Ch 17 obesity

what is weight centric care (traditional approach)?

uses weight as a proxy for health, pathologizing larger bodies

asserts that health does not exist outside of “normal” BMI range

emphasizes focus on body weight for all people and weight loss for “overweight” and “obese” people

assumes changes in body weight is caused by simple imbalance in energy I/O

entrenches weight stigma

describe weight inclusive care

provides respectful and compassionate care for people in all body shapes and sizes

recognizes that many factors influence health and body weight, and health exists across the spectrum of size diversity

weight loss is not treatment for disease

works to eliminate societal and medical weight bias

guided by “do no harm”

what does BMI consider overweight and obese?

overweight is greater than 25 and obese is greater than 30

generally related to excessive body weight, but does not mean excessive body fat

how does waist circumference correlate to obesity?

strong predictor of obesity-related, long term health problems and correlates well with metabolic disease risk

what are potential causes of obesity?

occurs when people consume more calories than they expend over time

why is not fully understood

“set point” theory: internal thermostat that regulates body fat

some people can burn hundreds of extra calories in activities of daily living to help control weight; likely due to combo of genetic and environmental factors

how do genetics effect obesity?

involved in: how likely a person is to gain/lose weight, where body fat is distributed, response to overeating

studies have shown that adopted children tend to have similar weights to biological parents and not adoptive

how does environment affect weight?

rise in obesity without change in gene pool

root cause is lifestyle and environment

influences: abundance of palatable, low-cost, high cal density food, increasing consumption of soft drinks and snacks, food eaten away from home, growing portion size, low levels of physical activity, increase in electronic use

how does the traditional view see complications of obesity?

high BMI is major risk for cardiovascular disease, DM, musculoskeletal disorders, and some cancers

describe the misclassification of cardio metabolic health with BMI

nearly half of overweight, 29% obese, and 16% obesity 2 and 3 are metabolically healthy

over 30% of normal weight individuals were metabolically unhealthy

metabolic health defined as: BP, fasting triglycerides, HDL, BG, CRP, insulin resistance

what healthy behaviors are more important than weight when it comes to risk of death?

>/= 5 servings of fruits/vegetables daily

12 x per month leisure time physical activities

not smoking

more than 0 and up to 1 alcoholic drink/day for women and 2 for men

what are the benefits of 5-10 % weight loss?

reduction in type 2 DM

reduction in CV risk factors

improvements in blood lipid profile

improvements in BP

improvements in sleep apnea

describe modest weight loss

more attainable

easier to maintain over long term

sets the stage for subsequent weight loss

how do you evaluate weight loss readiness?

objectively identify who may benefit from weight loss

assessing the client’s level of motivation is crucial

imposing treatment on an unmotivated or unwilling client may prevent future attempts at weight loss

what is the traditional approach to weight loss?

normally lifestyle approach for people with a BMI over 30

includes: diet modification, exercise, behavior modification

may use pharmacotherapy and surgery in conjunction based on BMI and presence of comobidities

what is diet modification like?

fewer calories

macronutrient components: low CHO, low fat, balanced diets

micronutrient composition

nutrition education and promoting adherence

describe a low CHO diet

diets that severely limit fruit, veggies, and whole grains may be deficient in fiber and micronutrients, particularly thiamin, folic acid, vitamin c, and magnesium

weight loss and improvements in BP, BG, insulin, and insulin resistance were the same after 12 months on low CHO compared to isocaloric low fat

long term safety has not been determined

what is a low fat diet?

most common recommended for WL

low fat generally means sat and trans intake are lower

clinical trials have demonstrated that low fat weight loss diets, when used in combo with lifestyle counseling and physical activity, promote 5-10% WL and prevent/reduce DM/HTN

when fat intake is very low and diet is primarily vegetarian, intake of vitamin E, B12, and zinc may be inadequate

describe balanced diets

patterned after my plate guidelines

approximately 50% carb, 30% fat, and 20% protein: intakes w/in ranges recommended by DRIs

low calibre diets produce weight loss regardless of which macronutrients the emphasize, when total calories are not the same, mac distributions of the diet do not affect amount of WL over time

how does physical activity contribute to WL?

favorably impacts metabolic rate

aerobic physical activity progressing to 150 min/week or more performed on 3-5 steerage days per week

greater amounts of exercise are associated with better long-term weight loss maintenance

resistance trainmen of single set exercise involving the major muscle groups performed 2-3 times per week reduce sedentary behavior

what is behavior modification?

focuses on changing the client’s eating and exercise behaviors

key strategies: self-monitoring, goal setting, stimulus control, problem solving, cognitive restructuring, relapse prevention

when is pharmacotherapy used?

recommended for people w/:

BMI >30

people with BMI > 27 with comorbid conditions

people with waist circumference greater than 35 in (women) and 40 in (men) are also candidates if comorbidities are present

what types of medications are used to assist weight loss?

appetite suppressants: phentermine for short term use

lipase inhibitors: Alli. OTC to gain FDA approval for WL, expected WL is modests

describe surgery for weight loss

most effective treatment for severe weight loss

appropriate for clients whose BMI is 35-39.9 who have major comorbidities

works by: restricting the stomachs capacity, creating malabsorption of nutrients and calories, or both

what is a laparoscopic adjustable gastric banding (LAGB)?

inflatable band encircles uppermost stomach and is buckled

small pouch of abt 15-30 ml capacity created w/ limited outlet between pouch and main section of stomach

diameter can be adjusted by inflating/deflating a small bladder in the bed through small sub q reservoir

size of outlet can be changed as needed

mortality is lowest out of all bariatric surgeries

successful WL after LAGB requires frequent follow-up and band adjustments

describe a roux-en-y bypass (RYGB

combines gastric restriction to limit intake w/construction of bypass of duodenum and first part of jejunum

creates malabsorption of nutrients

dumping syndrome

superior to gastric resection in both promoting and maintaining sig weight loss

post-op complications: anastomotic leaks, internal Henies, GI bleeding, ulcers in bypass segments, stomal stenosis, and gallstone formation w/ rapid WL

what is laparoscopic sleeve gastrectomy?

removes 60-85% of the stomach longitudinally, resulting in a small pouch resembling a sleeve or long thin banana

malabsorption and umping syndrome do not occur b/c pylorus is preserved

what does post bariatric surgery diet look like?

starts w/ small quantities of sugar free clear liquids

advances as tolerated to full liquids, followed by pureed foods, and then regular diet w/in 5-6 weeks after surgery

what are risks associated with weight-centric paradigms?

weight bias and stigma

ineffective or harmful healthcare

weight cycling

worsened mental health

dieting leads to disordered eating leading to eating disorders

death

describe weight stigma and behaviors

weight stigma has been found experimentally to increase caloric intake

internalized weight stigma (discriminatory attitudes about one’s own body) is associated w/ exercise

describe weight stigma and body weight

weight discrimination promotes weight gain and onset of obesity

perceived weight discrimination was significantly associated w/ relative increases in weight, waist circumference, and odds of becoming obese over the follow up period

how do ED develop?

it is multifactorial and influenced by: biology, trauma, chronic stress, addiction, social/environmental

restrictive diets are unsustainable, often resulting in a cycle of restricting then binging

how does weight centric focus affect pt-centered care?

unnecessarily delayed care due to requirement to lose weight prior to treatment

delayed diagnosis leads to poor prognosis to larger bodies blamed for outcome

over-treating people who do engage w/ the health system

medication and treatment inconsistencies

what are weight inclusive intervention models?

intuitive eating

health at every size

body trust

non-diet approach

well now

am I hungry

eating competence