dap exam 2 (see quiz 3&4 for diabetes info)

static energy balance

changing one side of the energy balance equation results in either weight gain or weight loss

3500

classic energy balance equation: 1 lb = ______ kcal

dynamic energy balance

numerous biological and behavioral factors regulate and influence both sides of the energy balance equation

genetics, gut microbiome, fat cell development, sleep and circadian rhythm, stress, inflammation, viruses/pathogens

name the seven biological influences that can cause obesity

lipoprotein lipase, leptin, ghrelin, carbohydrate-insulin model

name the four enzyme and hormone factors that can influence obesity.

genetics

studies have demonstrated the role of _______ in susceptibility to obesity, as well as influence on energy storage and energy expenditure.

lipoprotein lipase (LPL)

enzyme that promotes fat storage in fat and muscle cells — increased levels increase fat storage efficiency

more LPL

individuals with obesity have _____ _____ activity in fat cells (even in modest amoungs)

leptin

hormone produced by fat cells under direction of the (ob) gene — decreases appetite, increases energy expenditure

leptin resistance

what condition is obesity associated with, as it relates to leptin?

leptin

what hormone does a gain in body fat stimulate the release of, resulting in appetite suppression and energy expenditure?

ghrelin

protein synthesized and secreted by stomach cells — promotes energy balance by appetite stimulation and energy storage

eat

what does ghrelin trigger the desire to do?

carbohydrate-insulin model

increasing fat deposition in the body resulting from the hormonal responses to processed carbohydrates that can drive weight gain

fat storage, blood glucose concentration, hunger hormone response

gut bacteria/microbiome may alter the following processes:

hyperplasia

number of fat cells increases

hypertrophy

cells expand in size (including fat cells)

late childhood and early puberty

when does hyperplasia mostly occur?

more cells develop to store fat

what happens after max hypertrophy has occurred?

increasing number

which do fat cells have a better capacity for: increasing size or increasing number?

energy storage

main function of white adipose tissue:

heat production

main function of brown adipose tissue:

insulin sensitivity

metabolic role of white adipose tissue:

enhance glucose and lipid metabolism

metabolic role of brown adipose tissue:

androgenic hormones, adipokines

hormones produced by white adipose tissue:

UCP1

hormones produced by brown adipose tissue:

lower leptin, increase ghrelin

what effect does short sleep duration have on hormones?

cortisol

what hormone does chronic stress effect, which may impact appetite changes?

cytokines

adipose tissues secrete what inflammatory compound?

turn on

what does chronic overeating do, as it relates to inflammation?

obesity can be caused by pathogenic organisms

what is the hypothesis surrounding “infectobesity”?

increasing with no change in gene pool

why is it believed that environmental stimuli play a big role in obesity rates?

high-calorie foods, fast food restaurants, portion sizes, high fat content

what are four possible changes in eating behavior, that may count as environmental stimuli?

emotional, behavioral, hedonic

what are the three types of hunger (beyond physical)?

appetite

psychological desire to eat — learned motivation; experienced as a pleasant sensation accompanying the sight, smell, or thought of food

physical hunger

internal drive programmed by heredity; physiological need to eat, a drive to obtain food in response to an unpleasant sensation that demands relief

physical inactivity

too little expenditure — modern environment fosters this

neighborhood obstacles

environments that lack opportunities for safe PA and access to fresh, nutrient-dense food linked to obesity

food deserts

low-income areas with limited access to affordable and nutritious food

obesogens

environmental pollutants foreign to the body and disrupt metabolism/energy balance (endocrine disruptors)

bisphenol A and pthalates

what are two examples of obesogens?

true

true/false: gout is a medical complication of obesity

true

true/false: cataracts is a medical complication of obesity

true

true/false: pancreatis is a medical complication of obesity

false

true/false: IBS is a medical complication of obesity

false

true/false: erectile dysfunction is a medical complication of obesity

breast, uterus, cervix, colon, esophagus, pancreas, kidney, prostate, thyroid, liver, gallbladder, ovaries, myeloma, brain

cancers associated with obesity include:

inflammation

normal protective reaction of the immune system to injury, infection, physiologic or metabolic stress

local, systemic, acute, chronic

four types of inflammation:

homeostasis restored

what happens when causes of acute inflammation are resolved?

chronic

prolonged, sustained, low-grade inflammation contributing to the increased risk for chronic disease

cytokines and adipokines

what two pro-inflammatory compounds signal the inflammatory response to remove insult and initiate healing?

cardiometabolic

what kind of disease risk is directly associated with increased body fat and abdominal obesity?

physical inactivity, poor diet, poor sleep, stress

four factors contributing to chronic inflammation:

secrete hormones and cytokines

what does metabolically active adipose tissue do?

viscerally

where is metabolically active adipose tissue?

hyperlipedemia; high TGs, glucose, insulin, HbA1c, CRP-high sensitivity, homocysteine

markers of cardiometabolic inflammation:

metabolic syndrome

cluster of risk factors related to obesity, insulin resistance, and visceral adipose tissue that indicates a proinflammatory state and increased risk for CVD and Type 2 DM

3

diagnosis for metabolic syndrome takes how many of the diagnostic criteria?

waist circumference — men > 40 in, women > 35 in

metabolic syndrome diagnostic criteria relating to abdominal obesity

>150 mg/dL

metabolic syndrome diagnostic criteria relating to triglycerides

men <40, women <50

metabolic syndrome diagnostic criteria relating to HDL

>130/>85 mm Hg

metabolic syndrome diagnostic criteria relating to blood pressure

>100mg/dL

metabolic syndrome diagnostic criteria relating to fasting glucose

comprehensive lifestyle program, prescription medication, surgery

three possible pathways for the treatment of obesity:

healthy eating, physical activity, behavior therapy

three aspects of a comprehensive lifestyle program as a treatment for obesity:

<2%, 1-2 lbs

what is a reasonable weight loss goal per week

5-10%

what is a reasonable weight loss goal per 6 months

improve overall health and control of chronic diseases

what does 3-5% weight loss do?

some lean mass loss

what will always happen in weight loss?

frustration, failure

what happens with unreachable weight loss targets?

250-1000 kcal deficit, >1200 kcal/day

what is a realistic energy intake for weight loss?

whole foods

what types of foods should be focused on in a healthful eating plan for weight loss?

small

what should portions look like in a healthful eating plan for weight loss?

Mediterranean diet, DASH diet, plant-based diet

three evidence-based meal patterns are:

small, frequent

eating what kind of meals is associated with successful weight loss and maintenance, as it relates to meal spacing?

adequate water intake

meets fluid needs, assists GI tract to adapt to increased fiber intake

combining dieting and physical activity

what is the most effective way to achieve weight loss?

increasing energy expenditure, LBM (which increases BMR), appetite control, improving psychological health

physical activity contributes to weight loss by:

150-300 mins

physical activity guideline for Americans: moderate intensity aerobic activity

75-150

physical activity guideline for Americans: vigorous intensity aerobic activity

behavior therapy

cornerstone of any lifestyle intervention; incorporates goal setting, stimulus control, cognitive restructuring, and relapse prevention

the client

who does behavior therapy place responsibility with (by using the empowerment approach)?

>30

BMI needed to be prescribed an obesity drug (no co-morbidities)

>27

BMI needed to be prescribed an obesity drug (1+ co-morbidities)

delay gastric emptying, increase satiety, improve insulin sensitivity

what are the three mechanisms of action of obesity drugs?

>40

BMI needed to be considered for obesity surgery (no co-morbidities)

GLP-1 Receptor Agonists

mimic GLP-1s by raising insulin, decreasing appetite, and slowing gastric emptying

Dual Agonists

activate GLP1 and GIP receptors

oral GLP-1

oral version of GLP1 —> same mechanism, different delivery

Triple Agonist

GLP1 and GIP and glucagon —> change appetite and energy expenditure

Triple Agonist

what GLP1 Receptor Agonist class is still in trials/emerging

semaglutide, liraglutide, dulaglutide

three examples of GLP1 Receptor Agonists

Ozempic, Wegovy, Trulicity

three name brand examples of GLP1 Receptor Agonists

tirzepatide (Mounjaro)

example of a Dual Agonist (and one name brand)

rybelsus

one name brand example of oral GLP1

malnutrition

what should be monitored for when a GLP1 agonist is being taken?

loss of lean muscle mass

what is a major concern with GLP1s?

osteopenia and osteoporosis

what is a patient at risk for with high loss of lean muscle mass?

lemon aromatherapy, ginger

what is used to treat nausea in GLP1 cases?