Weight loss supplement stims sympathetic nervous system
Ephedra
Supplements good for weight loss
MVM Fiber Green tea Green coffee bean Caffeine 5HTP (reduce appetite) Pyruvate (increased metabolic r8) Chromium (promotes insulin sensitivity)
Plants with organosulfur compounds affecting carcinogen metabolism
Allium vegetables: garlic, onion, leeks, shallots
Brassica/cruciferous vegetables: cabbage, broccoli, cauliflower, kale, brussel sprouts, bok choy
Beta-carotene supplements didn’t do the same as a high beta carotene diet. Why?
Other nutrients present in beta-carotene rich foods
Brassica family (cruciferous vegetables)
Broccoli, cabbage, cauliflower, kale, brussel sprouts, bok choy…
(BCCKBB)
Preparation of meat to influence cancer risk
Nitrite preservatives = increase colon cancer risk 15-20%/50g
High temp cooking and grilling = same increase
Lycopene
Tomatoes
Indole-3-carbinol
Brassica extracts
Isoflavones
Soy
Lignin’s
Flaxseed
Soy and soy isoflavone controversy w/ cancer risk
- gonadal hormone-modifying activity
No studies have found an increased cancer risk, actually increased soy is consistent with prevention of aggressive prostate cancers.
Soy isoflavones = exhibit anti-estrogenic properties
Calcium and Vitamin D in cancer prevention
D: immunity, inflammation, cellular growth regulation/survival
Ca2+: binds tumor promoting substances in the gut, effects proliferation and differentiation and cell survival
Strongest link = against colorectal cancer from milk products
High milk intake = small increase in prostate cancer risk in men = 2 much Ca2+!
Vitamin or mineral deficiencies shown to increase cancer risk
High synthetic beta-carotene = increased lung cancer in smokers
Excess folic acid = growth of precancerous/cancerous cells, but pregnant women should have some
Deficient folic acid = impairs DNA health
Vitamin D deficiency for optimal calcium absorption
High calcium over RDA = increase risk of prostate cancer
What cancer sites have tomato etract supplements shown promise in prevention and treatment?
Prostate cancer
Note: diets high in AO’s (vitamin C and flavanoids, alpha and beta carotene, lycopene) not supplements = effective in cancer prevention.
Vit A, C and flavnoids participate in carcinogen metabolism
BRASSICA VEGETABLE COMPOUNDS DO WHAT
Alter gonadal hormone metabolism and activity. Samesies with soybean compounds.
So good for gyne precancer lesions, not cancer prevention. Need more studies
Gene nutrient and microbiome nutrient interactions might influence which people may benefit from certain cancer prevention strategies
Gene varients = slower metabolism of brassica-related compounds allow them to have a larger benefit in cancer prevention.
Gut microbe differences = play a role in determining activity/health effects from consuming soy isolfavones and flaxseed lignin’s
