Weight Management Lecture 1

Question 1

t/f obese children have a higher risk of adult obesity

Answer 1

treu

Question 2

what are the 5 A’s of helping with obesity?

Answer 2

1. ask permission to talk about weight
2. assess their story
3. advise on management
4. agree on goals
5. assist with their drivers and barriers

Question 3

list 3 reasons people want to lose weight

Answer 3

1. image
2. health (physical and psychological)
3. performance

Question 4

list 5 ways people try to lose weight

Answer 4

1. diet
2. exercise
3. medication
4. surgery
5. controlling other factors such as stress, energy etc

Question 5

the cause of obesity is NOT simply ___, but rather the complex interplay of _____

Answer 5

inbalance of calories in vs out; multiple genetic factors, metabolic and behavioural and environamnetal factors

Question 6

how are humans hard-wired against weight loss?

Answer 6

decreased food intake and increased physical activity lead to a negative energy balance and trigger cascade of metabolic and neurohormonal adaptive mechanisms

Question 7

what are the ABC’s of weight couseling?

Answer 7

ask permission
build a relationship
critically look for weight bias

Question 8

what is weight bias?

Answer 8

negative attitudes towards others bc of their weight

Question 9

what is weight stigma?

Answer 9

stereotypes and labels we assign to people who have obesity

Question 10

what is weight stigma?

Answer 10

actions against people with obesity that can casue social exclusion and inequities

Question 11

BMI should serve only as a ___

Answer 11

screening measurement

Question 12

t/f BMI should be used with other information to identify who may benefit from obesity management

Answer 12

treu

Question 13

BMI is the most commonly used objective surrogate marker for

Answer 13

body fat

Question 14

how is BMI calculated ?

Answer 14

weight (kg) / height (m2)

Question 15

1 lb is ____kg

Answer 15

2.2

Question 16

integration of BMI and ____ in clinical assessment may identify the higher risk phenotype of obesity better than either alone, particularly is those with low BMI

Answer 16

waist circumference

Question 17

what is the Edmonton obesity staging system measuring?

Answer 17

assessment of risk factors & physical symptoms (risk factors and established co-morbidities) psychological symptoms and physical limitations

Question 18

does BMI provide information on the distribution of fat?

Answer 18

no

Question 19

body fat in what region is associated with higher prevalence of comorbidities

Answer 19

central

Question 20

wasit circumference should be measured at what stage of breathing?

Answer 20

end of normal exhale

Question 21

cut-off values for waist circumference vary with ___, ___ and ___

Answer 21

gender, age, ethnicity

Question 22

can you have a high BMI and be healthy?

Answer 22

yes!

Question 23

in healthy individuals with a high BMI, is there any evidence to suggest long-term benefits of intentional weight loss? What should the focus be for these individuals?

Answer 23

no; focus on healthy lifestyle and not gaining weight

Question 24

BMI measurements are most useful for what age category?

Answer 24

20-65

Question 25

what 2 adult groups may not be accurately represented by their BMI?

Answer 25

those who do a lot of muscle resistance training and those with extreme short/tall stature

Question 26

is BMI appropriate for infants, children, adolescents, pregnant and breastfeeding women?

Answer 26

no

Question 27

why is BMI not appropriate for adults over 65?

Answer 27

1. not associated with increased mortality in this group | 2. being underweight is the greater concern

Question 28

t/f health canada recommends that diagnosis of obesity not be based off BMI alone

Answer 28

true

Question 29

what are the 3 regions of the brain that regulate weight?

Answer 29

1. hypothalamus 2. mesolimbic 3. cognitive lobe

Question 30

what is the main role of the hypothalamus in weight regulation?

Answer 30

energy homeostasis

Question 31

what is the main role of the mesolimbic in weight regulation?

Answer 31

pleasure center, involved in the rewarding aspect of eating

Question 32

what is the main role of the cognitive lobe in weight regulation?

Answer 32

executive functioning (voice of reason) that can override the mesolimbic

Question 33

when does the cognitive lobe work best in weight regulation and supressing the mesolimbic?

Answer 33

under smooth conditions of rest, low stress and support

Question 34

what is the important goal of therapy for weight management?

Answer 34

focus on improved health and wellbeing, not the amount of weight lost

Question 35

t/f even modest and sustained weight loss is associated with improvements in co-morbidities associated with obesity

Answer 35

true

Question 36

the pathophysiology of obesity is a complex interaction of ___ and ___

Answer 36

individual factors and societal factors

Question 37

list 3 medical conditions that are "organic" causes of weight gain

Answer 37

1. cushings disease 2. hypothyroidism 3. endocrinopathies

Question 38

what sort of risk factors are associated with stage 1 obesity? Examples?

Answer 38

obesity-related subclinical risk factors ; borderline hypertension, impaired fasting glucose; elevated liver enzymes

Question 39

what type and severity of physical symptoms might be seen in stage 1 obesity?

Answer 39

mild (currently not requiring medication for comorbidities); trouble breathing on moderate exertion; occaisional aches and pains

Question 40

what type and severity of psychological symptoms might be seen in stage 1 obesity? How is the quality of life impacted?

Answer 40

mild obesity-related physchological symptoms and or mild impairment of well-being. QOL not impacted

Question 41

stage 3 obesity is associated with a sugnificant level of at least 1 of what 4 factors? is quality of life impacted?

Answer 41

1. end-organ damage (heart attack, diabetes complications 2. obesity-related psychological symptoms 3. functional limitations 4. impairment of well-being no

Question 42

what is the effect of obesity on leptin?

Answer 42

brain gets feeling of chronic low leptin levels

Question 43

what structures in the hypothalamus that increase appetite

Answer 43

agouti related peptide and the neuropeptide y

Question 44

what structures in the hyptholamus suppress appetite?

Answer 44

pro opimelanocortin (POMP C) and cocaine and amphetamine regulating transcript (CART)

Question 45

ghrelin ____ (raises / lowers) metabolism

Answer 45

lowers

Question 46

ghrelin stmilulates what parts of the hypothalamus?

Answer 46

the AgPR / NPY (stimulates hunger)

Question 47

release of insulin stimulates what hypothalamus structures? what does it supress?

Answer 47

POMC / CART (suppresses appetite); inhibits the AgPR and NPY

Question 48

leptin is released from ___ and stimulates ___ and supresses ___

Answer 48

adipose tissue; POMPC and CART ; AgPR and NPY

Question 49

soluble and insoluble fiber promote satiety by ___

Answer 49

delaying gastric emptying and causing feeling of fullness

Question 50

glycemic index compares _____ to ingestion of ___g of available carbohydrates from a test food with that of a reference food (glucose or white bread)

Answer 50

blood glucose ; 50

Question 51

t/f a higher glycemic index produces more of an insulin spike than lower gylcemic index foods

Answer 51

true

Question 52

t/f high-fiber low glycemic index diet results in fewer glycemic spikes

Answer 52

treu

Question 53

what is the focus of medical nutrition therapy?

Answer 53

individualized eating patterns, food quality and healthy relationship with food

Question 54

t/f medical nutrition therapy includes mindfulness-based eating practices that may help reduce cravings, reduce reward-driven eating, improve body satisfaction and improve awareness of hunger and satiety

Answer 54

true

Question 55

t/f medical nutrition therapy assesses for micronutrient deficiencies

Answer 55

true

Question 56

what is a negative physiologic impact of very-low calorie diets?

Answer 56

may effect neurobiological pathways that control appetite, hunger and cravings. Body weight regulation may result in increased food intake and weight gain

Question 57

what are the risks of a low carb LCD +/- protein diet (keto_

Answer 57

increased bone calcium loss, dehydration, gout, kidney and liver disease

Question 58

low fat diets can produce significant weightloss up to ___ years

Answer 58

3

Question 59

t/f low fat diets are comparable to reduced energy diets in comparison of weight loss

Answer 59

true

Question 60

what is the mediterranean diet?

Answer 60

high intake of natural fats, plant foods, moderate intake of fish, poultry, dairy and red wine (low inatke of red meat , eggs and sweets)

Question 61

what is the DASH diet?

Answer 61

dietary approach to stop hypertension; emphasizes high intake of fruit, low-fat dairy, veggies, grains, nuts and low intake of red/processed meat and sweets

Question 62

who is considered for weight loss surgury?

Answer 62

BMI > 40 or BMI 35-40 with combined high-risk comorbidities

Question 63

what are the 2 main types of weight loss surgury?

Answer 63

1. gastric bypass | 2. banded gastroplasty

Question 64

what is gastric bypass?

Answer 64

creating a short bowel to produce malabsorption of ingested calories

Question 65

what is banded gastroplasty?

Answer 65

a small stomach is created to prevent large caloric intake at any one time

Question 66

which weight loss surgery is associated with greater improvement of weight loss outcomes and better long term outcomes?

Answer 66

banded gastroplasty

Question 67

what are some of the complications of weight loss surgery?

Answer 67

wound healing, metabolic distrubances, severe diarrhea, bloating, anorectal pain, disruption of drug absorption

Question 68

what is an example of a drug used for weight loss?

Answer 68

Bupropion 90mg / Naltrexone 8 mg (Contrave)

Question 69

what BMI may be eligible for Bupropion naltrexone treatment?

Answer 69

>30, 27 with comorbidities

Question 70

what is the usual function of bupropion?

Answer 70

inhibits reuptake of DA and NE and causes mild appetite suppression

Question 71

what is naltrexne used for usually?

Answer 71

opioid antagonist

Question 72

how is buproprion naltrexone suspected to suppress appetite?

Answer 72

by increasing firing of the POMC

Question 73

t/f combination of weight loss mediaction and lifestyle is more successful than lifestyle alone

Answer 73

true

Question 74

medications used for weight loss have at least one of the following effects

Answer 74

1. reduce food intake (suppress appetite) 2. reduce. nutrition absorption 3. increase enerfy expenditure

Question 75

a ____% reduction in weight is realistic for weight loss medications

Answer 75

5-10

Question 76

t/f weight loss requires reduced calories

Answer 76

true

Question 77

what is the effect of orlisat of weight loss?

Answer 77

inhibits fat absorption by blocking pancreatic lipase, makes oily stools that might make patients want to eat less fat to avoid this

Question 78

what are some notable drug interactions with orlisat?

Answer 78

1. reduction of fat-soluble vitamin absorption 2. can reduce absorption of synthroid 3. may affect absorption of oral contraceptives

Question 79

what are some innapropriate mediactions for weight loss?

Answer 79

laxatives, syrup of ipecac, diuretics, thermogenic agents

Question 80

who should NOT take bupropion naltrexone?

Answer 80

those with uncontrolled high BP, seizures, bulimia, anorexia, opioid use, MAOIs, severe kidney / liver damage

Question 81

is there risk of suicidal thoughts with use of bupropion naltrexone?

Answer 81

yes

Question 82

what is a risk of bupropion naltrexone for those with type 2 diabetes?

Answer 82

hypogylcemia if pt on glucose lowering treatment

Question 83

what are some adverse effects of bupropion naltrexone?

Answer 83

nausea, constipation, dizziness, dry mouth acute glaucoma and headache

Question 84

should bunaltrexone be taken with a high fat meal?

Answer 84

no

Question 85

can bunaltrexone be crushed or broken? why /why not?

Answer 85

no, risk of seizures

Question 86

what is liraglutide?

Answer 86

long-acting analog of human glucagon-like peptide (incretin)

Question 87

what is the function of the liraglutide?

Answer 87

stmulates insulin secretion, reduces postprandial glucagon levels, slows gastric emptying and acts on sateiety pathwasy to reduce food inatke

Question 88

who should NOT take liraglutide?

Answer 88

if family history of medullary thyroid cancer or multiple endocrine neoplasia syndrome type 2

Question 89

what are some of the adverse effects of liraglutide?

Answer 89

nausea, vommiting, upset stomach, gall stones, pancreatitis, increased heart rate, low blood sugar and difficulty sleeping

Question 90

how is liraglutide dosed?

Answer 90

SC injection