Module 10

Question 1

Briefly explain each step of the obesity algorithm.

Answer 1

1. Data collection: information about the patients/client is collected
2. Evaluation and Assessment: Edmonton Staging System classification made for patient
3. Management decisions: tailor a particular intervention towards an individual’s needs
4. Motivational interviewing

Question 2

Why is the Edmonton Staging system a better measure of obesity than BMI?

Answer 2

• It can predict risk of mortality (whereas BMI risk is all the same)
• Higher stages associated with higher hazard ratios for CVD and cancer

Question 3

What are the 5 A’s of obesity management?

Answer 3

1. Ask - are they ok with discussing their weight?
2. Assess - eating behaviours, drivers of excess weight gain, and obesity stage.
3. Advise - health risks of obesity, the benefits of modest weight loss, treatment options
4. Agree - on realistic goals
5. Arrange/Assist - individualized dietary and exercise prescription, Assist in identifying and addressing barriers; provide resources; assist in finding and consulting with appropriate providers; arrange regular follow up

Question 4

After periods of dieting, what tends to happen. Give some reasons for why this happens.

Answer 4

1. People regain the weight after the dieting ends
2. This may be due to physiological adaptations that cause ghrelin levels to increase and levels of satiety factors (leptin, peptide YY, cholecystokinin) to decrease

Question 5

Briefly outline the Minnesota starvation study and what it found.

Answer 5

Study design:

• 3 months observation, normal diet (~3492 kcal/d)
• 6 months semi-starvation, calories halved (1570 kcal/d)
• 3 month structures refeeding (4 groups at different caloric intakes)
• Optional 8 weeks of unrestricted feeding

Findings:

• After the study, men ate beyond initial levels (around 3000-5000 kcal/day)
• Weight returned to 109% of initial
• Body fat percentage remained higher than initial weight

Question 6

What was the most notable finding from the “Biggest Loser” study

Answer 6

Even though the participants were able to spare fat-free mass, their RMR dropped disproportionately (metabolic adaptation)

Question 7

Define metabolic adaptation.

Answer 7

Residual RMR after adjusting for changes in body composition and age

Question 8

List some potential strategies for preventing metabolic adaptations during weight loss.

Answer 8

• Focus on higher protein intake
• Perhaps increase fiber intake
• Diet breaks and refeeds