question

Fat mass

answer

fat from all body sources including brain , skeleton and adipose tissue

question

Fat-free mass (FFM)

answer

includes water, protein, and mineral components; proportions differ between individuals

question

Lean body mass (LBM)

answer

Muscle; Higher in men than women, increases with exercise and decreases in older adults

question

What is the major determinant of RMR?

answer

LBM!; decrease in LBM can hinder weight loss

question

To achieve long-term weight loss, loss of fat mass while maintaining _____ and _____ is desirable

answer

FFM and RMR

question

What is the most variable component of LBM?

answer

Water! (60-65% of body weight); state of hydration induces several pound weight fluctuations

question

Essential fat

answer

-necessary for normal physiologic functioning -stored in small amounts in bone marrow, heart, lung, liver, spleen, kidneys, muscles and nervous system -Men - 3% is essential -Women - 12% is essential (breasts, pelvic regions, thighs)

question

Storage Fat

answer

-energy reserve; mainly TG's in adipose -accumulates under skin, around internal organs -most is expendable

question

Total body fat associated with optimal health

answer

M: 10-25% W: 18-30%

question

White Adipose Tissue (WAT)

answer

stores energy as repository for TBs, serves as cushion to protect abdominal organs, insulates body to preserve heat (carotene gives it yellow color)

question

Brown Adipose Tissue (BAT)

answer

-rapid source of energy for infants; 5% of their body weight -brown color due to extensive vascularization for energy and heat production

question

Adipocyte

answer

-mature fat cell -lipid droplet surrounded by thin cytoplasm containing nucleus and mitochondria -store fat = to 80-95% of their volume

question

Hyperplasia

answer

increased number of cells occurs as normal growth process during infancy and adolescence

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Adiposity rebound

answer

increase in body fat around 6 years of age; rebound before 5.5 years is predictive of higher level of adiposity going into adulthood

question

Hypertrophy

answer

increased cell size can expand 1000x numbers of fat cells do not decrease

question

Weight loss of what % is required to decree fat cell size?

answer

5%

question

Semivolatile organic compounds (SVOCs)

answer

-Accumulate in adipose tissue from exposure to toxins, chemicals and pesticides -Interfere with key weight control mechanisms of the body (alter metabolism, disrupt endocrine function, damage mitochondria, increase inflammation, alter circadian rhythms, stress...)

question

What moves lipid from the blood into the adipose cell?

answer

lipoprotein lipase (LPL)

question

What does LPL do?

answer

moves lipid into the adipose cell from the blood and hydrolyzes TG into FFA and glycerol

question

How do hormones affect LPL activity?

answer

-Sex hormones are present - normal distribution of fat -Decrease in sex steroid hormones (menopause/gonadectomy) --> increase in central obesity

question

Activity Thermogenesis (AT)

answer

-energy expended in voluntary activity -most variable component of energy expenditure ~15-30% of TEE

question

How much of TEE is explained by RMR?

answer

60-70%

question

NEAT

answer

Nonexercise activity thermogenesis -energy expended for everything that is not sleeping, eating, sports-like activity -can vary up to 2000kcal/d between individuals

question

What % of people in the US versus Canada are overweight?

answer

66% vs 36%

question

What % of people in the US vs Canada vs Europe are obese?

answer

32%, 23%, 15-25%

question

Causes of overweight and obesity

answer

Hereditary Lack of PA Inflammation Lack of sleep, high stress, circadian rhythm Pleasure in taste, less responsive to satiety, unrealistic meal portions "Obesogens" Viruses, pathogens, microflora

question

When FFA are needed by other cells, what enzyme hydrolyzes them once again (after esterification in adipocytes)

answer

Hormone-sensitive lipase (HSL)

question

How are children able to overcome over- and underfeeding?

answer

Hypophagia (undereating) and Hyperphagia (overeating)

question

Long-term regulation of weight seems to involve a feedback mechanism using what protein signals?

answer

adipocytokines; released when 'normal' body composition is disturbed

question

Insulin

answer

moves glucose into cells (out of blood)

question

Leptin

answer

contributes to long-term fullness by sensing body's overall energy stores

question

Adiponectin

answer

made by fat cells; helps body respond better to insulin by boosting metabolism

question

Ghrelin

answer

the hunger hormone!

question

Overweight =

answer

BMI 24.9-29.9 (elderly 27-30)

question

Obese =

answer

BMI > 30

question

Waist Circumference that indicates health risk

answer

M: >40 in W: >35 in

question

Waist Circumference correlates with ???

answer

cardiovascular risk including: -hypertension, atherosclerosis, heart disease, stroke risk

question

WHR

answer

Waist hip ratio -waist smaller than hips is positive for heart health -GOAL: M (<1) W (<.8)

question

NAFLD

answer

Non-alcoholic fatty liver disease -associated with obesity -progresses to end stage liver disease if

question

Optimal BMI range for longevity

answer

20.5-24.9

question

Risk factor for cancer, infertility, poor wound healing, poor antibody response to hep B vaccine...

answer

Obesity

question

Common comorbidities of obesity

answer

T2DM, HTN, Stroke, certain cancers, infertility...

question

Two major types of fat deposition

answer

Android Gynoid

question

Android

answer

apple-shaped; men and post-menopausal women; more commonly experience impairments in glucose metabolism

question

Gynoid

answer

pear-shaped; women; excess gluteofemoral fat in thighs and buttocks; support demands of pregnancy and lactation

question

Visceral Adipose Tissue (VAT)

answer

under peritoneum and in intraabdominal cavity; highly correlated with insulin resistance

question

Metabolic Syndrome dx criteria

answer

Must have 3 or more of the following -waist circ >35in (w) >40in (m) -serum TG at least 150mg/dL -HDL less than 40mg/dL (m) 50 (w) -BP >135/85mm Hg -fasting glucose 100mg/dL or higher

question

low level of VAT and high level of CRF equates to what?

answer

cardiometabolic health!

question

Lifestyle modification

answer

best treatment for obesity

question

Goal of obesity treatment

answer

weight management; attaining the best weight possible in the context of overall health

question

Obese persons who lose what % of body weight are likely to improve which biomarkers?

answer

5-10%; blood glucose, BP and cholesterol levels

question

Why is mobilizing fat the most efficient form of weight loss?

answer

Twice the kcal of protein; spares LBM -wt loss over a longer period achieves this

question

Why do men reduce weight faster than women?

answer

higher LBM and RMR

question

Lifestyle modification strategies

answer

1. Easy to achieve short-term goals 2. Self-Monitoring 3. Stimulus Control 4. Confronting Barriers 5. Sleep and stress mgt 6. Social support 7. Contracting

question

Example of 'easy to achieve short term goal'

answer

"include one fruit at lunch" " trim regular food portions"

question

Example of 'self-monitoring'

answer

"use a food and activity log" "perform a regular weigh in"

question

Example of 'stimulus control'

answer

"shop when not hungry and with a list" "avoid distractions during meals"

question

Example of "confronting barriers"

answer

"practice problem solving steps" "plan ahead"

question

Example of social support

answer

attend organized support groups use family, friends and co-workers as support systems

question

For which level of overweight/obese is surgical intervention (sometimes) appropriate?

answer

morbid obesity (BMI>40)

question

General guidelines to treat obesity

answer

1. low cal diet, increased PA and life-style modification 2. the preceding + pharmacotherapy 3. Surgery + individual dietary regimen, PA and LM 4. Prevention of weight regain via energy balance

question

Restricted Energy Diets

answer

Deficit of 5-1000kcal daily in order to mobilize fat stores to meet daily energy needs -diet is nutritionally adequate EXCEPT in calories -Extra fiber is recommended to improve satiety, slow gastric-emptying and reduce caloric density

question

Formula Diets/Meal-Replacements (who are they appropriate for?)

answer

good for ppl who have difficulty with self-selection or portion control

question

Commercial Programs (of merit)

answer

Weight Watchers is the only one with substantial supportive evidence

question

Extreme Energy Restriction/Fasting

answer

hypotension can result; also, gout and gallstones

question

VLCD

answer

Very low cal diets -provide 200-800kcal -little evidence to support -rich in protein (.8-1.5g/kg IBW) -designed to include full complement of vit/min etc -generally 12-16weeks -reserved for those with BMI>30 -generally negative side effects -no significant differences in long-term weight loss

question

Moderate-fat, balanced nutrient reduction diets containing 20-30% fat, 15-20% protein and 55-60% CHO; focuses on energy density of foods

answer

Volumetrics

question

Very low fat diets <10% of cals from fat; very restrictive

answer

Dr. Dean Ornish's Program for Reversing Heart Disease The Pritikin Program

question

Severe carb restricted diets

answer

Dr. Atkins' New Diet Revolution The Carb Addict's Diet The Zone Diet South Beach Diet -weight loss ensues because of cal restriction, not small insulin ranges

question

Most variable component of EE

answer

physical activity (activity thermogenesis)

question

Why is PA so important in weight loss?

answer

Helps balance the loss of LBM and reduction of RMR that inevitably accompany intentional weight reduction -also expend additional energy and increase sensitivity to insulin

question

Adequate levels of PA as recommended by USDA

answer

60-90min daily

question

Aerobic benefits; Resistance Training Benefits

answer

CVHealth through elevated RMR, cal expenditure, energy deficit and loss of fat; increase LBM and RMR + ability to use more of the energy intake and increases BMD

question

What BMI should one be to use appropriate pharmacotherapy?

answer

30+ or 27 with comorbidities or significant risk factors

question

What does pharmacotherapy help in weight management?

answer

Decrease appetite, reduce absorption of fat, increase energy expenditure

question

Categories of CNS-acting agents

answer

Catecholaminergic and serotoninergic

question

Side effects of CNS-acting agents

answer

dry mouth, headache, insomnia and constipation

question

What are the only medications approved by the FDA for weight loss?

answer

Orlistat and Sibutramine

question

Which CNS-acting agents are not recommended for obesity treatment?

answer

Catecholaminergic - act on the brain

question

Serotoninergic agents: action and examples

answer

-act by increasing serotonin levels in the brain -fenfluramine -dexfenfluramine -both have been removed from the market

question

Sibutramine

answer

-combination of catecholaminergic and seritoninergic -inhibit the reuptake of serotonin and norepinephrine in the CNS to increase satiety, reduce hunger, and lessen drop in metabolic rate that occurs with wt loss -stimulates sympathetic nervous system and may have CV effects

question

Who is Sibutramine not appropriate for?

answer

-CV disorders -use with certain antidepressants (MAOI) (hypertensive crisis may occur)

question

Orlistat

answer

-inhibits gastrointestinal lipase, which reduces ~1/3 of the amount of fat absorbed from food -supplements are typically recommended, separated from the drug by 2 hours bc of lower fat-soluble vitamin absorption

question

Side effects of Orlistat; benefits of Orlistat

answer

increased fecal urgency oily spotting flatus with discharge --- reduced LDL, increased HDL, improved glycemic control, reduced blood pressure

question

Only OTC weight loss product

answer

Alli- contains half the prescription dose of Orlistat

question

Non-diet Paradigm

answer

body will attain its natural weight if the individual eats healthfully, becomes attuned to hunger and satiety cures and incorporates physical activity -focuses on achieving health not a number -advocates promote size acceptance and respect for diversity of body shapes and sizes

question

accepted form of treatment for the extreme/class 3 obese

answer

Bariatric surgery

question

Failure of what criteria must be met before consideration for bariatric surgery?

answer

-CR, exercise, lifestyle modification, psych counseling, family involvement (inability to reduce body fat by 1/2 and wt by 1/3

question

Diet progression after Gastric Bypass

answer

liquid->semisolids/puree->soft foods->regular small meals/snacks (6wks total)

question

Gastroplasty

answer

reduces size of the stomach by applying rows of stainless-steel staples to partition the stomach and create small gastric pouch, leaving only small opening into distal stomach; banded by a piece of mesh

question

Chapter 22 Nutrition in Weight Management – Flashcards

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