Week 5 Flashcards
Obesity - definition for now
Excess body fat accumulation that may impair health
- usually measured by body mass index
Adults BMI and obesity
A persons body weight in kilograms divided by their heigh in meters squared (kg/m2)
- overweight: BMI 25.0-29.9 kg/m2
- Obese: > 30.0kg/m2
Children - BMI and obesity
- overweight: BMI 85-95 percentile on growth chart (for age and sex)
- obese: BMI > 95 percentile on growth chart (for age and sex)
BMI controversy
A body builder who has a BMI that is 30.2 kg/m2 is not overweight or obese but clinically we can say he is
Increasing Obesity - Canada
increasing from 2003-2022
- weird spike in about 2014-2015
- 2003 was about 20% and 2022 was about 30%
Adult obesity prevalence by region
BC - 22%
Alberta - 29%
Saskatchewan - 35%
Manitoba - 29%
Ontario - 26%
Quebec - 27%
New Brunswick - 38%
PEI - 30%
Nova Scotia - 35%
Newfoundland and Labrador - 38%
Changing rates of obesity in world
Most places are increasing but Americans are greatly increasing.
Prevalence in Indigenous population
- higher in indigenous communities compared to non-indigenous people
- higher on reserves
Health risks associated with obesity
People w obesity are less likely to:
- get married
- have a family
- get prompted
due to stigma!!
health risks:
- type 2 diabetes
- gallbladder disease
- metabolic syndrome
- breathlessness
- sleep apnea
- cardiovascular disease
- hypertension
- osteoarthritis
- hyperuricemia, gout
- cancer
- psychosocial issues
- reproductive hormone abnoramilites
- polycystic ovary syndrome
- impaired fertility
- low back pain
- fetal defects
- dyslipidemia
High BMI increases risk of CVD mortality
likelihood is higher in men with obesity
- people w low BMI due to eating disorders can also die and women are more common in this aspect
Fat around the waist
Increases the risk of cardio vascular disease, type 2 diabetes, cancer, metabolic diseases, etc. in comparison to fat elsewhere on the body
- if someone is obese but they have low fat around the waist they are at less risk of developing certain diseases
visceral adipose tissue is associated with
- high triglycerides
- low HDL-C
- small dense LDL particles
- high insulin/glucose
- high blood pressure
- prothrombotic state
- endothelial dysfunction (arteries dilating and constricting)
- atherosclerosis
Close to the organs thats why its bad!
Obesity in adults - a clinical practice guideline
Obesity - complex disease in which abnormal or excess body fat impairs health
Effects: lowered health, quality of life, and lifespan
- people w obesity experience weight bias and stigma
- increased complications and mortality independent of weight or BMI
- BMI is NOT an accurate tool for identifying obesity-related complications
Stigma: acting on weight-biased beliefs
weight bias
thinking that people with obesity do not have enough willpower or are no cooperative
The lancet Commission
defined obesity, clinical obesity, and pre-clinical obesity
obesity - Lancet Commission
obesity is characterised by excessive adiposity, with or without abnormal distribution or function of the adipose tissue
Pre-clinical obesity - Lancet Commission
pre-clinical obesity is characterised by a state of excess adiposity with preserved function of other tissues and organs. Pre-clinical obesity confers an increased risk of developing clinical obesity as well as several other non-communicable diseases (NCDs), including type 2 diabetes, CVD, certain types of cancer and mental illness
clinical obesity - Lancet Commission
clinical obesity is a chronic, systemic illness characterised by alterations in the function of tissues, organs or the individual, due to excessive ardor abnormal adiposity
Obesity defined for 2 to 20 year old
Underweight - BMI <5th percentile for age and sex
Normal weight - BMI between the 5th and 85th percentile for age and sex
Overweight - BMI between 85th to 95th percentile for age and sex
Obesity - BMI > or equal to 95th percentile for age and sex
Childhood obesity and excess weight rates in Canada
1978/79 - aged 2-17 23% overweight or obese
2004 - aged 2-17 35% overweight or obese
2017 - aged 5-17 30% overweight or obese
longitudinal retrospective study: Netherlands - weight gain first 3 months
87 people, 18-24 years assed for cardiovascular risks
- assessed rate of weight gain age 0-1
Rapid increase in weight first 3 months:
- increased insulin resistance
- decreased HDL-C
- increased total cholesterol/HDL-C ratio, triglycerides, central adiposity
Compared to gradual weight gain over the year
Do children eat more calories within the home or outside of the home?
Children eat nearly twice as many calories at restaurants compared to their homes
Milk in children over the years
- replaced with high calorie sodas
- not meeting RDA (recommended daily allowance) of calcium for growing bones
non-dairy sources of calcium: fish bones (salmon, sardines), fortified products (soy/almond milk), supplements - no protein in replacement drinks
Milk is a better post-sport drink - between 1977-78 and 2000-01 milk consumption decreased by 39% in children aged 6-11
- consumption of fruit drink rose by 69% and carbonated drinks rose by 137%
Early obesity leads to early Type 2 diabetes
Type 2 diabetes were once a disease that occurred primarily in adults:
- 10-to-30 fold increase in American children with type 2 diabetes in the past 10 to 15 years
- one in every 3 American children born in 2000 will likely be diagnosed with diabetes in their lifetime
- type 2 diabetes is being diagnosed in Canadian First Nations children as young as 8 years old
95% of children w Type 2 diabetes are obese
The energy balance
Energy out on one side, weight management in middle, and energy in on the other side
- fat gain occurs when energy in (food) > energy out (physical activity, metabolism)
Physical activity and weight loss
- studies of exercise-induced weight loss demonstrate variable results
- compared to diet, exercise not as effective
- meta-analysis reveal exercise only-induced weight loss at 0.1-0.2 kg/week intervention
- however, exercise combined with diet is most effective
maintaining ideal body weight
- combine a regiment of diet and exercise
- recommended weight loss of 1 to 2 pounds per week
- easier to prevent weight gain than to lose weight
- weight cycling may be worse than not losing weight: better to maintain weight
- no fad diet or over-the-counter supplement demonstrates prolonged weight loss
- concentrate on health behaviours
Perceptions of causes and responsibility of obesity
- both individuals and communities 12%
- its something whole communities need to deal with 34%
- its something individuals should deal with on their own 52%
International plans/action: common themes
- multiple interventions at multiple levels
- high intensity school-based programs
- limited screen time
- built environment
- attention on socially and economically disadvantaged
- education
- workplace programs
- community programs
- early childhood development
- regulations: labelling, advertising to children
Obesity in adults: a clinical practice guideline (more in-depth)
- obesity is a prevalent, complex, progressive and relapsing chronic disease, characterised by abnormal or excessive body fat (adiposity) that impairs health
- people living with obesity face substantial bias and stigma, which contribute to increased morbidity and mortality independent of weight or BMI
- this guideline update reflects substantial advances in the epidemiology, determinants, pathophysiology, assessment, prevention, and treatment of obesity, and shifts the focus of obesity management toward improving patient-centred health outcomes, rather than weight loss alone.
- obesity care should be based on evidence-based principles of chronic disease management, must validate patients lived-experiences, move beyond simplistic approaches of “eat less, move more” and address the root drivers of obesity
- people living with obesity should have access to evidence-informed interventions, including medical nutrition therapy, physical activity, psychological interventions, pharmacotherapy and surgery
Syndrome
a recongizable complex of symptoms and physical or biochemical findings for which a direct cause is not understood. with a syndrome the components coexist more frequently than would be expected by chance alone
metabolic
refers to biochemical processes involved in the bodys normal functioning
metabolic syndrome
- recognition of the clustering of metabolic risk factors related to CVD
- majority of individuals with metabolic syndrome have insulin resistance and/or are obese
- combination of risk factors at ‘low’ levels may markedly increase CVD risk
- prevalence increases with age
Harmonisation of metabolic syndrome criteria
any 3 or more of the following:
- waist circumference: use population and country-specific criteria
- triglycerides: > 1.69 mmol/L
- HDL-C: men <1.00 mmol/L women <1.30 mmol/L
- blood pressure: >= 130/85 mmHg
- glucose: > or equal to 6.0 mmol/L
potential problems with the metabolic syndrome
- loss of data using dichotomous variables
- components of the metabolic syndrome differ in their ability to predict type 2 diabetes and cardiovascular disease (CVD)
- does the metabolic syndrome predict CVD independently of its components?
- does the metabolic syndrome have a single ethology?
Potential advantages of the metabolic syndrome
- metabolic syndrome is an operational definition for “cardio metabolic” risk
- nobody measures global risk or uses multivariate predicting equations (metabolic syndrome is easier)
- encourages providers to look for other risks factors
- encourages behavioural therapy rather than just treating risk factors individually
- metabolic syndrome better predictor of diabetes than CVD?
Metabolic syndrome “treatment:
- no treatment
- treat each risk factor independently (in the absence of known cause for the whole syndrome)
- healthy lifestyle:
–> 5-10% weight loss - moderate calorie restriction
–> moderate increases in physical activity - pharmacologic measures for each of the syndrome components
