Week 5 --> Obesity part b

Question 1

Obesity burden on healthcare

Answer 1

14% of American total spendings
9% of Australian total spendings

Question 2

Potential causes of rising obesity

Answer 2

Long term positive energy balance
Hyperthyroidism
Medications corticosteroids, antidepressants

Question 3

Cognitive and genetic contributions

Answer 3

Addictive eating shows similar brain activation as substance abuse

Role of leptin
- a hormone your adipose tissue
(body fat) releases that helps your
body maintain your normal weight
on a long-term basis.
Body fat distribution is genetically determined

Question 4

Hormones that reduce appetite

Answer 4

Ghrelin
- lowers following gastric bypass,
increased following weight loss

Peptide YY and serotonin play a role in satiety (fullness) during high protein diets

Question 5

What is metabolic set point theory

Answer 5

The theory posits that the human body has a predetermined weight or fat mass set-point range

Question 6

The multidisciplinary approach for obese patient

Answer 6

• Endocrinologists/physicians
• Clinical nurse consultant
• Dietitian
• Psychologist
• Exercise physiologist

Question 7

Patient population of an obesity clinic

Answer 7

• BMI >35
• 65% Female, 35% male
• Mean BMI 45.8kg/m2
• Weights ranging from 84.2kg-
  272.8kg (new clients only)
• % Patients over 150 20.4%
• % Patients over 200kg 4.4%

Question 8

Realistic goals for weight loss

Answer 8

• Short term 1-4 kg/month
• Medium term 5-10% initial weight
• Long term10%+ Initial weight

Question 9

Realistic goals for waist loss

Answer 9

• Short term 1-4cm/month
• Medium term 5% after 5 weeks
• Long term 102cm (men), 88cm
  (women)

Question 10

Stage one metabolic screening and assessment

Answer 10

Anthropometry (height, weight, waist circumference, BIA or DXA)

Blood pressure

Questionnaires (psych, food, exercise)

Bloods (cholesterol, glucose, insulin, leptin)

Diet analysis

Sub max fitness testing

Question 11

Stage 2 screening

Answer 11

Know your body education on results from metabolic screening + assessment

Food

‘Non Hungry eating’ psychology

Exercise regiment

Question 12

Stage 3 individual consultation

Answer 12

GP
Dietitian
Psychologist

Question 13

Exercise prescription and guidelines

Answer 13

For general pop: variety of intensities

For obese pop: Target 175-age (HR)

For aerobic fitness/CVD
prevention: Target 60-90% of HRmax (220-age)

Commence at low intensity

Some unable to perform large amounts of exercise initially, focus on diet

Progressively increase intensity from low to moderate intensity (55-70% MHR)

Consider non-weight bearing activities (cycling, swimming) to reduce loading on joints

Question 14

Exercise prescription

Answer 14

Combine with hypocaloric diet

Preventing weight gain: accumulate 30 min of added activity/day (7500+ steps/day) 300 min wk target

For weight loss: 30-60 min of added activity (10,000 steps/day) 300 min wk target

For weight loss without changing diet more than 12,500 steps/day

For weight loss post obese accumulate 60 mins of added activity (12,500 steps/day)