Weight management Flashcards

1
Q

what is the energy balance equation?

A

Energy intake = energy expenditure +- energy stored

Energy expen doesn’t tend to change

Energy intake can be changed

Energy intake > expen = store energy

Intake < expen = wont store energy in body - lose energy and weight - fat stores

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2
Q

units of food energy

A

SI unit: joule (J)
- Energy used when mass 1kg moved through 1m by force 1N

Non-SI unit: calorie (cal)

  • Energy required to raise temp of 1g water by 1 degree
  • Kcal = energy required to raise temp 1kg water by 1 degree

1kcal = 4.2 kJ

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3
Q

the total (gross) energy value of food

A

Total energy value

  • Estimation in bomb calorimeter
  • (Oxidation to CO2, H20 and N02)

Bomb calorimeter:

  • Food is ignited electrically in presence of oxygen
  • Heat of combustion measured from rise in water temp

Works well for carb and fat

Protein not fully combusted in body – broken down to ammonia and urea

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4
Q

what is metabolisable energy?

A

energy actually supplied to tissue by each food

Fibre and plant sources passed through as faeces

Digestible energy left

Metabolisable energy – energy body actually uses – calories

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5
Q

metabolisable energy of macronutrients (Atwater factors)

A

table

Diff carbs have diff monomers – pure glucose doesn’t produce same energy as fructose – not all plant material combusted – not all carb equal

Same for fat – most fat digested – very energy dense – can be stored densely – not stored with water

HoC for protein variable – AAs have diff HoC – digest most but some not fully digested depending on source – not fully oxidised

Alcohol also has calories

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6
Q

components of energy expenditure

A

Basal/resting met rate (BMR/RMR)
- Accounts for 60-70% total energy expen – fuel body processes

Energy expen of PA (EEA)

  • Accounts for 25-30% energy expen – greater if athletes – lots of training
  • Non-ex activity thermogenesis (NEAT) – fidgeting, get up and move around, everyday activities
  • Deliberate ex

Diet-induced thermogenesis (DIT)
- Increase in met rate after meal – accounts for 10% energy expen – takes energy to digest, break down and store food/meal

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7
Q

basal metabolic rate

A

Minimum level of energy to sustain vital functions in waking state – heart, breathing, protein turnover

Heart and resp functions = 10%

Protein turnover = 25%
- Related to FFM – larger amount = higher rate

Fat and carb turnover

Maintenance of ion gradients across membranes

Measurement

  • In supine position – no muscle contraction
  • Thermoneutral env – don’t want shivering
  • After 8h sleep and 12h fasting
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8
Q

diet induced thermogenesis

A

Energy required to digest, absorb and assimilate food nutrients

Obligatory thermogenesis

  • Protein – 20-25% - requires lots of energy
  • CHO – 5-7% - don’t have major store
  • Fat – 2-4% - doesn’t take much energy to store and not used to synthesise structure

Adaptive/facultative thermogenesis
- Due to increase in sympathetic NS activity in response to feeding

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9
Q

thermic effect of ex

A

(EEA)

Sedentary indv: 10% of EE, athlete: 15-30% EE

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10
Q

thermic effect of illness

A

Partial starvation – -10-40% RMR

Postabsorptive - +10

Multiple fractures - +10-30%

Severe infection - +30-60%

3rd degree burns (>20% BSA) - +50-100% - temp raised to body temp – maintain met rate

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11
Q

what is obesity?

A

too much body fat

% body fat

  • Men >30%
  • Women >35%

Waist circumference

  • Men >102cm
  • Women >88cm

Waist:hip ratio

  • Men >0.9
  • Women >0.85
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12
Q

internal control of energy intake (homeostatic)

A

Evolved to be able to store fat well and energy

Body adapted to take in as much as possible to be stored

Hunger – need food

Satiety – have enough energy – stop eating

Desire of hypothalamus is to eat – protect from starvation

Melanocortin system – stops us eating

Neuropeptide Y – promotes eating – signals to give you the desire to eat

Peptide YY, GLP1 – incretin hormones – short peptides – used in treatment diabetes – anti-obesity drugs

Don’t get signal to stop eating if hypothalamus resistant to leptin

Reduced gut hormones – continued desire to eat

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13
Q

external factors influencing intake

A

Psych (non-homeostatic)

  • Cortical and limbic system influences to overcome metabolic determinants of eating – related to reward/pleasure pathways – ‘always room for dessert’ – simulated most by sweet and fatty ratio
  • Palatability
  • Variety

Cost
- Cheaper foods often energy dense

Convenience/time of day
- Snacks often energy dense

Social and peer pressure – eating is a social activity – want to eat if you see others doing it

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14
Q

genetic causes - leptin deficiency

A

Female, at 9 years, weight nearly 100kg

Homozygous mutation in leptin gene

V. low blood leptin concentration despite body fat exceeding 50% body weight

Hyperphagia

Monogenic disease

Designed recombinant leptin – injected it – desire to eat reduced and body weight started to decrease

Didn’t work with others – hypothalamus becomes resistant

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15
Q

low PA

A

due to PA rather than energy intake

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16
Q

dietary components

A

Fat

  • Many ‘fat foods’ and convenience products contain high levels fat
  • Leads to passive overconsumption energy
  • Some evidence that indvs with reduced ability to oxidise fat at risk of weight gain

Sugar

  • ‘Hidden’ energy consumption
  • Decreases fat oxidation and increases fat storage
  • Fat/sugar combo
  • Increase in insulin – prevents fat oxidation

Alcohol

  • Decreases fat oxidation and increases fat storage
  • 7 kcal/g
17
Q

high fat/energy dense foods lead to passive overconsumption

A

In facility for 7 days – measured energy expen and intake – accurate

Meals had hidden fat – all looked and weighed the same

All ate same amount over 7 days

Lost weight in low fat

Medium and high put on weight

Easy to overconsume energy in form of fat – hidden in food

18
Q

preventing obesity: ex v diet

A

1g fat = 9kcal

70kg indv running at 8min/mile pace would expend approx. 900kcal in 1h

How many g fat?

High-intensity exercise tasks are usually not feasible for individuals with very high BMI and body fat %.

Energy expenditure that can be achieved through more gentle physical activity is more typically <500 kcal/day

45 g of fat

Therefore, achievable increase in energy expenditure through exercise must be used in conjunction with reduced daily calorie intake.

19
Q

dietary advice

A

600-700 kcal/day weight loss is manageable

  • = 4500 kcal/week
  • 1 kg of fat = 9000 kcal
  • = 0.5 kg/week or 13 kg over 6 months

Most weight loss is 75-90% adipose tissue and 10-25% FFM

Requires change in lifestyle
- Commitment of patient to change

Diet

  • Low fat, low energy density, low energy content, high fibre.
  • Replace saturated with monounsaturated fat, high GI with low GI foods, and increase protein (20% or greater)
  • Very low calorie diets (800 kcal/day for several weeks) also efficacious
20
Q

bariatric surgery

A

Reduces energy intake to 1200 –1500 kcal/day

> 30% weight loss in first year which is maintained for many years

Protein malnutrition?

Iron deficiency and vitamin D deficiency

Increases gut hormone response patients feel full with reduce desire to eat

21
Q

how do you prevent caloric disparity?

A

energy output = energy input

22
Q

how much of the US popn are overweight/obese?

A

65%

30.5% obese

leads to increase in diabetes and CV disease

23
Q

what % do genetic factors account for in excessive body fat accumulation?

A

25-30%

24
Q

what happens with a defective gene for adipocyte leptin production and/hypothalamic leptin insensitivity?

A

causes brain to assess adipose tissue status improperly

creates chronic state of pos energy balance

25
Q

how much does the standard dietary approach to weight loss lose?

A

0.5kg/week

5-20% actually lose weight

1-2/3 returns weight within a year and all within 5 years

26
Q

why does reducing body fat improve perf?

A

directly increases relative muscular strength and power and aerobic capacity

reduced drag force

27
Q

what 3 methods unbalance energy balance equation to produce weight loss

A

1) reduce energy intake below daily energy expen
2) maintain normal energy intake and increase energy output
3) decrease energy intake and increase energy expen

28
Q

what are the disadvantages of extremes of semistarvation?

A

loss of FFM

lethargy

possible malnutrition

depressed resting metabolism

29
Q

how can you increase body’s ability to conserve energy?

A

repeated cycles of weight loss-weight regain

makes weight loss with subsequent dieting less effective

30
Q

what does daily energy expen consist of?

A

sum of resting met, thermogenic influences and energy generated during PA

PA affects variability among humans in daily energy expen

31
Q

what do moderate increases in PA do?

A

blunt appetite and depress energy intake of previously sedentary, overweight person

32
Q

what does ex do?

A

enhances fat mobilisation and catabolism

aerobic retards lean tissue loss

resistance increase FFM

33
Q

what does rapid weight loss during first few days of caloric deficit reflect?

A

loss of body water and stored glycogen

greater fat loss occurs per unit weight lost as caloric restriction continues