HNES 370 exam 3

Obesity is most commonly defined as

BMI > 30 kg/m2

Fat free mass

All body parts that are not fat (body fat weight-total body fat)

Lean body mass

Generally includes muscle, bones, tendons, ligaments, etc., and small essential fats

Advantages of Body Mass Index

Simple to measure and calculate
Categories
Generally understood
Related to body fat (population-based) s useful for athletes
Linked with disease and function

Limitations of Body Mass Index

Indirect measure of body composition
Distribution of adiposity not considered
Possible misclassification of obesity presence

Less useful for athletes
Inconsistent predictive value for older adults

The subclassification of obesity is characterized by excessive body fatness with no signs of ongoing illness

Preclinical

How to manage preclinical obesity

Health consulting
Monitoring over time
Referral to intervention

How to manage clinical obesity

Emphasize programs that will restore function
Examine risk-benefits of treatment types
Assess improvement of signs & symptoms relative to weight loss

chronic disease due to obesity alone, and characterized by signs and symptoms of ongoing organ dysfunction and/or reduced ability to perform daily activities

Clinical

These are included in management plans for individuals with clinical obesity

Emphasizing restoration of organ function

Examine risk/benefits of treatment types

Assess improvements relative to weight loss

What are contributors to obesity

Energy balance

Poor sleep

Stress

Environment

Genetics

Medications and health conditions

Hormonal conditions

Significance of obesity linked to

Heart disease

Stroke

Diabetes

Functional limitations

Osteoarthritis

Early all-cause mortality

Lots of medical cost

Fat overflow to other tissues is known as

Ectopic fat

Waist circumference for obesity measurements

≥102 cm in men

≥88 cm in women

Waist to hip ratio when measuring for obesity

>0.90 in men
>0.85 in women

Waist to height ratio when measuring for obesity

>0.50 for all

BF% when measuring for obesity

Males 25%

Females 32%

Fat under skin and on top of muscle

Subcutaneous fat

Fat surrounds internal organs

Visceral fat

Fat above the waist

central obesity (android)

Fat below the waist

Peripheral obesity (gynoid)

What fat has health risks

subcutaneous fat

Bariatric surgery

Weight loss can sometimes be advised
Procedure shows efficacy for key outcomes
Negative impacts exist

Malnutrition

May include undernutrition, inadequate vitamins or
minerals, overweight, obesity, and leading to diet-related non-communicable disease

Undernutrition wasting

Low weight for height- indicates recent and substantial weight loss

Undernutrition stunting

Low height-for-age- recurrent undernutrition

Undernutrition underweight

Low weight-for-age (5% in youth)- the result of wasting and/or stunting

Underweight BMI

<18.5 kg/m2 in adults

Fit-Fat paradox

Persons with obesity that are physically fit may have better health outcomes
- Being “fit and fat” vs. “unfit and not-fat

While obesity is linked to morbidity, functional limitations, and early all-cause mortality, other factors could be modified and thereby confound

Adiposity
PA participation
Cardiorespiratory fitness

Youth populations could be viewed as important because

Behavior development
Human development
Early morbidity and functional limitations
Longevity

Risk from one obese parent

50% increased odds for being obese

Risk from two obese parents

80% increased odds for being obese

Role of parents for youth populations

Genetic
Family history
Environmental

Health behaviors
- Food, physical activity, sleep

Diet in children

Consumed “significant” amounts of energy-dense, nutrient poor foods
18%-33% of infants and toddlers consumed no vegetables
- Child palate gives preference to sweet and salty taste

• Repeated exposure helps

Restriction to palatable foods

overconsumption when available

Pressuring consumption of healthy foods

lower intake

Healthy food as reward

lower healthy food consumption

Authoritarian parenting styles for food

overeating, food rejection, picky eating

Physical Activity Guidelines for Americans recommends

at
least 60 minutes of moderate-
vigorous physical activity each
day for youth

Youth PA recommendations include

>60 vigorous PA daily

Aerobic exercise >3 days/week

Bone strengthening exercise >3 days/week

Why is youth fitness data less robust than adult data

Lack of standardized testing

Between what of youth meet the 60 minutes of moderate- vigorous PA recs

20-28%

About how many of youth aged 12-19 years use active transportation for at least 10 minutes continuously once or more a week

38%

About how much of children 6-17 years are part of organized sport

51%

About how much of schools allow kids to participate in physical activity outside of PE class

54%

Inconsistent recess time mandates:

Two states mandate over ? minutes of daily recess; five states require ? minutes, while another five stipulate less than ? minutes. Ten states require recess without specifying duration, and 28 (56%) have no requirements

30, 2030, 20

International recommendation of less than ? how screentime per day
What behavior is hard to measure in these population
studies

2 hours; Sedentary

Big 5

Large waist circumference

High blood pressure

High fasting glucose

High triglycerides

Low HDL

Large waist circumference- Metabolic syndrome

>90 cm in men

>85 cm in women

High blood pressure- Metabolic syndrome

>130/85

High triglycerides- Metabolic syndrome

>150 mg/dL

High fasting glucose- Metabolic syndrome

>100 mg/dL

Low HDL- Metabolic syndrome

<40 mg/dL for men

<50 mg/dL for women

Genetics- Metabolic syndrome

Metabolism

Nutrient partitioning

Fat storage

Race and Ethnicity

Sedentary behavior- Metabolic syndrome

Less muscle=less glycogen storage, lower expenditure, lower insulin sensitivity

GLUT4

Dietary habits- Metabolic syndrome

Ultra processed sugary carbs

Alcohol & nicotine consumption

• Hyperglycemia, hyperlipidemia, Hypertension

Saturated & trans fats

Psychosocial- Metabolic syndrome

Family & society norms

Education

Socioeconomic status

Type 1 diabetes

autoimmune condition where the immune system attacks
insulin producing beta cells, resulting in inadequate insulin production

Diabetes

Metabolic disorder where the body cannot effectively regulate blood sugar

Type 2 diabetes

body's cells do not respond effectively to insulin resulting in
prolonged periods of elevated blood glucose

Long term complications of diabetes

Obesity
Heart disease
Stroke
Heart attack
Atherosclerosis
Early death or disability

Acute complications of diabetes

Hyperglycemia
Hypoglycemia
Ketoacidosis
Hyperosmolar hyperglycemic state

Diabetes is what

7th leading cause of death

Type 2 diabetes signs

• Excessive thirst and urination

• Fatigue

• Blurred vision

• Diabetic neuropathy

• Numbness in the extremities

• Dark patches of skin

• Unexplained weight change

• Poor immune function

Diagnosis of diabetes

A1C test

Fasting plasma glucose

Oral glucose tolerance test

Causes of hypertension

Primarily influenced by lifestyle, genetics, and aging
Secondarily by underlying conditions (kidney disease and hormone imbalances)

Normal BP

less than 120/ less than 80

Elevated BP

120-129/less than 80

Stage 1 hypertension

130-139/ 80-89

Stage 2 hypertension

140 or higher/90 or higher

Severe hypertension

Higher than 180/higher than 120

Side effects of hypertension

Often asymptomatic
Slowly causes stiffening of the blood vessels
Damage to vascular walls
Long term damage to internal organs

Total peripheral resistance

Viscosity

Vessel length

Vessel radius

Vascular Changes

Blood vessels begin to narrow and lose elasticity, increasing vascular resistance
Endothelial dysfunction reduces nitric oxide, limiting vasodilation
Increased vasoconstrictor activity raises vascular tone

Neural response

Increased sympathetic nervous system activity causes
vasoconstriction and elevates heart rate
Elevated norepinephrine levels increase peripheral
resistance & cardiac stimulation

Fluid balance

Increased sodium and water retention raises blood volume,
increasing cardiac output
Reduced renal excretion of sodium contributes to volume
expansion

Hormonal response

Activation of the Renin-Angiotensin-Aldosterone System
(RAAS) causes vasoconstriction and fluid retention

Angiotensin II promotes vasoconstriction and aldosterone
release, further increasing volume and pressure

Physiological response: Cardiac response

Increased afterload forces the heart to pump harder to eject blood
This can result in hypertrophy of the left ventricle
Decreased stroke volume is compensated for through increased HR

Physiological response: Regulatory dysfunction

Baroreceptor sensitivity becomes impaired
Leads to new "normal"

Physiological response: Effects

BP increases

Vascular damage

Effects of exercise for hypertension

PA is a major modifiable risk factor
May be as effective as medication in cases of mild hypertension
Decreases TPR, decreases SNS activity, improves endothelial and vascular function
Measurable benefit in 8-24 weeks

How many us adults have hypertension

47.7%

Mortality for hypertension

Silent killer

Mortality rates harder to estimate

Does more damage through indirect means

Dyslipidemia

Abnormal lipid levels

• higher LDL

• higher triglycerides

• Lower HDL

Dyslipidemia leads to

Atherosclerosis- Plaque build up in arteries

Dyslipidemia causes

CVD, heart attack, and stroke

Regular exercise improves lipid profiles:

Decrease total cholesterol
Decrease LDL cholesterol
Decrease triglycerides
Increase HDL cholesterol

Lipids levels in the blood stream are abnormal

problems with absorption in the intestines, energy storage, or bile acid formation

Lipids types include

• LDL cholesterol

• triglycerides

• HDL cholesterol

Atherosclerosis Stage 1: Fatty Streak

Formation of a fatty streak on the endothelial lining of the arteries

Atherosclerosis Stage 2: Fibrous Plaque

Fibrous plaque develops within the inner layer of the arteries, a great number of macrophages, smooth muscle cells, and lymphocytes are present
These cells are filled with cholesterol, as the plaque grows it will begin to protrude into the vessel causing narrowing of the lumen in the arteries

Atherosclerosis stage 3: Complicated lesion

Starts when a fibrous plaque ruptures, causing the cholesterol and connective tissue under to be exposed, leading to a blood coagulation reaction
This is where blood clots can lead to stroke and heart attacks