Section 4

Question 1

What is the primary prevention to reverse obesity and how to ?

Answer 1

When at a point when you never been overweight or obese by improving insulin sensitivity and preventing + energy balance

Question 2

What is the secondary prevention to reverse obesity and how to?

Answer 2

Starting overweight and pre diabetic but decreasing by using treatment by detecting and reverse, prevent disease and inducing (helping) the negative energy balanxs

Question 3

What is the tertiary prevention to reverse obesity and how to?

Answer 3

Starting with diabetes and obesity and prevention or delay of complications

Question 4

What is a disadvantage of short term weight loss via diet induced in an obese person ?

Answer 4

Only a small minority of obese people maintain diet induced weight loss in the long term

Question 5

How does hormones adaptations play a role in weight loss that leads to weight re gain and why

Answer 5

When on a 3 month diet allowed a 17% weight loss was seen however after 6 months ghrelin was seen at a higher rate in the blood which drove more hunger and allowed for more weight regain due to long persistence of hormonal adaptation to weight loss

Question 6

What is the 2 factors to determine an energy gap ?

Answer 6

Your energy requirements before weight loss and energy requirement after weight loss

Question 7

What is metabolic adaption ?

Answer 7

Energy cost of physical activity(declines in energy expenditure) that is often beyond what is expected due to changes in body weight/composition

Question 8

What are 3 side effects that come with weight loss ?

Answer 8

1. RMR (suppressed) decreases with decreasing body mass
2. Thermic effect food decreases with total energy intake
3. Cost of physical activity declines with weight loss ( less energy burned during excercise

Question 9

What was the 6 years results of the biggest looser competition and why was the outcome

Answer 9

Contestants lost substantial weight however after 6 years they had a Persistant metabolic adaptation but all but 1 individuals gained weight some even past their original weight

Question 10

What happens to RMR when weight is gained

Answer 10

When weight is regained RMR doesn’t comes back it remains depressed

Question 11

What happens to metabolic adaption when weight gain occurs ?

Answer 11

Its goes low

Question 12

What are 5 common strategies to maintain weight loss?

Answer 12

1. Eat a low calorie, low fat diet
2. Consistent self monitoring of body weight ,food intake and physical activity
3. Eating breakfast everyday
4. High level of physical activity 60min of mod physical activity
5. Reducing screen time to 10hrs a week

Question 13

What is the comparison of energy intake and energy expenditure in today day vs the 1900s and has it contribute to obesity

Answer 13

We are eating less than the 1900 but our energy expenditure PA continuously to decrease whilst out energy intake plateaued and cant go further down lead to a positive energy balancing and obesity epidemic

Question 14

What does lowering carbohydrates intake do?

Answer 14

It improves glycemia and decreases hb1ac and glucose tolerance

Question 15

What is the difference between low cho diet vs ketogenic diet ?

Answer 15

Low cho diet is Less than 26% CHO with high fat and keto diet is 5-15% CHO with super high fat and this best way to reverse diabetes

Question 16

Why is the ketogenic diet better ?

Answer 16

Because ketone bodies are produced by the liver when there is low cho and FFA is high and it is utilized as fuel instead of glucose

Question 17

What area is nutritional ketosis and area in ketoacidosis(life threatening hypoglycemia)?

Answer 17

Normal Ketosis is between 0.5-3mM , ketoacidosis 10+ mM

Question 18

In the 2 year study of long term effects of nutritional ketosis for T2D what was the percentage effects of hba1c snd fasting insulin but what happens over 2 years ?

Answer 18

H1bac reduced by 12% and fasting insulin decreased by 42% but after 2 years it increase abdominal fat content once more

Question 19

How does a low cho diet compare and medication compare to only medication ?

Answer 19

A low cho diet reduced/eliminated medicine in take over 2 years while usual care medicine increased medical intake and insulin dosage over 2 years

Question 20

Is diet (macronutrient composition) or behaviour factors key and main influence for weight loss and why

Answer 20

Diet didnt matter as much because weight loss was not
Differentiated by much , Behavioural is the main influence as a study was done with highly motivated and educated participants but they couldnt achieve weight losses needed to reverse obesity as individual treatment is powerless against an high calorie environment

Question 21

What is the normal distribution of susceptibility to dis regulation in energy balance and weight maintenance?

Answer 21

It is a zone of dysfunction where it can be entered at a high or low levels due to epigenetics

Question 22

What 4 ideas create an obesigenic environment and why ?

Answer 22

1. Our biology we have more desire to eat and eat more sweet & fat along with no drive to be active
2. Economics
3. Food environment where food is easily available and energy dense food with large portions
4. Physical activity environment as there is little need for physical activity and entertainment and cars and discourage walking environments

Question 23

What was EPODE and what did it do ?

Answer 23

It was europe study that took a small town and took everybody to make a joint effort to eat and move around more where they built facilities and offered programs to promote healthy eating where results saw children being overweight decreased by 8.8% whilst nearby towns risen

Question 24

what is the about of moderate PA needed to prevent weight regain ?

Answer 24

mod pa 200-300 min/wk

Question 25

what 4 socio economic factors lead to low obesity rate ?

Answer 25

1. pedestrian safety 2. low crime 3. increase in property 4. proximity to supermarkets , parks, landmarks

Question 26

what 3 socio economic factors lead to high obesity rates ?

Answer 26

1. physical disorder 2. garbage litter and graffiti 3. proximity to bars , liquor , fast food

Question 27

what are 3 policies that lessen the impact of the environment ?

Answer 27

1. information like nutritional facts 2. taxes 3. marketing

Question 28

what are 3 policies that incorporate incentives for healthy behaviors ?

Answer 28

1. workplace 2. School 3. Communities

Question 29

how did acute exercise reduce post prandial hyperglycemia in comparison to a diet and nothing at all in T2D ?

Answer 29

compared to the control and diet after exercise there was significant drop in blood glucose whilst the other remained high

Question 30

What was the difference of plasma TG levels with acute exercise after a high fat meal in a non diabetic vs a diabetic

Answer 30

between rest and exercise in a non diabetic person not much changed however in a diabetic person when exercise was done significant changes occurred and plasma TG levels went down significantly compared to rest

Question 31

what was shown in the study of an exercised leg and a non exercised leg in a human muscle

Answer 31

it shows how a healthy exercised leg after three hours maintained high glucose uptake and improved insulin sensitivity (uptake) while the other leg remained low and had low senstivity

Question 32

what are the 4 ways how a healthy human prevent hypoglycemia and maintain blood glucose homeostasis?

Answer 32

1. mobilization of glucose from liver glycogen stores (glycogen breakdown 2. utilization of plasma FFA from adipose tissue instead of glucose 3. making glucose in the liver from AA and lactic acid and glycerol 4. blocking glucose uptake in cells

Question 33

what are the hormonal responses to graded exercise in a healthy individual and insulin level ?

Answer 33

hormones like EP AND NE and glucagon etc rise while insulin drops but begins to rise again

Question 34

what are the hormonal responses to prolonged exercises in a healthy individual and insulin level ?

Answer 34

hormones like Ep and NE etc rise but plateau whilst insulin sharply drops

Question 35

what are the 2 ways insulin and glucagon secretion are controlled during exercise ?

Answer 35

1. Epinephrine and NEpenphrine stimulates the beta adrenergic cell in the alpha cell and increase plasma glucagon and cause gluconeogenesis ( glycogen to glucose) 2. Epinephrine and Norepinephrine stimulate the alpha adrenergic cell and decrease plasma insulin which cause gluconeogenesis in the liver

Question 36

what does an increase in insulin cause in Adipose tissue, Muscle & Liver?

Answer 36

in adipose tissue in increase TG synthesis in muscle and liver production of glycogen and less plasma glucose uptake (glycolysis)

Question 37

what does an increase of glucagon cause in adipose tissue and liver ?

Answer 37

in adipose tissue more plasma FFA due to TG breakdown in liver more plasma glucose via gluconeogenesis and less glycogen

Question 38

what does catecholamine like Epinephrine and NE and growth hormone and glucagon and cortisol all do to the liver, Adipose and tissue what is the only difference in cortisol

Answer 38

in tissue is blocks glucose uptake and increase FFA oxidation in adipose tissue its breaks down TG in liver gluconeogenesis or utilize glycogen in muscle it uses protein to make AA as fuel for gluconeogenesis

Question 39

in a T2D person in a postabsorptive state ( approx 3 hr after a meal ) what was seen done with the drug glibneclaminde-sulf only , excercise only and both to insulin and glucose

Answer 39

for glucose not much difference both of them together reduced glucose the most whilst exercise alone kept blood glucose high for insulin it varied more as exercise reduced insulin the most and sulf the drug kept insulin the high and elevated

Question 40

how much are T1D individual are at risk of hypoglycemia during exercise than non diabetics?

Answer 40

they have a 25 fold higher risk

Question 41

how prolonged can hypoglycemia occur after exercise and what can it lead to in a T1D person ?

Answer 41

it can occur during or up to 17hrs after exercise so T1D people can have nocturnal hypoglycemia due to long lasting insulin sensitivity

Question 42

what are 2 reason why people with T1D at risk of hypoglycemia during exercise ?

Answer 42

1. inhibition of endogenous insulin secretion is not function 2. bad counterregulatory responses to hypoglycemia

Question 43

what can exercise the day prior do to a t1d individual during their next exercise ?

Answer 43

it further impairs counterregulatory responses like glucagon and epinephrine during their next day exercise

Question 44

who are at more risk for exercise induced hypoglycemia; males or females?

Answer 44

males

Question 45

what are 4 practical guidelines to limit glucose before and during exercise?

Answer 45

1. cut insulin dosage by 10-40% before exercise based on intensity and duration 2. supplement with 20-60 g of CHO every 30 min 3. check blood glucose after 30 min of exercise 4. post exercise cut pre meal insulin by 10-30 %

Question 46

what is the hypoglycemia autonomic failure pathway

Answer 46

insulin deficiency which leads to no increase in glucagon and T1D diabetes where than you have an imperfect insulin replacement which all leads to hypoglycemia and hypoglycemia causes reduced autonomic responses so decrease symptoms and epinephrine which leads to defective glucose counterregulation and further hypoglycemia