weight management Flashcards
1
Q
define body weight
A
the sum of bone, muscle, organs, body fluids and adipose tissue
2
Q
some or all components of body weight are subject to normal variation and change resulting from:
(4)
A
- growth
- reproductive stress
- variation in physical activity
- effects of aging
3
Q
consistency in body weight is orchestrated by:
(4)
A
- neural mechanisms
- hormonal mechanisms
- chemical machanisms
- individual genetic polymorphisms
4
Q
define fat mass
A
fat from all body sources including the brain, skeleton and adipose tissue
5
Q
define fat-free mass
A
includes water, protein and mineral components
6
Q
proportions of _ mass are relatively constant from person to person
A
fat-free mass
7
Q
lean body mass is muscle that
(4)
A
- is higher in men than women
- increases with exercise
- is lower in older adults
- is a major determinent of resting metabolic rate (RMR)
8
Q
adjusted body weight calculation
A
(actual body weight - ideal body weight (Healthy BMI)) x 0.25 + ideal body weight
9
Q
what is body fat a combination of?
A
combo of essential and storage fats
- that are expressed together as a percent total body weight
10
Q
why is essential fat necessary and where is it stored?
A
- necessary for normal physiologic functioning
- stored in small amounts in the bone marrow, heart, lung, liver, spleen, kidneys, muscles and nervous system
11
Q
what is storage fat and where is it stored?
A
- it is the energy reserve
- it accumulates under the skin and around the internal organs to protect them from trauma
- most is expendable
12
Q
what are the averages of total body fat for men and women
A
men: 18-24% of total body weight
women: 25 - 31% of total body weight
13
Q
what does adipose tissue influence and where is it primarily located?
A
adipose tissue exerts a profound influence on homeostasis
located primarily:
- under the skin
- in the mesenteries
- in the omentum
- behind the peritoneum
14
Q
what is white adipose tissue?
A
it stores energy as a repository for triglycerides
- cushions abdominal organs
- insulates the body to preserve heat
15
Q
what is brown adipose tissue?
A
- mainly located in scapular and subscapular areas
- made up of small droplets and many more ion-containing mitochondria - which makes its appear brown
- activated from cold exposure to regulate body temp
16
Q
what do mature adipocytes consist of?
A
a large central lipid droplet surrounded by a thin rim of cytoplasm, containing the nucleus and the mitochondria
17
Q
cells can store fat equal to ~-~% of their volume.
A
90-95%
18
Q
what is hyperplasia?
A
increasing the number of cells
19
Q
what is hypertrophy?
A
increasing the size of existing cells (as liipid is added)
20
Q
increases in fat cell size are more common in _ and _ but cell number can _ after the fat content of existing cells has reached capacity
A
teens and adults
increase
21
Q
most deposited fat comes directly from _
A
dietary triglycerides
22
Q
the fatty acid composition of the adipose tissue mirrors the fatty acid composition of the _
A
diet
23
Q
excess dietary carbohydrates and protein are converted to _ in the liver via _
A
fatty acids
lipogenesis
24
Q
under normal conditions, little dietary carbohydrate is converted to _
- the conversion process requires _x more energy than is required to store dietary fat as fat
A
fatty acids
3x
25
semivolatile organic compounds accumulate in adipose tissues from exposure to:
- toxins
- chemicals
- pesticides
| these are released when adipose tissue is mobilized during wt loss
## Footnote
dont encourage women of higher weight to lose it during pregnancy (toxins, pesticides, chemical released into blood which could go to the fetus and we dont know what the result of that is)
26
what is lipoprotein lipase?
an enzyme that moves lipid from the blood into the adipose cell, by hydrolyzing TGs into FAs and glyceryol
- glycerol goes to the liver
- FAs enter the adipocyte and are re-esterified into TGs
27
body weight is a product of:
- genetic effects
- epigenetics effects
- the environment
28
body weight regulation is often described as a homeostatic biological feedback system designed to "____" a stable blody weight
- regardless of energy ____ or energy ____
- is, unfortunately, assymetric in that it more vigorously _ weight loss than weight gain
Body weight regulation is often described as a homeostatic biological feedback system designed to “**defend**” a stable body weight
- Regardless of energy **expenditure** or energy **intake**
- Is, unfortunately, asymmetric in that it more vigorously **defends** weight loss than weight gain
29
what is known about body weight regulation is in the realm of _ regulation
appetite
30
adaptation to energy restriction is well known but highly _
unpredictable
31
satiety is associated with....
satiety is associted with the state, after eating, during which excess calories and nutrients are being stored
32
hunger is present when....
hunger is present when the satiety stores are being stored
33
hunger triggers are much _ than indicators of satiety
stronger
34
external cues for eating can easily override _
satiety
35
children are more able to eat less or more when _ or _ occurs
overfeeding or underfeeding
36
adults are less able to compensate for overeating over time, which leads to ...
gradual elevation of weight over time
37
resting matabolic rate (RMR) explains _____ -_____% of total energy expenditure
60-70%
38
RMR declines with...
age
restriction of energy intake
39
when the body is deprived of adequate energy, the body conserves energy by dropping RMR as rapidly as _% in weeks
15%
40
what is activity thermogenesis?
activity termogenesis is energy expended in voluntary activity
- most variable component of energy expenditure
41
under normal circumstances activity thermogensis accounts for ____ - ____% total energy expenditure
~15-30%
42
nonexercise activity thermogensis (NEAT) is energy expended for all activity that is ...
NOT sleeping, eating, or sports-like exercise
| going to work, typing, doing yard work, fidgeting
43
NEAT varies as much as _kcal/day between individuals
2000 kcal
44
to reverse obesity, promote....
standing and ambulating for 2.5 hours/day and reengineer work, school, home environments to support a more active lifestyle
45
what does insulin do to affect weight
insulin controls the amount of glucose in the blood by moving it into the cells for energy
46
how does the hormone leptin affect body weight
leptin contributes to long-term fullness by sensing the bodys overall energy stores
47
how does the hormone adiponectin affect body weight
adiponectin is made by fat cells, it helps the body respond better to insulin by boosting metabolism
48
how does the hormone ghrelin affect body weight
ghrelin tells the brain when the stomach is empty, prompting:
- hunger pangs
- drop in metabolism
49
the stomach communicates with the brain via the _ nerve, which travels from the _ to the _
Stomach communicates with the brain via the **vagus** nerve, which travels from the **brain** to the **stomach**
50
when full, the stomachs _ _ sends a message to the brain indicating satiety
stretch receptors
51
what factors of weight are influenced by genes?
number and size of fat cells, regional distribution of body fat and resting metabolic rate
52
what can activate or deactivate obesity-triggering genes?
nutrition and/or lifestyle
53
classes of drugs known to lead to weight gain
| 6
1. diabetes medications (glyburide)
2. thyroid hormone replacement (synthroid)
3. psychotropics (olanzapine)
4. antidepressants (aripiprazole)
5. steroids (predisone)
6. antihypertensives (beta blockers)
54
shortned sleep alters _ regulation of both hunger and appetite
endocrine
55
recurrent sleep deprivation can modify the _, _ and _ of food intake
amount, composition and distribution
56
stress stimulates the release of _
cortisol
57
cortisol stimulates the release of _ to maintain blood glucose levels
insulin
- this leads to increased appetite
58
chronic stress with constantly elevated cortisol levels can leave to _ changes
appetite
59
cortisol is normally _ in early morning and _ around midnight
high / low
60
those with night-eating syndrome have delayed circadian rhythm related to genetic factors that alter _ levels
cortisol
61
what is sensory specific satiety?
- as foods are consumed, they become less desirable, so people eat more when offered a variety of choices than when a single food is available
62
what is a benefit of sensory-specific satiety
the benefit is that this inclination encourages intake of a varied and nutritionally balanced diet
63
what is the negative of sensory specific satiety?
it can lead to overconsumption
64
levels of leptin which supresses appetite, are _ in the obese than in normal weight individuals
higher
| they build a resistance to the effects of leptin
65
passive overeating is partly resulting from _ portion sizes accepted as normal
large
66
what are obesogens?
| (endocrine disruptors)
chemical components foreign to the body that disrupt normal metabolism of lipids, ultimately resulting in obesity
67
at high levels of exposure, obesogens:
| 5
1. increase insulin resistance
2. expand fat storage
3. alter satiety and appetite regulation
4. more significantly reduce RMR following weight loss
5. decrease the level of rise in RMR with weight gain
68
give three examples of obesogens/ endocrine disruptors:
1. bisphenol A (BPA)
2. phthalates
3. organophosphates
69
_ complex polysaccharides promote and maintain a healthy _
microbiome
70
what are the clinical assessment tools for weight
bmi
waist circumference
waist/hip ratio
71
studies have determined that the optimal BMI with the least risk of mortality is a bm of _ to _
23 - 24.8
| above or below this is associated with increased mortality risk
72
inflammation due to adipose tissue can result in the development of...
| 7
1. hyperlipidemia
2. metabolic syndrome
3. diabetes mellitus
4. muscle protein loss
5. CVD
6. stroke
7. some cancers
73
regional patterns of fat deposit differ between _ and _
men and women
74
what are the 2 major types of fat deposition?
- excess subcutaneous truncal-abdominal fat (apple shaped android fat distribution_
- excess gluteofemoral fat in thighs and buttocks ( pear shaped gynoid fat distribution)
75
diagnosis of metabolic syndrome requires three or more of these abnormalities...
| 5
1. waist circumfrence of 40 or more" in men and 35 or more" in women
2. serum triglycerides 1.69 mmol/L or more
3. HDL level less than 1.04 in men and less than 1.30 in women
4. blood pressure of 135 / 85 mm Hg or higher
5. fasting glucose of 5.5 mmol/L or more
76
wide spread weight bias and discrimination have been documented in _, _ and _
education, employment and health care
77
goal of obesity treatment should be to acieve...
enough weight loss to significantly imrpove overall health
78
mobilizing fat is more efficient and spared _ _ _
lean body mass
79
steady weight loss over a longer period favors:
- reduction of fat stores
- limits loss of protein tissues
- limits the decline in resting energy expenditure that can accompany energy restriction
80
recommend calorie deficits resulting in a loss of around 0.5-1 lb/week for those with BMI _-_
and 1-2 lb/week for those with BMI _
- when these deficits are maintained, they lead to a 10% weight loss in _ months
27-35
>35
6 months
- after the 6 months, focus is to maintain weigh
81
men lose weight faster than women of similar size because of their...
greater lean body mass and high resting metabolic rate
82
what are the 3 main focuses when restructuring a persons lifestyle
1. environment
2. nutrient intake
3. physical activity
83
when restructuring a persons lifestyle it is important to use 4 main methods, what are these?
1. goal setting
2. stimulus control
3. cognitive restructuring
4. relapse prevention
84
stimulus control involves:
- identifying stimuli that may encourage incidental eating
- indentifying and limiting exposure to high risk situations
85
possible strategies to use in stimulus control
- learning to shop (with a plan)
- avoiding shopping when hungry
- keeping high-cal foods out of the house
- limiting times and places of eating
- consciously avoiding situations where overeating occurs
86
problem solving in lifestyle modification is a process of...
| 6
1. defining the intake problem
2. generating possible solutions
3. evaluating and choosing the best solution
4. implementing the new behaviour
5. evaluating outcomes
6. reevaluating alternative solutions (as needed)
87
cognitive restructuring teaches patients to...
idenify, challenge and correct negative thoughts that undermine their efforts to lose weight and maintain weight loss
88
a cognitive therapy (CBT) program underscoring the connection between _ and _ and how to manage that connection has proven useful
emotions and eating
89
settling on appropriate treatment depends on the patients:
- goals
- health risks
90
dietary modifications - treatment options
1. balanced, reduced calorie macronutrient adjusted eating plan, increased physical activity and lifestyle modification
2. balanced reduced calorie macronutrient adjusted eating plan, increased physical activity, lifestyle modification AND pharmacotherapy
3. Bariatric surgery + individually prescribed eating regimen, physical activity and lifestyle modification
4. prevention of weight regain by actively balancing energy intake/output
5. mindset interventions (e.g. cognitive restructuring, motivational interviewing, psychological counselling)
91
explain what a restricted energy eating plan is
most widely prescribed method of weight reduction
- should be nutritionally adequate except for energy, which is decreased to the point at which fat stores must be mobilized to meet daily energy needs
( a deficit of 500 - 1000 kcal/day usually meets this goal)
- energy level varies between 1200 and 1800 k/cal per day
- can be tailored to individual preferences
- should be encouraged to eat mainly whole foods
92
1.2 g/kg/day of protein appears to be adequate to:
.
.
.
when energy intake is restricted
| 3
1. minimize loss of lean body mass
2. prevent reduced resting energy intake
3. preserve bone mineral density
93
alcohol contributes _ % kcal/g
7
94
vitamin and mineral supplements that meet age-related requirements are recommended when intake is _ kcal for women and _ kcal for men
Vitamin & mineral supplements that meet age-related requirements are recommended when intake is:
- less than or equal **1200 kcal for women **
- less than or equal to **1800 kcal for men**
95
goal of commercial and self help programs is to provide...
structure and replace higher calorie foods
96
per serving, most meal replacements contain:
_ g protein
- _ amounts of CHO
- _ g fat
- _ g fibre
- _% of the daily allowance for vitamins and minerals
**10-20 g** protein
**varied amounts** of CHO
**0-10 g** fat
**5 or less** g fibre
**25-30%** of the daily allowance for vitamins & minerals
97
formula diets are meal replacements that are:
.
.
.
- commercially prepared
- ready-to-use (or a powder that can be mixed)
- portion controlled
98
where can formula based meal replacements be found?
over the counter in drug stores, weight loss settings, supermarkets or in a clinical setting
99
usually drinks or shakes are:
.
.
.
- milk (casein or whey), pea protein, rice protein, or soy boased
- high in calcium
- have 150-250 kcal / 9oz
100
describe Very-Low Calorie Diets (VLCDs)
- how many kcal they provide
- protein
- how long they are prescribed
- what they are designed to provide
- provide less than 800 kcal/day
- relatively rich in protein (0.8-1.5 g/kg / day)
- usually prescribed for 12-16 weeks
- designed to include full complement of vitamins, minerals, electrolytes and essential fatty acids (but not calories)
101
adverse side effects of VLCDs
| 9
1. increased risk of gallstones
2. cold intolerance
3. fatigue
4. lightheadedness
5. hair loss
6. constipation or diarrhea
7. dry skin
8. menstrual irregularities
9. gout
102
reduced energy diets should be...
| balanced lower cal diets
- nutritionally sound
- not harmful
- feasible to maintain over time
103
reduced energy diets require sustainability in...
| 3
- ease of adherence
- availability and affordability of foods
- cultural and social acceptability
104
diets that decrease caloric intake result in _
all low cal diets result in loss of _
weight loss
body fat
105
high fat, low CHO keto diets cause a greater loss of _ than _
body water than body fat
106
low carb diets cause ketosis and can significantly increase _ concentrations
blood uric acid
107
blood lipid levels _ as body weight decreases
decrease
108
energy restriction improves _ control
glycemic
109
as body weight decreases, blood pressue _
decreases
110
what is the most variable component of energy expenditure?
physical activity
111
increased lean body mass in proportion to fat through physical activity, helps to balance lost lean body mass and _ in RMR
decrease
112
positive effects of increased physical activity
.
.
.
- strengthen cardiovascular integrity
- increased sensitivity to insulin
- expending additional energy/calories
113
adults 18-64 should accumulate _ min moderate to vigorous intensity aerobic physical activity per week
- in bouts of _ min
150+ min / week
- in bouts of 10 or more mins
114
beneficial to add bone and muscle strenthening activities using _ muscle groups at least _ day/week
2 or more
2 day per week
115
for weight maintenance or prevention of weight gain, _ - _ min of weekly physical activity may be more effective
200-300 min
116
even if unable to achieve higher levels of activity, there is evidence indicating that participating in at least _ min/day of moderate intensity activity can have significant health benefits
30 min/day
117
resistance training increase _ , adding to RMR and _ bone mineral density
lean body mass
increasing
118
aerobic exercise is important for cardiovascular health through
. elevated _
. _ expenditure
. energy _
. loss of _
elevated RMR
calorie expenditure
energy deficit
loss of fat
119
non physiologic benefits of physical activity include:
- relief of boredom
- increased sense of control
- improved sense of well being
120
Recommendations for exercise from the American College of Sports Medicine differ for weight loss vs. weight maintenance
- physical activity less than 150 min/week has a _ effect on weight loss
- physical activity more than 150 min/week results in _ weight loss
- phsyical activity between _ - _ min/week results in the greates weight loss
Physical activity less than 150 min/week has a minimal effect on weight loss
Physical activity more than 150 min/week results in modest weight loss (2-3 kg)
Physical activity between 225-420 min/week results in the greatest weight loss (5-7.5 kg)
121
Pharmaceutical agents for weight loss/ maintenance can:
.
.
.
- decrease appetite
- decrease absorption of fat
- increase energy expenditure
122
what 4 prescription medications are approved for overweight and obesity in canada?
1. naltrextone-buproprion (contrave)
2. liraglutide (saxenda) - injection
3. orlistat (xenical)
4. semaglutide (wegovy)
123
explain CNS acting pharmaceutical agents for weight loss/maintenace
- some act on the brain, increase availability of norepinephrine
( anorexic agents such as amphetamines have a high potential for abuse and are not recommended for treatment of obesity)
- serotoninergic agents
(act by increasing serotonin levels in the brain
- non-CNS agents
(ex. orlistat)
124
common side effects of CNS acting agents are:
.
.
.
.
- dry mouth
- headache
- insomnia
- constipation
125
explain the non-diet paradigm
- maintain that the body will attain its natural weight if the individual eats healthfully, becomes attuned to hunger and satiety cues
- focus is on achieving health and not attaining a certain weight
- encourages size acceptance and respect for the diversity of body shapes and sizes
126
non diet studies consistenly show improvements in physchological variables:
.
.
.
- self-esteem
- quality of life
- depression
127
non diet bahvioural programs typically address:
.
.
.
.
. sometims included: _
- emotional eating triggers
- balanced nutrition
- social support
- exercise
- sometimes included: cognitive restructuring (CBT)
128
what. isconsidered the only long-term effective treatment for extreme or class three obesity with a BMI of 40 or more? (or with a BMI 35 or more with comorbidities)
bariatric surgery
129
before being considered for bariatric surgery, person must demonstrate having failed in a comprehensive program including:
.
.
.
.
.
- calorie restriction
- exercise
- lifestyle modification
- psychological counseling
- family involvement
130
once accepted for bariatric surgery, the patient is evaluated for:
.
.
- physiologic and medical complications
- psychologic problems
131
what is the ultimate goal of bariatric surgery?
to decrease the amount of food that can be eaten at one time and produce early satiety
132
after bariatric surgery, the diet progrsses from:
.
.
.
.
- clear liquid (first 24 hours)
- full liquid (week)
- puree (month)
- soft (4 weeks)
- regular diet as tolerated (after 8 weeks)
133
complications of bariatric surgery may include...
vitamin deficiencies
electrolyte problems
intestinal failure
134
what is a laparoscopic sleeve gastrectomy?
- what are its complications?
involves removing around 80% of the stomach and creating a thin gastric pouch by sewing or stapling the stomch longitudinally
complications:
- gastric bleeding
- stenosis
- leak
- reflux (most common)
135
what is gastric bypass surgery?
involves reducing the size of the stomach with the stapling procedure
- then connecting a small opening in the upper portion of the stomach to the small intestine by means of an intenstinal loop
use of the lower part of the stomach is omitted
- patients may having dumping syndrome as food empties quickly into the duodenum
136
16 or less& of gastric bypass patients experience postoperative complications including:
- aastomotic leaks
- strictures
- perforation
- gastric fistula
- bowel obstruction
- wound infections
- respiratory failure
- intractable nausea and vomiting
137
what is laparascopic adjustable gastric banding (LAGB)?
a band creating the reduced stomach pouch can be adjusted so that the opening can be made smaller or enlarged
- the band filled with saline, has a tube exiting from it to the surface of the belly
- this allows for the injection of additional fluid or reduction of fluid into the lap band
| patients like bc it is reversible but docs think complication / benefit
138
bariatric surgery required lifelong follow-up and monitoring. what should be monitored by the RD?
- total body fat loss
- full macronutrient AX including
(thiamine, B12, folate, iron, vit D, calcium, Vit A, E, K (fat soluble), zinc, copper)
139
what does an intragastric ballon do?
what are the complications
- it is a nonsurgical management
- a balloon made of silicone is placed endoscopically in the stomach for 6 months
- during this time patients are expected to learn and develop healthy eating habits that persist when the balloon has been removed
complications:
- abdominal pain
- nausea
- esophagitis
- flatulence
- gastric ulcer
140
energy requirements for weight maintenance after weight reduction are lower than at the original weight because smaller bodies have smaller _
RMRs
(resting metabolic rate)
141
common behaviours for keeping weight off inlcude...
- eating a relatively low fat diet (24%)
- eating breakfast every day
- weighing regularly (once per day to once per week)
- engaging in high levels (60-90 min/day) of physical activity
142
how can repetitious diets be useful for controlling intake?
because people tend to overeat when they have many choices at mealtimes
143
what. isthe plateau effect and how can people move out of this phase?
people in a weight loss program arrive at a weight plateau (when weight remains the same for a long period)
- to move out of this phase, reestablishing an energy deficit is required
144
does childhood obesity increase risk of obesity in adulthood?
yes
145
children who are obese after _ years of age have a greater probability of obesity in adulthood if either the mother or father is also obese.
6 years
146
children or adolescents with a BMI greater than the 85th percentile and complications of obesity, or with a BMI greater than the 95th percentile without complications should be assessed for...
genetic markers
endocrine issues
psychologic conditions
secondary complications
- HTN
- dyslipidemia
- type 2 DM
- sleep apnea
- orthopedic problems
147
what is the primary goal in wight management for kids and teens?
to ahieve healthy eating and activity, NOT to achieve ideal body weight
148
for those 2-5 years old with no secondary complications of obesity, goal is either:
.
.
if secondary complications are present _ may be the goal
- prolonged weight maintenance
- slowing rate of weight gain
weight loss
149
children who already exceed optimal adult weight can safetly lose wieght at _ - _ lbs per year until optimal adult weight. isreached
10-12
150
balanced macronutrient intake for children includes:
- _ - _ % CHO
- _ - _ % fat
- _ - _ % protein
45-60% CHO
25-40% fat
10-35% protein
151
low vitamin _ is predominant in obese children
D
152
_ interventions are the only type of effective treatment in weight management for kids
family-centered
- should be long term
153
undernutrition can lead to under functioning of the _, _ and _.
- other risk factors include:
.
.
.
.
pituitary, thyroid gonads and adrenal glands
- loss of energy
- susceptibility to injury and infection
- distorted body image
- other psychological problems
154
underweight or unintentional weight loss can be caused by:
.
.
.
.
.
1. inadequate oral food and beverage intake
2. excessive physical activity
3. inadequate capacity for absorption and metabolism of foods consumed
4. wasting diseases that increase the metabolic rate and energy needs as in cancer, AIDS, or hyperthyroidism
5. excess energy expenditure during psychologic or emotional stress
155
list pharmaceutical appetite enhancers
1. corticosteriods
2. megestrol acetate
3. mirtazapine
4. dronabinol
5. anabolic agents (testosterone)
156
add _ - _ kcal per day to encourage weight gain
500 - 1000
- leads to 1-2lb weight gain per week
157
when increase intake to gain weight it is important to increase gradually to avoid...
- gastric discomfort
- discouragment
- electrolyte imbalanced
- cardiac dysfunction
158
high energy diets should aim for _ % fat, and minimum _ - _% protein
30% fat (majority MUFAs and PUFAs)
12-15% protein
