Weight Management and Nutrition

How is obesity generally defined using BMI scales?Defined using Body Mass Index (BMI) scales, which categorize individuals based on their BMI value calculated from their height and weight.

What BMI is considered Underweight?BMI<18.5.

What BMI is considered Healthy weight?BMI 18.5-24.9.

What BMI is considered Overweight?BMI 24.9-29.9.

What BMI is considered Obese?BMI>30.

What BMI is considered Class 3 Obesity?BMI>40.

Why is the BMI scale considered a limited modeling tool for defining obesity?it doesn't account for the distribution of weight between fat, muscle, and bone. Additionally, it doesn't differentiate between subcutaneous fat (under the skin) and visceral fat (fat between muscles and organs), which have different health implications.

Describe the directional changes in obesity in the US over the last 2-3 decades?increase in the prevalence of obesity in the United States. The percentage of Americans classified as obese has risen from 30.5% to 41.9%. Moreover, the prevalence of severe obesity has also increased, from 4.7% to 9.2%.

What are some common comorbidities associated with obesity?high blood pressure, type 2 diabetes, stroke, polycystic ovarian syndrome, breathing problems (such as sleep apnea and asthma), joint problems (osteoarthritis and musculoskeletal pain), gallstones and gallbladder disease, and non-alcoholic fatty liver disease (NAFLD).

Describe the relationship between obesity and socioeconomic status (SES)?individuals with higher levels of education (such as college degrees) tend to have a lower incidence of obesity. However, this relationship can vary among different demographic groups. For example, Hispanic and white men from both higher and lower income groups had lower levels of obesity compared to the middle-income group. On the other hand, black men had the highest levels of obesity in the highest income group.

What are some key features of the behavioral intervention approach for obesity?more effective for overweight or not-obese patients (BMI <30). These interventions focus on self-monitoring food intake and weight, identifying barriers, problem-solving, providing social support, and maintaining behavioral changes.

What are some considerations and limitations of behavioral interventions for obesity?requirement for significant effort and time commitment for protocol adherence, the costliness of offering in-person advising with variable availability, and the lower and less reliable impact compared to pharmacological or surgical interventions.

How do anti-obesity medications (pharmacotherapy) target weight loss?target hormones in the gut and neurotransmitters in the brain to help individuals make behavioral changes that support weight loss. These medications aim to manage the drive to eat, including hunger, cravings, and attention to food, as well as increase feelings of fullness after eating.

What are some examples of anti-obesity medications (AOMs)?Contrave, Wegovy, Saxenda, Xenical/Alli, Qsymia, and Phentermine. These medications belong to various drug categories and target different mechanisms related to weight loss.

What are some considerations and limitations of anti-obesity medications (pharmacotherapy) for obesity treatment?their intended use for long-term treatment addressing chronic conditions, their suitability for individuals with a BMI >30 or >27 with obesity-related comorbidity, their underutilization due to factors like medication shortages, expense, and stigma/attitudes towards obesity.

How does metabolic/bariatric surgery help with weight control?surgical manipulation of the digestive tract through procedures such as Rou-en-Y gastric bypass, sleeve gastrectomy, lap bands, and duodenal switch. These surgeries help control the amount of food an individual can consume or the amount of nutrients absorbed from food, thus contributing to weight control.

What are some considerations and limitations of metabolic/bariatric surgery for obesity treatment?preparation that requires time, commitment, and resources, making it difficult for some individuals to afford or access. These surgeries are typically not recommended for people who are just overweight or moderately obese; they are more suitable for individuals with a BMI >40 or >35 with obesity-related comorbidities. Additionally, these surgeries are currently underutilized due to factors such as expense/coverage, stigma associated with obesity, and concerns about potential side effects.

What are some factors that impact weight behaviors?Genetics, Behavioral factors, Psychological factors, Environmental factors, Sociocultural factors, Hormonal factors, Metabolic factors, Physiological factors

What are some factors that impact eating behaviors?Psychological factors, Emotional factors, Social factors, Cultural factors, Environmental factors, Economic factors, Sensory factors, Health factors

What is meant by the intention-action gap?disconnect between a person's intentions, values, or attitudes and their actual actions. It signifies that having knowledge or understanding of what needs to be done is not sufficient to drive behavioral change. Despite having the intention to do something, individuals may struggle to translate those intentions into actions. Bridging this gap often requires more comprehensive behavioral changes and therapeutic interventions to successfully achieve weight-related goals.

Define internalized weight stigma?when an individual internalizes the negative societal and cultural beliefs associated with weight stigma and applies them to themselves. This may lead to self-blame and self-hate as a result of the stigma they perceive based on their own weight.

Define weight stigma?act of discriminating against, stereotyping, or devaluing individuals based on their weight. This can be perpetuated by various sources such as family, peers, medical professionals, colleagues, and friends.

Identify some consequences of weight stigma?Increases in:Food intake, Binge eating, Stress, Obesity Decreases in:Quality of life, Weight loss efforts, Mental health and overall well-being

Describe 1-2 examples of what physicians can do to avoid perpetuating weight stigma?Becoming familiar with their own biases about weight and obesity and confronting them. Educating themselves about the topic of health at any size. Recognizing the intention-action gap in patients and helping them identify barriers to weight loss.