1
Q
what is the difference between visceral fat and ectopic fat
A
visceral is stored deep in the belly AROUND the organs.
ectopic fat deposited in non-adipose tissues where fat is not normally stored in large amounts.
-more responsible for insulin resistance
2
Q
what is abdominal obesity
A
condition where excessive visceral fat around the stomach
apple or beer belly shape
3
Q
what are adipokines
A
cytokines produced by adipose tissue
4
Q
what is the consequences of high levels of adipocytes
A
increase inflammation which increases the risk of CVD and other diseases
5
Q
can obesity be causally related to many conditions
A
difficult to prove and understand a causal relationship but many correlational relationships
6
Q
in 2004 what did the CDC report on sleep say about the trend
A
3/10 adults sleep 6 or less hours a night. up from 2/10
7
Q
what is the correlational relationship between BMI and sleep
A
more sleep less BMI
8
Q
what is the threshold of sleep that leads to increase in BMI
A
most studies show less than 7 sleep have higher BMI
9
Q
how does sleep deprivation change food intake
A
increase in food intake. experimental evidence in humans and rats
10
Q
how does length of sleep change leptin and ghrelin levels
A
decrease leptin
increase ghrelin
11
Q
what to know about cortisol
A
stress hormone
can be beneficial short term but not long term
most potent glucocorticoid
causes insulin resistance
12
Q
what is Cushing’s syndrome and how is connected to metabolic syndrome
A
Cushing’s syndrome is excess cortisol of any cause.
linked by 5 factors
1. abdominal obesity
2. hypertension
3. hyperglycaemia
4. insulin resistance
5. dyslipidemia
13
Q
what happens to people’s weight in response to chronic psychological stress
A
40% gain weight
20% weight stable
40% lose weight
overweight/obese tend to gain weight more often
14
Q
what do twin studies show about the relationship between parental obesity and child obesity
A
show that obesity is mostly environmental because two foster parent condition shows no higher incidence of obesity among kids of 2 obese parents
15
Q
what is assortative mating and what does it have to do with obesity
A
Assortative mating is the non-random tendency for individuals to partner with others who are similar to themselves on specific traits.
lean individuals mate with lean individuals. obesity mate with obesity
16
Q
what did overfeeding and underfeeding twin studies show about change in weight and relationship to other factors
A
high abdominal visceral fat gain (AVR) was most genetically related
underfeeding condition showed that genetics plays factor in how much weight each person lost because twins tend to lose similar amounts compared to each other.
17
Q
how is childhood obesity defined by the CDC
A
age and sex based percentile cut off points
-85th percentile BMI is at risk for overweight
-95th percentile BMI is overweight
18
Q
why does the CDC use percentile of BMI to classify obesity instead of a set number BMI
A
BMI changes rapidly in childhood following a non linear pattern.
19
Q
is the relationship between birthweight and adult BMI J-shaped or u-shaped
A
not sure but underlying idea is that low or high birthweight is at risk of abnormal adult BMI
20
Q
what did the dutch famine study show about type of pregnancy starvation and obesity in child later in life
A
trimester 1 and 2 exposure increased risk of adult obesity
-permanent changing of appetite or metabolism?
trimester 3 exposure decreased risk of obesity
-TM3 is when baby lays down fat
21
Q
how could early GWG effect the mother
A
gestational diabetes
postpartum weight retention
22
Q
what birthweight had an increased risk of overweight
A
greater than 4000g
23
Q
what is the prevalence of obesity and overweight in canada
A
20%
34%
24
Q
define obesity
A
defined as a prevalent, complex, progressive and relapsing chronic disease characterized by abnormal or excessive body fat that impairs health
25
according to a modern definition of obesity, what should the basis for diagnosis
presence of functional, medical and or psychosocial impairments related to presence of abnormal body fat.
BMI and waist circumference are screening tools
-BMI first then waist if BMI is 25-35
26
what are the 5As approach to obesity management
ask
-recognize obesity as chronic disease
-permission to offer advice and treatment
assess
-identify root causes, complications and barriers to obesity treatment
advise
-discuss treatment options and adjunctive therapies
agree
-agree with person regarding goals of therapy
assist
-engagement by HCP in follow up and reassessment
27
why is a comprehensive history useful in obesity treatment/diagnosis
identify root causes of weight gain as well as complications of obesity and potential barriers to treatment be included in the assessment
28
what tests should be performed on a person with obesity to determine cardiometabolic risk (3)
BP in both arms
fasting glucose or glycated hemoglobin
lipid profile
29
what is EOSS and what is it used for
Edmonton obesity staging system
used to determine the severity of obesity and to guide clinical decision making
30
what are the WHO classification for weight status
25-30 OW
30-35 obese class 1
35-40 class 2
40+ class 3
31
what are the differences between the stages in EOSS
stage 0
-no issues or signs of risk factors
stage 1
-signs of obesity related subclinical risk factors
-> borderline hypertension, impaired FG
or
-MILD physical, psycholoical symptoms
--> no impact on QOL
stage 2
-established obesity related comorbidities
-->HTN, T2D, sleep apnea, PCOS, osteoarthritis
or
-moderate psychological or functional limitations
--> QOL beginning to be impacted
stage 3
-significant obesity related organ damage
or
-significant psychological symptoms
-->MDD, suicidal ideation
or
-significant functional or well being limitations
stage 4
-end stage comorbidities
-severely disabling psychological/functional symptoms
32
what stages in EOSS meet clinical criteria for admission
stage 2+
stage 0-1 refer to primary care for preventative treatment
33
what are the 3 pillars of obesity management
psychological intervention
-behaviour modification
-manage sleep, time, stress
-CBT
pharmacological
-liraglutide
-naltrexone/bulpropion
-orlistat
bariatric surgery
-sleeve gastrectomy
-roux en y gastric bypass
-biliopancreatic diversion
34
what is the criteria for pharmacological therapy for obesity
30 BMI
or
27 BMI with related complications
35
what is the criteria for bariatric surgery
40 BMI
or
35-40 BMI if complications
or
30 if poorly control T2D
36
what are the 3 goals of obesity intervention
prevention (1pound a year)
losing weight
maintaining weight loss
37
what does clinically significant weight loss mean
greater or including 5% of baseline body weight loss
reduction of cardiovascular disease and T2D risk factors
38
why is diet interventions alone not optimal for weight loss
greater FFM loss less fat mass loss compared to combined with exercise
39
what are the two methods of understanding exercise volume
frequency x time
EE
40
why wouldn't increasing EE work for weight loss
normal amounts of exercise only increases EE by a little
adherence to changes in PA is poor
increasing EE could lead to increases in EI
41
does even high amount/intensity exercise lead to clinically significant weight loss
no but lean mass dues increase
42
what type of exercise is optimal for weight loss/ adherence
short bouts with at home equipment shown to have greatest changes in weight and greatest adherence long term
43
at what intensity is the greatest absolute fat oxidation
65%
44
at what intensity is the greatest relative fat oxidation
25%
45
in experiments how did medium intensity and high intensity exercise effect weight loss when controlled for EE
greater weight loss in hight intensity
46
can resistance training prevent the decrease in FFM that comes with diet induced weight loss. in which populations should this effect be more important for
only partially. diabetes and elderly
47
what other advantages of physical activity for participants looking to lose weight (5)
fitness
QoL
improve risk factors (BP,glucose)
fat distribution
prevention of weight regain
48
how does an improvement in exercise capacity of 1 met improve survival
12%
49
what is the strongest predictor of death
exercise capacity
50
what are the steps of energy balance physiologic regulation
afferent hormonal signalling
central integration
efferent signaling
behavioural change
51
which are the episodic hormones
ghrelin
ppy
Glp1
pp
cck
insulin
52
which are the tonic hormones
insulin
leptin
53
does lactate contribute to post exercise diet suppression
yes.
high intensity exercise produces more lactate and has greater suppression. GLP1 and PPY doesn't do this.
more lactate is also correlated with lower ghrelin
bicarb condition also shows lower ghrelin
54
does blood glucose contribute to post exercise diet suppression
blood glucose doesn't change with intensity of exercise. cannot be a mechanism
55
does IL-6 contribute to post exercise diet suppression
no
56
how does being obese effect post exercise appetite supression
lower decreases in ghrelin so less suppression
57
how does the ovarian hormones effect appetite
higher food intake in luteal phase and also higher progesterone
58
how does luteal phase impact exercise induced suppression of diet
higher ghrelin and less suppression of diet
59
how does the presence of ovarian hormones impact exercise suppression of diet. how do we know this
menopausal vs premenopausal show premenopausal have higher ghrelin and high appetite
minimal change in anorexigenic hormones
60
what is dieting
attempting to maintain a certain weight through nutritional intake
61
what is a lactovegetarian diet
certain types of dairy but not eggs and rennet foods
62
what is lacto-ovo vegetarian
includes eggs and dairy
63
what is flexitarian diet
predominately vegitarian but meat is occasionally consumed
64
what does professional associations say about vegetarian diets
appropriately planned vegetarian diets are healthful, nutritionally adequate and provide health benefits in the prevention and treatment of certain diseases
65
what are the advantages of vegetarian diet (7)
lower sat fat
lower added sugar
low consumption of cholesterol
high intake of some micronutrients and fibre
lower BMI
lower odds of mortality from heart disease
better insulin control (less resistance)
66
what are the disadvantages of vegetarian diet (6)
low protein
low iron
low calories
low vitD
low b12
limited choice of foods makes consumption of nutrients more difficult
67
how does vegetarian diet and keto diet compare
similar feelings but vegetarian ate 600kcal less than keto.
68
what is the definition of a low carb diet
no universal definition
less than 20g CHO for 2 weeks then 50
69
what is a low fat diet
<30% of EI from fat
may also include:
<10EI from saturated fat
no transfat
less high cholesterol food
70
what is the carbohydrate insulin model
high carbs lead to high insulin then cellular semi starvation and obesity
71
why is carbohydrate insulin model (CIM) not widely accepted
calorie for calorie, fat restriction results in more body fat loss than carbohydrate restriction in people with obesity
carb restriction did lead to increased fat oxidation but not greater body fat loss
72
what to know about keto diet
10% carb 20%protein 70% fat
good for t2d and works for weight loss
idea is that ketones can supply brain and also exert appetite suppressing effects
limitation is long term adherence is low
73
what to know about Atkins diet
10% carb protein 25% fat65
great short term performance compared to other diet but similar long term due to issues with adherence
74
what is the similarities and differences between zone and paleo diet
same macro 40carb 30protein 30fat
zone encourages fruits and veg, lean protein, whole grain, monosatirated and omega 3 fatty acid
paleo is nuts meat eggs oil fresh fruit and veg
paleo performs greater short term but effect fades after 2 years
75
is there a difference in long term performance between low fat and low carb diets when not controlling for calories
no. also no genetic link or advantage between choosing between the two
76
what is most important factor to losing weight long term
adherence to caloric deficit.
what type of diet doesn't matter long term.
77
how does glycemic status as a predictor of weight loss
normoglycemic has greater weight loss on low fat diets (short term)
prediabetic or diabetic show greater weight loss on low carb diet (short term)
78
how does motivation impact weight loss
important for long term weight loss
low motivation show significant weight regain
79
define high protein diet
no common definition
80
why would a high protein diet work for weight loss
high satiety
energy demanding to store excess protein
can taste good
preserve FFM
81
why wouldn't a high protein diet work for weight loss
concerns with high meat consumption
potentially costly
82
what specific use case might high protein diet be useful
to prevent weight regain. only diet to seem to work for this
83
is FFM equivalent to muscle mass when losing weight?
no. glycogen and water
84
what are the risks to high protein diets
often very similar to low carbohydrate diets
health issues with consuming high meat
85
what is the risk of eating lots of meat
high cooking temperature producing carcinogens
haem iron found in red meat seems to be problematic
17% increase risk per 100g red meat a day
18% increase risk per 50g processed meat a day
86
what is the definition of very low calorie diet
less than 800kcal
or
<50% of RMR
87
why would a Very low calorie diet work
simple to follow
large deficit
rapid weight loss can be motivating
could be a starting point to other changes
breaking habits?
88
why wouldn't a very low calorie diet work
not a long term solution
no changes in behaviour
expensive
requires medical supervision
safety
89
how much can a person expect to lose with a very low calorie diet
15-25% of initial weight in 3-4 months
weight regain is very extreme
90
what are the negative side effects of VLCD
gallstones. reduced by eating more than 7g of fat
cold intolerance, hairless, headache, fatigue, dizziness, volume depletion, muscle cramps and constipation
91
how many people actually get surgery for weight loss
1/171 individuals with BMI > 35
92
how long can wait times be for bariatric surger
8 years in some cases
93
are medications for obesity covered through public drug benefit programs
no
94
who is allowed to have bariatric surgery
40BMI or greater
-strong desire for weight loss
-understanding of the impact of surgery
35-40 with major medical comorbidity
-severe sleep apnea
-severe diabetes
-physical problem
95
what are some contraindications to bariatric surgery. 8
over 60
medical conditions making surgery high risk
pregnancy
genetic conditions
certain mental health disorders
substance abuse/ alcohol abuse
poor attention or refusal to make lifestyle changes
unable to comprehend advice
96
what makes Edmonton adult bariatric specialty clinic different from others
provides medical and psychological interventions for weight management in addition to surgery
initial clinic assessment determines patient specific barriers
develop individual care plan
-behaviour modification
-counseling for nutrition, PA, and MH
-drug treatment and bariatric surgery
97
how do comorbidities of obesity change with bariatric surgery
improved with weight loss
98
what is the difference between restricted procedures and malabsorptive procedures
restricts the amount of food the stomach can hold
reduces the amount of calories and nutrients the body absorbs
99
what are the advantages and disadvantages of adjustable gastric banding (AGB)
100
what are the advantages and disadvantages of sleeve gastric
101
what to know about Roux-en-Y gastric bypass advantages and disadvantages
y shaped section of the small intestine is attached to the pouch to allow food to bypass the lower stomach
102
what is dumping syndrome
103
what are the potential complications of abdominal surgery
infection
hemorrhage
hernia
bowel obstruction
anastomotic leakage
dumping syndrome
nutritional deficiencies
increased risk of death and suicide
104
what is body countering surgery
skin flap removal
105
what disadvantages of bariatric surgery other than surgical complications
high cost
waiting list
people don't want surgery
potential need of body countering surgery
psychological effects
106
what types of supports would someone need if they were getting bariatric surgery
before and after surgery (fix underlying issue)
psychological
nutrition
exercise
skin flap surgery
107
what is the effect of bariatric surgery on health
40% decrease mortality
50-90% reduction in diabetes incidence
55% reduction in coronary artery disease
60% reduction in cancer
108
what is the categorization criteria for diabetes remission
partial remission
- A1C<6.5%
- no hypoglycaemic agents
-1 year duration
complete remission
-A1C<5.7% (normal ranges)
-1 year duration
-no hypoglycaemic agents
Prolonged remission
-A1C<5.7% (normal ranges)
-5 years duration
-no hypoglycaemic agents
109
what is the suggested surgery criteria for diabetes by some professionals at Diabetes surgery summit
inadequately controlled diabetes and BMI as low as 30 or 27.5
110
is surgery or medical/lifesyle intervention more effective for diabetes remission
surgery is more effective. about twice as much
2-3% decrease A1C surgery
1-1.5% decrease medical/lifesyle
111
why would metabolic surgery cause diabetes remission (7)
favourable changes in gut hormones
-ppy, GLP1, oxyntomodulin
favourable bile acid signalling
increase glucose metabolism by small intestine
changes in intestinal nutrient sensing that increases insulin sensitivity
reduced intestinal glucose transport
reduced circulating BCAA
alterations in gut micobiota
112
what outcomes can be expected from bariatric surgery for BMI 30-34.9
decrease in BMI of 5-7. compared to just 2.8kg over 1 year from behavioural intervention
prevalence of metabolic syndrome decreased by 34.8% after 2 years
A1C decrease of 2.6-3.7
113
how many percent of people have private healthcare insurance have weight loss medication coverage
10%
114
who would qualify for weight loss medication
BMI over or including 30
BMI 27 with comorbidities
115
what to know about orlistat
commercial name Xenical
works by inhibiting the breakdown of fat so it passes directly through the digestive system
can cause flatulence and inability to control bowel movements
can have issues with long term adherence
not great for diabetes or hypertension
116
why might a weight loss show excellent short term performance but poor long term
poor adherence
117
how much weight can a person expect to lose after 2 years of orlistat
2.9kg is the average
118
is orlistat useful for managing cardiometabolic risk
no. low reduction in risk factors like LDL, TG, Cholesterol and bodyweight
119
what to know about liraglutide
97% the same structure as human GLP-1 but longer half life
commercial name saxenda
causes weight loss by slowing gastric emptying, satiety on brain. reducing hypoglycaemia
120
how does liraglutide dosing change depending on goals
weight loss requires high dosages of up to 3mg daily
diabetes is lower at 1.2 or 1.8mg daily
121
describe the effectiveness of liraglutide
much stronger effect compared to orlistat that scales with dosage however long term adherence may be a problem due to reported side effects like nausea and headaches. most people seem to quit following dosages assigned after about 7-8 weeks
122
what are some of the major issues with liraglutide use
risk of thyroid cancer and pancreatitis outweighs benefits and long term impact is not well known
123
what to know about contrave
a combination of naltrexone and bupropion. addiction drug and antidepressant respectively.
work on two separate areas of brain responsible for hunger and cravings
attractive because it is a tablet not an injection. max dose is 2 a day
124
in canada, who is contrave approved for
BMI over 30
BMI over 27 if one weight related condition.
-HT, T2D, dyslipidemia (high fat in blood)
125
how well does contrave work
can expect 500kcal reduction with PA and contrave
60% lost 5% or more of BW and kept it off for 1 year.
126
how effective is semiglutide and why is this a problem
can expect 16% reduction in BW in 1 year
can be a problem because high expectations from patients ex. 25-35% in 1 year are likely not realistic.
127
what are some issues with semiglutide use
weight loss will plateau and is often regained if meds stopped
do not solve behavioural issues causing initial weight management failure
128
explain the treatment gap in weight loss treatment modalities
surgery still provides vastly superior results
