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MIDTERM - all previous sets
Terms in this set (136)
What does BMI stand for?
Body Mass Index
What is the calculation for BMI?
What is the current overweight/obese rate for American Adults?
1 in 3
What is the current overweight/obese rate for American children (2-19yr)?
1 in 6
What was the Bogalusa Heart Study and its major findings?
Study done in Louisiana, starting in 1972 looking at behavioral and biological CVD risk factors in children. They measured trends over time to understand pathogenesis of adult disease. Longitudinal study. Found that CVD starts in childhood with strong association to overweight and obesity.
What years did obesity rates increase dramatically in the US?
Are the US obese population more poor or rich in their socioeconomic status?
What are the 7 factors for Ideal Cardiovascular health?
1. No smoking
3. Nutritious Diet
4. Weight Loss
5. Maintain healthy BP
6. Maintain cholesterol
7. Reduce blood sugar
Define visceral fat
Fat around or near the organs, stored in the abdominal cavity
Define subcutaneous fat
Fat under the skin
Why are women supposed to carry a little more fat and men not so much
Women in history have needed more fat for baring children. Men always worked and hunted and only had enough to get them through the nights of hunting and gathering.
Define Type 1 BM
Insulin is not produced by the pancreas, deficient
Define Type 2 DM
Is Type 1 or Type 2 DM more common?
Describe the 6 factors that determine what we decide to eat
3. Allergies, intolerance
3 Phases to Gastrointestinal control
Factors that determine palatability during the Cephalic phase. What our brains think.
Appearance, temperature, texture (+ pressor, tactile, pain), smell, sound
How do taste cells relay information back to the brain?
Receptor cells (taste buds) interact with fluid in the mouth. Surrounding cells send signals to nerve fibers that send signals to the brain. The brain is told if the food is salt, sweet, bitter, sour.
What major structure in the brain influences eating habits?
Does ghrelin increase or decrease hunger?
What is the function of Leptin?
Hormone secreted by adipose tissue which signals the hypothalamus that we are full
Describe set-point theory
Every person has a set-point of weight. Weight loss induces increase appetite and reduced energy expenditure. Weight gain reduces appetite.
What is 'hungry' brain?
The state of having food restrictions and fat depletion so the brain is constantly thinking of food.
Why should we create memories and emotions associated with food?
If we can attach memories and emotions to foods that are high in nutrients for us then our brains will be trained to want those more. Those brain pathways are crucial in maintaining a diet high in nutrient dense foods.
Why is there pressure to maintain leanness with the benefits of retaining extra body fat?
Being lean in evolutionary times was for the benefit of hunting and gathering. You would be more likely to become prey with extra body fat. However extra body fat allowed for more energy storage so when long nights of hunting and gathering were required those hunters could survive. The pressure to survive outweighed the pressure to have more food available for consumption.
Defense against weight gain and weight loss
The body doesn't want to gain weight to stay mobile and active to gather and obtain food. However once the UL is pushed and weight loss needs to occur it is much harder for us to go back the other way because our threshold for need is higher.
How do obese individuals respond to exogenous leptin and how can leptin sensitivity be restored?
The body doesn't take exogenous leptin well, therefore with the proper diet and proper management of leptin treatments the body slowly re-acclimatizes itself.
Environmental factors contributing to increase energy intake
2. Portion size
3. Energy Density
6. Presence of food cues
What is the relationship between the hypothalamus and the orbitofrontal cortex in relation to hunger and satiety signals?
Its like a cycle. The hypothalamus receives information from the orbitofrontal cortex about hunger/satiety and then the hypothalamus responds causing the orbitofrontal cortex to send signals if we will be pleased by the food or not.
the decrease in appetite for a certain food as it is consumed during a meal, without decrease in appetite for other foods. Important for how much food is eaten during a meal.
Satiety at fixed meal times/availability
when satiety signals only decrease a little the "grazing" effect happens which overloads our brain signals and we begin to want to eat again.
Energy-dense foods and satiety
EDF's may not allow for gastric distension to contribute sufficiently to satiety. This affects meal times and long term feeding styles
Stress causes us to want to eat when in the presence of food.
External non-food cue and food intake
The smell of food was linked to more children wanting to eat and therefore over eating leading to obesity.
What is the familiarity effect?
Foods that have been eaten before, and were favorable to the individual, tend to be preferred.
What is the effect of stress on food intake?
Stress can cause over/under eating. Most of the time it is over-eating. Coping with stress by choosing sweet foods instead of nutritious ones.
Social norms and modern environment on eating
Grazing, snacking, eating on the go, availability, cost, production/storage
Preloading and normal/obese weight affects
Preloading wasn't as enticing to normal weight children as was external food cues such as smell. Preloading is extra food given before a meal. However obese children would probably be enticed by both pre and actual meal consumption.
Shortfalls of research on restrained eating
Researchers need to look at normal individuals with no outside help able to control their eating habits, to translate this to research on individuals who struggle with restrained eating.
Environmental cues and behavioral therapy on modified reactions to external cues
Basically helping an individual leaning how to train their mind to see and feel external cues differently. Being exposed to different things to help learn how to deal with all the cues in a positive way.
Income spent on food
in 2006-it was 9.9% of household income spent on food. in 1960 it was 14.8%. however in the 1960's only 24% of all food was bought outside the home (restaurants) to then in 2006 42% outside the home.
Brain's reaction to food images and conscious recognition
The brain releases dopamine in response to certain food images and advertising. The craving and motivation to act on food. This reaction is largely uncontrollable. Not mediated by consciousness it is an automatic sensation.
Subliminal cues on eating behaviors
People were shown images of food so quickly that their brains could not mentally process the image and they said they didn't see it yet they were enticed to eat. Your brain reacting to cues without you being consciously aware it is being done.
What is branding?
a type of conditioning that creates automatic association between desired qualities and characteristics and a specific product.
Sedentary behaviors increasing
Computers and technology have cause more sedentary behaviors. Availability of food and not using the energy provided by the foods is also sedentary behavior.
Exercise and what is perceived/reality
49.1% of Americans reported PA of 30min or more a day. Reality less than 5% met the actual PA guideline.
How obesity should be combated?
"real solution would be to control and reduce those forces that are causing the tsunami,change the cues we are exposed to on a daily basis or make explicit the cues we cannot change"
Prevalence of weight discrimination vs. racial discrimination in the US ("the stigma of obesity")
- ^ by 66% over the past decade
- "is comparable to the rates of racial discrimination, especially among women"
Identify behavior that indicates weight stigmatization in the healthcare setting. (Weight Bias in Healthcare)
- not treating/caring properly b/c "he did it to himself" or similar thoughts
- Insisting/forcing to weigh
- Not having properly sized equipment
- Basically everything opposite of recommendations (next two cards)
Incorporate 5 guidelines for bias-free treatment into a nutrition assessment and/or intervention [actually 6] (Weight Bias in Healthcare)
- Consider that patients may have previously experienced bias from providers
- Explore all causes of the patient's presenting problems, not just weight
- Recognize that many patients have tried to lose weight repeatedly
- Emphasize behavior changes with patients rather than focusing only on weight
- Recognize that small weight losses can result in significant health gains
- Acknowledge the difficulty of making lifestyle changes
List ways to identify healthcare providers' attitudes toward overweight/obese patients (Weight Bias in Healthcare)
- Do I make assumptions based on weight regarding character, intelligence, success, lifestyle, etc.?
- Am I comfortable working with patients of all sizes?
- Do I give appropriate feedback to encourage healthful behavior change?
- Am I sensitive to the needs and concerns of obese individuals?
- Do I treat the individual or only the condition?
Describe the features of the negative stereotype of a person who is overweight or obese ("the stigma of obesity")
- "lazy, unmotivated, lacking in self-discipline, less competent, on-compliant, and sloppy"
- Rarely challenged in Western society
Name manifestations of weight stigma in the workplace ("the stigma of obesity")
- "disadvantages in hiring, wages, promotions, and job termination"
- "Examples of weight stigma in employment settings included being the target of derogatory humor and pejorative comments from co-workers and supervisors, and differential treatment because of weight such as not being hired, being denied promotions, or fired because of one's weight."
- "women were 16 times more likely to report weight-related employment discrimination than men"
Describe the common perception of overweight/obese patients by PHYSICIANS ("the stigma of obesity")
- behavioral problem caused by inactivity and overeating
- Spent less time per visit with obese patients than those of normal/healthy weights
- thought seeing heavier patients were a greater waist of time, and that they were more annoying
- perceive the problem to be with the INDIVIDUAL, while the patients sees the issue as stemming from MEDICAL causes or LOW INCOME
Describe the common perception of overweight/obese patients by NURSES ("the stigma of obesity")
- saw obese patients as lazy, lacking in self-control, non compliant
- "nurses with lower BMIs expressed more negative perceptions of obesity
- nurses with a high BMI reported patients making comments about their weight
Describe the common perception of overweight/obese patients by MED STUDENTS ("the stigma of obesity")
- similar to physicians
- Reported that 'severely obese patients were the most common target of derogatory humor by attending physicians, residents, and students, which occurred most often in surgery and obstetrics-gyno settings
Describe the common perception of overweight/obese patients by DIETITIANS ("the stigma of obesity")
- "fat phobia"
- "The majority of students (ranging from 71-91% agreed or strongly agreed with the stereotypes that overweight people overeat, are inactive, slow, insecure, shapeless, and have no endurance, low self-esteem, and poor self-control" (yikes) "over half of students agreed or strongly agreed that overweight people are unattractive, have no willpower, and are lazy."
- Dietetic students split into two groups read identical profiles, EXCEPT for weight and gender. Even though all the other info was the same, they rated the obese patients as "less likely to comply with treatment recommendations and as having worse diet quality and health status." However, they rated the patients to be similarly motivated
Describe healthcare workers' self-perceived ability to manage obesity and efficacy of their treatment. ("the stigma of obesity")
- basically, they were not confident in their ability to properly treat obese people
- 72% of 520 family physicians in a study believed they had: "limited efficacy in treating obesity and considered themselves poorly prepared by their medical training to treat overweight patients"
- "Residents who felt unqualified to treat obese patients were more likely to agree that behavioral factors were the primary cause of obesity"
Explain how the feeling that treating obesity is "professionally unrewarding" affects how a healthcare provider treats his/her patients. ("the stigma of obesity")
"Although one study has reported that fitness professionals generally consider counseling obese patients for weight loss to be professionally gratifying, most studies demonstrate that health professionals feel that treating obesity is professionally unrewarding"
List reasons that people who are overweight or obese may delay seeking healthcare, especially preventative healthcare. ("the stigma of obesity")
- They experience a lot of stigma from doctors, nurses, dietitians, mental health professionals
- They feel they are treated disrespectfully
- Higher BMI agree with "the chairs are never big enough." And "I am treated as a second class citizen"
- "disrespectful treatment and negative attitudes from providers, embarrassment about being weighed, receiving unsolicited advise to lose weight, and gowns, exam tables, and other equipment being too small to be functional"
****Basically, they don't feel they are taken seriously
Acknowledge reasons that someone who was obese as a child may attain less education than someone who has always been thin. ("the stigma of obesity")
- Weight bias: "stigmatizing attitudes toward obese students;" "believe that obese individuals lack willpower;" "LOWER EXPECTATIONS FOR OBESE STUDENTS ACROSS A VARIETY OF PERFORMANCE AREAS"
- Social factors: poor relationships with peers due to stigma
Name interpersonal sources of weight stigmatization ("the stigma of obesity")
- (women's) dating profiles are judged differently when they include "negative weight descriptors (obese, overweight, fat)" but not positive (full-figured) or objective (197lbs)
- obese women are seen as less sexual beings than thinner women
- 72% of obese and overweight women in a study reported family members as the most common interpersonal sources of weight stigma; friends and spouses were also common
- There are mixed results in some of this research relating to loneliness, relationship strain, quality of relationships
Compare the characterization of an overweight person to a thin or underweight person in entertainment media (for children and adults). ("the stigma of obesity")
- pretty much what you'd expect...
- The majority of characters in entertainment media are thin, and if there is an overweight/obese character, it is in a minor, stereotypical role
- "Heavier characters are rarely portrayed in romantic relationships, are more likely to be the objects of humor and ridicule, and often engage in stereotypical eating patterns."
- "negative comments directed toward heavy females were typically reinforced by audience laughter"
- "a content analysis of 75 central male characters on television found that the heavier the male character, the more negative self-references he made about his own weight...followed by audience laughter."
- Thin --> positive messages; overweight --> negative messages; even in cartoons! There are LESS overweight characters and MORE underweight characters in 1990s than there were in 1930s
- "overweight characters were far more likely to be depicted as unattractive, unintelligent, and unhappy than their normal-weight or underweight counterparts...shown eating junk food and engaging in physical aggression, and half as likely to be classified as a 'good guy' compared to thinner characters."
Identify specific ways to alter the physical environment to increase the comfort level of a patient who is overweight in a healthcare setting. ("Promoting a positive...")
- Create an accessible and comfortable office environment
- use medical equipment that can accurately access patients who are obese
- reduce patient fears about weight
monitor obesity-related medical conditions and risk factors
- offer preventive care services
- encourage healthy behaviors
**examples in the handout/paper online
Contrast the framing of obesity in news media to that of other health conditions like AIDS or cancer. ("the stigma of obesity")
- Obesity --> INDIVIDUAL BLAME
- "Rick and Evans argue that unlike other public health issues (e.g., AIDS and cancer), the media seldom discusses the implication so its perspective on those affected by obesity, which may be damaging to individuals' health by invoking feelings of shame, guilt, and inadequacy."
Acknowledge the legal difficulties in identifying and prosecuting weight discrimination ("the stigma of obesity")
- Michigan is the only state that prohibits employment discrimination on the basis of weight
- There are lawsuits, but not much support for them
- Americans with Disabilities Act is the closest statute for support, but they must meet the definition of a disability
- Could go the route where the "plaintiff's obesity is perceived by others (e.g., employers) to be disabling, even if no actual impairment exists, and that the individual was subject to weight discrimination on the basis of such perceptions" Typically only works with "morbid obesity"
Depression as a consequence of weight stigmatization ("the stigma of obesity")
- weight stigmatization may contribute/increase vulnerability
- "Retrospective research has demonstrated that a history of appearance-based teasing in childhood was associated with depression among adult women with binge-eating disorder, and among patients with bulimia nervosa."
- "suggest that is not just the history of being overweight in childhood that is important, but that weight-based teasing may play a key role in vulnerability to depression"
Cardiovascular health outcomes s a consequence of weight stigmatization ("the stigma of obesity")
- only studies are with adolescents, none for adults
- Possibly weight bias --> higher stress --> ^ CV reactivity and vulnerability to negative health outcomes; similar responses to racial discrimination
Self-esteem as a consequence of weight stigmatization ("the stigma of obesity")
- "...over 3000 adults...obese individuals reported lower levels of self-acceptance than normal-weight persons, which was fully mediated by perception of weight discrimination"
- "In a study of undergraduates (N=107), self-esteem was correlated negatively with antifat attitudes and negative stereotypes toward obese individuals"
Physical activity as a consequence of weight stigmatization ("the stigma of obesity")
"several studies have begun to document reduces participation in (and avoidance of) physical activities among youths who experience weight bias" only one published study for adults
Body image dissatisfaction as a consequence of weight stigmatization ("the stigma of obesity")
weight affects body image in women more than in men
Eating behaviors as a consequence of weight stigmatization ("the stigma of obesity")
- internalizing negative stereotypes --> more binge-eating, refusal to diet when presented with weight bias
- "it may be that experiences of stigma increase vulnerability to poor psychological functioning which in turn increases risk of binge-eating behaviors"
- more of the same, etc., etc.
Coping strategies and psychological well-being as a consequence of weight stigmatization ("the stigma of obesity")
- "women who used positive coping strategies to deal with bias reported healthier psychological adjustment, while negative coping responses were associated with higher distress.' (surprise, surprise)
- "For men, coping with weight bias through self-acceptance was associated with higher self-esteem, and coping with avoidance, negative self-talk, and crying were related to lower self-esteem. At the same time, certain coping strategies which appeared to be adaptive, such as positive self-talk and using religion or prayer, were related to higher depressive symptoms among men, and strategies such as crying and ignoring the situation, were related to lower levels of depression." Maybe bc they were IGNORING the issue, so didn't care. HA
Describe the effect of cultural norms on how we decide if a food is acceptable.
Norms - culture drives norms on what is acceptable to eat, what is good to eat, what is repellent, how where and when one eats, order of foods eaten, who gets priority to eat first, meaning of particular foods
Acceptable - portion sizes, availability vs. cost of the food, and overall defined by the cultural norms; Cultural values - it is all about what we consider disgusting or not. Examples: donuts near a cockroach, brownie in a poop shape, own spit in a cup.
Define the French paradox.
You would think French diet would be healthier, considering there is less heart disease and obesity. In reality, French don't care about fat and have whole fat products, whereas in the US there is more reduced-fat products.
Americans - report eating less healthy, eat shorter time. Larger serving size portions.
French - more report eating healthy, eat longer. Smaller portion sizes. ENJOY more their food.
Paradox explained = French eating less, but eat it longer and enjoy it more.
Compare the relationship that Americans have with food to the relationship that the French have with food, including the topics of "food availability culture," moderation versus abundance, quantity versus quality, speed versus conviviality, individual versus collective food values, and pleasure versus worry orientation.
Americans - all about value (how much you get for your money) - all about getting a large meal. Huge amount of food for little money. Food is very individual, about what YOU like. Americans eat a lot by themselves (at home, in a car, on the way to work, at their desk). Many health claims on the foods - worried about health, adjusted food is the problem solver - worry relationship with food.
French - all about quality, it's an art, a meal is a one in a lifetime experience. It is a family experience, meals are meant to be shared and there is designated time to enjoy time with other people while eating it and creating a different relationship with food.
Define normative discontent in context of body image and how it is reinforced by marketing.
Ideal image: be skinny, thin, perfect version of beauty - yet we are surrounded by high-sugar & high-fat foods everywhere, easily accessible and affordable to everyone.
Describe Michael Pollan's argument against "nutritionism." American and French Food
Reducing foods to nutrients, key is to think about nutrients, not foods. Food is delivery system and foods targeted for conditions. Misses what the entire food provides. Removes joy from eating. Food becomes medicine.
= basically, we forget to look at the food as a whole and use common sense; people focus too much on the functionality of nutrients in the food.
List examples that illustrate the differences between American and French (or traditional) food culture and expectations.
US: customer is put to work, constantly asked whether they're ready to order, all menu's are the same everywhere - unisized meals in a comfort zone. You pay, get everything, find your own seat, dirty seat, you have to pick up the food, eat as fast as possible. Quantity - large meal for little money is the win. It is considered rude to stay after meal is finished and you get the check while still eating.
Everywhere else: customer is the boss; quality is over quantity, always. No substitutions over sides, no such thing as lighter option (pick something else - it is meant to be served this way); the customer is there to enjoy the mastery of the chef. It is rude to order soda or ask for ketchup (drink wine that fits the meal or gourmet beer or water); It is expected to stay in the restaurant for 2 hours. You are there to enjoy friends and the meals. You have to ask for the check- they will not bring it.
Describe the relationship between caloric restriction, subsequent weight loss, and subsequent weight gain.
caloric restriction leads to short term weight loss. However, the more rapid the initial weight loss, the greater and more rapid the subsequent weight gain
Relate current interest in CHO restriction to the previous era of fat restriction
current preoccupation with CHO restriction appears to be in reaction to the previous era of fat restriction. The public feels misled by promises that fat restriction would lead to weight loss
Give reasons that a low CHO diet may result in greater short term weight loss
very low CHO diets can lead to dehydration and ketosis in the short term
Summarize the results of research on isocaloric diets with different macronutrient distribution
Energy intake rather than macronutrient distribution determines weight loss over the short term
Contrast the risks of a low fat diet with a low CHO diet
Little evidence suggests that fat restriction as a weight loss method is harmful
However, there are lots of adverse effects associated with CHO restriction: constipation, dehydration, depression, halitosis, hepatic injury, increased cancer risk, increased CVD risk, nausea, nephropathy, osteopenia, renal calculi (note: some of these are caused by a higher intake of protein and lower intake of whole grains and fruit that usually accompany a low CHO diet)
Describe the general consensus on the features of the "native" human diet in terms of macronutrient composition and plant vs. animal foods
25% cal from fat; 20-25% cal from protein; remainder from complex CHO; we were gatherers more than hunters, so meat contributed less to our subsistence than did the gathering of diverse plants
Explain the author's allegory of not seeing the forest (diet conducive to human health) for the trees (individual weight loss methods)
the focus on different diets that involve food exclusions, combinations, and the redistribution of macronutrients has blurred our ability to see the whole picture (failure to see the forest through the trees). There is substantial and compelling evidence for the basic dietary pattern that is conducive to human health so we should take a step back from the focus on different diets in order to see the whole lay of the land
Describe the dietary pattern recommended for health promotion
- 55-60% total cal from mostly complex CHO
- up to 20% from mostly plant-based protein
- 20-25% from fat (mostly mono and poly-unsat)
- min 25g fiber per day
- <10% sugar
- up to 2400mg sodium
- up to 300mg cholesterol
Compare the current standards of evidence for diet vs physical activity
we have as much evidence regarding the association between diet and health as we do regarding physical activity and health. However, we are constantly looking for an alternative to the recommended dietary pattern for health promotion
Describe the rates of dieting and weight cycling through the life span
in the US, rates of dieting from 1950-2008 have increased across the board:
- women---14% in 1950-1966 up to 57% in 2003-2008
-men---7% in 1950-1966 up to 40% in 2003-2008
- Weight cycling has shown variable results: 20-55% prevalence in women; 20-35% in men
Relate prevalence of dieting behaviors to BMI and overweight perceptions
Positive association for both relationships: as the prevalence of dieting behaviors goes up so do BMI and overweight perceptions
Name 4 factors that influence the onset of dieting in childhood and adolescence
1) stigmatization of obesity
2) influence of media
3) peer pressure
4) parental pressure
Identify weight sensitive sports and how they may contribute to weight cycling or body dissatisfaction
- gravitational sports (track), aesthetic sports (ballet), and sports with mandatory weight categories (boxing)
-dissatisfaction with weight or shape along with extreme dieting behavior increases risk for development of eating disorders
-competitive sports may start at young age and increase risk of weight cycling in adolescents
List 14 potential psychological and physical risks of repeated dieting and weight cycling
1) enhanced weight gain
3) insulin resistance
6) development of eating disorders
7) increased risk for sarcopenic obesity
8) body dissatisfaction
10) increased cardiac load
11) glomerular damage
12) vascular injury-from fluctuations in glucose and lipids 1
14) renal diseases
Name the 2 populations most likely to suffer ill effects of weight cycling
children and adolescents
Describe the "repeated overshoot theory"
Weight cycling may lead to fluctuations of CV and renal risk variables (ex: BP, heart rate, renal filtration, blood glucose, and blood lipids) with repeated overshoots even if the average values remain stable. The stress put on buy these repeated overshoots put an extra load on the heart and may lead to glomerular damage and vascular injury
Describe the benefits of physical activity on weight loss, total fat content, and body fat distribution, and compare these benefits to those of dieting
Protective benefits appear in overweight population if they exercise
Quality of life improves
List 6 cardiovascular benefits of physical activity, even if weight loss is not achieved
1) reduction in all cause mortality
2) reductions in cardiovascular morbidity
3) decreased HTN
4) decreased blood glucose
5) increased insulin sensitivity
6) decreased dyslipidemia
Describe the 2 ways in which body composition is altered by adding physical activity to dieting
Decreased Fat mass; increased muscle mass
Name 8 improvements in physical and psychological well-being caused by physical activity
1) increased cardio-respiratory fitness
2) greater muscular strength
3) improve mobility
4) improve quality of life
5) sense of psychological well being
6) decreased stress
7) decreased anxiety and depression
8) better sleep quality
Describe the influence of physical activity on long-term weight maintenance.
successful weight maintenance is dependent on level physical activity.
Review 7 components of a brief behavior assessment of a patient's weight loss initiative
1) sought out weight loss on own initiative?
2) what events led patient to seek weight loss?
3) stress level of patient
4) is there a binge eating disorder
5) does the patient understand the requirements to treatment
6) how much weight does the patient expect to lose
7) what other benefits does the patient anticipate?
Identify patients who may need exercise testing before beginning an exercise program
EVERY patient needs to be assessed
Name the recommended target for weight loss over 6 month
10% total body mass
Acknowledge 12 behavior management strategies for promoting physical activity in patient
1) establish realistic expectations
2) correct overly pessimistic/optimistic views
3) establish what rewards will work for them?
4) use environmental cues to remind patients of their exercise commitment
5) establish routine times and places
6) develop and sign a behavior contract
7) discuss disadvantages/advantages of exercise 8) discuss social support system
Explain why strength training should be included in an exercise program, and give recommendations for how often it should be performed.
it increases basal metabolic rate, and improves strength along with the ability to complete everyday tasks.
Understand the Activity Pyramid's recommendations
do lots of little things everyday, low intensity most of the week, high intensity some of the week, and cut down on tv watching
Name the tool that is considered to be the international standard pre-participation screening instrument
The Physical Activity Readiness Questionnaire
List the 4 components of the FITT exercise prescription
Define and give guidelines for frequency of exercise.
The number of times that you exercise in a week, most studies show that 3-5 times are beneficial
Define 1 method of defining absolute intensity of exercise, and 3 ways of measuring relative intensity of exercise
-METs, or metabolic equivalents.
light = 3 or less
moderate = 3-6
vigorous = >6
-Talk test, TT
Describe the recommended intensity of muscle-strengthening exercise—what weights should be used, and how many repetitions should be performed.
1 set of 8 to 12 reps
encouraged for 2 to 3 sets
Name the amount of total exercise time recommended by the Physical Activity Guidelines for Americans and how this amount can be divided.
150 minutes of moderate or 75 minutes of vigorous
daily sessions of 30 minutes total, does not have to be in a continuous bout
Explain guidelines on choosing a type of exercise for an individual patient
the best type of activity is one that the individual will perform regularly but are advised to do more than one
Describe an initial exercise prescription for a sedentary patient and how this can be progressed
the initial intensity needs to be something the patient should feel they can accomplish, and then progress from there to work up towards PA guidelines for Americans
Mechanism of Action: selective inhibitor of pancreatic lipase that reduces the intestinal digestion of fat
Effectiveness: not absorbed to any significant degree
Safety: side effects are blockade of triglyceride digestion in the intestine.
Small but significant decrease in fat-soluble vitamins.
Acyclovir will not be absorbed.
Severe liver damage in rare cases
Duration of use: long-term treatment for obesity
Mechanism of Action: selective in targeting serotonin-2C receptors; once activated in the hypothalamus food intake is reduced.
Effectiveness: well tolerated, safe.
Safety: adverse events include headache, nausea, dizziness, fatigue, dry mouth, constipation (mild).
Should NOT be used with selective serotonin reuptake inhibitors or monoamine oxidase inhibitors for the risk of serotonin syndrome.
Duration of use: long-term weight management
Phentermine/Topiramate ER (Qsymia)
Mechanism of action: extended-release medication; phentermine acts to reduce appetite through increasing norepinephrine in the hypothalamus. topiramate has an appetite-reducing mechanism not thoroughly understood, may be through its effect on GABA receptors.
Effectiveness: weight loss significance, improvements in BP, glycemic measures, HDL cholesterol, triglycerides.
Safety: side effects include paresthesia, dizziness, dysgeusia (altered taste), insomnia, constipation, dry mouth.
Phentermine- sympathomimetic agent; causes insomnia and dry mouth
Topiramate- carbonic anhydrase inhibitor; causes altered taste, tingling fingers and toes, could lead to mild metabolic acidosis
Contraindications include: pregnancy, glaucoma, hyperthyroidism.
Duration of use: long-term weight management in overweight and obese ppl
Mechanism of action: Bupropion acts on adrenergic and dopaminergic receptors in the hypothalamus; Naltrexone is an opioid receptor antagonist. Combined naltrexone might block inhibitory influences of opioid receptors activated which will stimulate a hormone to inhibit food intake.
Effectiveness: not truly known yet, could be useful tool.
Safety: the outlier effects; BP is looked at
Duration of use: probably long-term but still in clinical trials - reduces food intake. Phentermine (Most often prescribed for Wt loss in US)
Mechanism of Action: sympathomimetic producing central excitation
Effectiveness: very; Safety: side effects include insomnia, dry mouth, some increased heart rate and BP. Do NOT prescribe to patients with history of CD.
Duration of use: short-term for weight loss;
Long-term use: comes from long-term trials;
Short-term use: sympathomimetic drugs; data comes from short-term trials; have potential for abuse
-Insulin produces a weight gain;
-Sulfonylurea drugs produce weight gain;
-Thiazolidinediones produce weight gain;
-other drugs are wt neutral or can cause wt loss
SEE Table. 2 for specifics
How long should wt loss medications continue:
If pt does not lose at least 5% of initial wt in 3-6mo of treatment, alternative plans should be implemented.
FROM DIETARY SUPPLEMENTS ARTICLE---------------
Supplements : Absorption Blockers
1. Phaseolus vulgaris
SEE Table. 1
2. Ephedra/ephedrine alkaloids
3. GT or GT extract
5. Yerba mate
6. Seville/ citrus aurantium
7. Yohimbe from bark
SEE Table. 2
Supplements: Nutrient Partitioning
1. Ca /dairy products
4. Cr picolinate (Cr3+)
5. HCA, botanical extract native to India
SEE Table. 3
Supplements: Appetite suppressants
1. Soluble fibers
2. Hoodia gordonii
SEE Table. 4
Mechanism or use: CHO/starch blocker; alpha-amylase inhibitor
Scientific findings: acute use; in energy controlled diet saw Wt loss, in multicomponent wt loss program saw no Wt loss.
Side effects/safety: GI upset, bloating, gas;
Current status: little support of efficacy, more research needed
Mechanism or use: fat binder
Scientific findings: small but significantly great wt loss based off suboptimal study design
Side effects/safety: regarded as safe;
GI distress, flatulence, symptoms depending on dose. Avoid in ppl with shellfish allergies;
Current status: little support of evidence. unlikely to produce clinically significant wt loss
Mechanism or use: Inc thermogenesis, inhibiting degradation of cAMP;
Scientific findings: inc metabolic rate acute. chronic use produced tolerance.
Side effects/safety: >300mg/day can result in insomnia, irritability, heart palpitations, anxiety;
Current status: little research on long-term wt loss or maintenance
Mechanism or use:
CNS stimulant; inc metabolism dec appetite;
Scientific findings: effective when combined w/caffeine. small inc in wt loss
Side effects/safety: HTN, stroke, serious heart problems.
Current status: still available but often replaced by bitter orange
GT (green tea):
Mechanism or use: Inc thermogenesis, red lipogenesis, dec fat absorption/in fat oxidation;
Scientific findings: EGCG mix shows wt loss, EGCG + caffeine appears to be necessary to see effects in wt loss;
Side effects/safety: generally safe as tea; extracts associated with liver damage;
Current status: small effect on wt loss
Bitter orange (seville):
Mechanism or use: inc metabolism having lipolytic properties;
Scientific findings: few studies examining wt loss and bitter orange, mostly combined with other compounds;
Side effects/safety: inc HR, HTN, angina, ischemic colitis, seizures;
Current status: no evidence to support use for effective wt loss. studies needed
Mechanism or use: inc adipose Ca uptake, stimulating fat accretion. Increased fecal fat excretion. Inc appetite control;
Scientific findings: limited trials suggesting wt with energy restricted diets. may only help with appetite control when intake is low;
Side effects/safety: generally safe;
Current status: may only benefit those who consume low Ca diets
CLA (conjugated linoleic acid):
Mechanism or use: reduce fat mass by red adipocyte differentiation and metabolism.
Scientific findings: limited data to support dec fat mass or lean tissue gain;
Side effects/safety: GI distress, negativity inc blood insulin or red insulin sensitivity;
Current status: effects not clearly duplicated from animals to human subjects
Cr picolinate (chromium picolinate):
Mechanism or use: essential trace metal, potentiates action of insulin. could inc lean mass and promote fat loss;
Scientific findings: no benefit on wt loss or muscle mass gain under controlled conditions;
Side effects/safety: AI=30 ug/d for men; 20 ug/d for women 50-70yo. safe dose <200 ug/d . Cr6+ is carcinogenic.
Current status: minimal supportive evidence. unlikely to produce clinically significant changes in body comp or wt loss
Mechanism or use: hold H2O, inc satiety. influence production of satiety hormones;
Scientific findings: high fiber diet = low body wt. supplements may aid in wt loss;
Side effects/safety: GI upset, bloating, gas
Current status: high fiber may = small dec in wt. water-holding-fibers being developed may have greater effect on wt loss;
Mechanism or use: appetite suppression due to P57 a steroidal alkaloid
Scientific findings: none;
Side effects/safety: unknown, no published studies;
Current status: no evidence to support to use for wt loss
Current state of recommendations for dietary wt loss supplements:
No strong research evidence indicating one supplement will produce significant wt loss results, long-term specifically. Responsibility falls on health care professionals to educate public; Many wt loss supplements can have serious health effects w/ little benefit, many are banned substances.
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