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Questions and Answers

What is the type of transport process involved in glucose absorption?

  • Active transport (correct)
  • Facilitated diffusion
  • Passive transport
  • Simple diffusion

    • SGLT1 can carry fructose.

    False

    What is the name of the transporter responsible for the exit of monosaccharides across the basolateral membrane?

    GLUT2

    Proteins must first be digested into their constituent ______________________ and amino acids before being taken up by the enterocytes.

    <p>oligopeptides</p> Signup and view all the answers

    Match the following enzymes with their location:

    <p>Luminal enzymes = Stomach and pancreas Brush border enzymes = Enterocytes Enterocyte enzymes = Luminal</p> Signup and view all the answers

    How many major pathways are involved in the digestion-absorption of proteins?

    <p>4</p> Signup and view all the answers

    Gastric proteases are secreted as active enzymes for protein hydrolysis.

    <p>False</p> Signup and view all the answers

    How are oligopeptides digested in the enterocyte?

    <p>By brush border peptidases and cytosolic peptidases</p> Signup and view all the answers

    What is the main source of essential amino acids?

    <p>Dietary or plant sources</p> Signup and view all the answers

    In adults, proteins are almost exclusively digested to their constituent ______________________ and amino acids before absorption.

    <p>dipeptides, tripeptides or tetrapeptides</p> Signup and view all the answers

    What is the primary mechanism of protein absorption during the neonatal period?

    <p>Apical pinocytosis</p> Signup and view all the answers

    Adults do not absorb any intact proteins.

    <p>False</p> Signup and view all the answers

    Match the following sources with their characteristics:

    <p>Dietary sources = Provide essential amino acids Endogenous sources = Provide protein for digestion Animal sources = Provide essential amino acids Plant sources = Provide essential amino acids</p> Signup and view all the answers

    What is the uncertainty in protein absorption in adults?

    <p>The cellular route by which these substances are absorbed, as well as the relationship of the mechanism of protein uptake in adults to that in neonates.</p> Signup and view all the answers

    What is the term for non-digestible polymers found in fruits, vegetables, and cereals?

    <p>Dietary fibre</p> Signup and view all the answers

    Salivary amylase is inactivated by gastric acid.

    <p>True</p> Signup and view all the answers

    What is the storage form of carbohydrate in animals?

    <p>Glycogen</p> Signup and view all the answers

    The three monosaccharide products of carbohydrate digestion are ___, ___, and ___.

    <p>glucose, galactose, and fructose</p> Signup and view all the answers

    Match the following enzymes with their substrate:

    <p>Lactase = Lactose Maltase = Maltose Sucrase-isomaltase = Sucrose Alpha-amylase = Starch</p> Signup and view all the answers

    What is the first step in carbohydrate digestion?

    <p>Intraluminal hydrolysis</p> Signup and view all the answers

    Brush border disaccharidases are found in the stomach.

    <p>False</p> Signup and view all the answers

    What is the membrane protein responsible for glucose and galactose uptake at the apical membrane?

    <p>Sodium/glucose transporter 1 (SGLT1)</p> Signup and view all the answers

    What is the primary function of the small intestine?

    <p>Continues digestion and primary site for nutrient absorption</p> Signup and view all the answers

    The pancreas secretes digestive enzymes into the stomach.

    <p>False</p> Signup and view all the answers

    What is the main function of the liver in the gastrointestinal system?

    <p>Bile secretion</p> Signup and view all the answers

    The process of taking nutrients into cells or across tissues and organs through diffusion or osmosis is called ______________.

    <p>absorption</p> Signup and view all the answers

    Which of the following is not a type of carbohydrate?

    <p>Amino acids</p> Signup and view all the answers

    The mouth and oropharynx initiate protein metabolism.

    <p>False</p> Signup and view all the answers

    Match the following organs with their primary functions:

    <p>Mouth = Mechanical breakdown and lubrication of food Stomach = Temporary food storage Small intestine = Continues digestion and primary site for nutrient absorption Liver = Bile secretion</p> Signup and view all the answers

    What is the importance of whole protein uptake in adults?

    <p>It is important in mucosal immunity and disease processes</p> Signup and view all the answers

    All absorbed protein products exit the villous epithelial cell as individual amino acids.

    <p>True</p> Signup and view all the answers

    What is the primary mechanism of protein absorption from the intestinal lumen?

    <p>H+-driven cotransporter</p> Signup and view all the answers

    Amino acids appear in the cytosol of intestinal villous cells as the result of either their uptake across the ____________ membrane or of the hydrolysis of oligopeptides that had entered the cell.

    <p>apical</p> Signup and view all the answers

    How many distinct transport systems are present at the apical membrane of enterocytes?

    <p>7</p> Signup and view all the answers

    Amino acids can only move from the apical membrane to the basolateral membrane.

    <p>False</p> Signup and view all the answers

    What is the characteristic of lipids that determines their biological fate?

    <p>Chemical structure and interactions with water and other lipids</p> Signup and view all the answers

    Match the following transport processes with their characteristics:

    <p>Na+-dependent transporters = Mediate uptake from the blood for the purposes of cell nutrition Na+-independent transporters = Mediate amino acid exit from the cell into the blood</p> Signup and view all the answers

    What is the impact of obesity on life expectancy compared to normal-weight individuals?

    <p>Decreases by 7 years</p> Signup and view all the answers

    Exercise and diet modifications are not effective in managing obesity.

    <p>False</p> Signup and view all the answers

    What is the second leading cause of preventable death in the USA?

    <p>Obesity and sedentary lifestyle</p> Signup and view all the answers

    In Australia, per capita spending is approximately ______________ more for an obese individual versus someone of normal body weight.

    <p>$830</p> Signup and view all the answers

    Match the following BMI ranges with their corresponding categories:

    <p>25.0 to 29.9 = Overweight ≥ 30 = Obesity</p> Signup and view all the answers

    BMI is a perfect measure of body fat.

    <p>False</p> Signup and view all the answers

    What is the primary approach to managing obesity?

    <p>Behavioural-based approach</p> Signup and view all the answers

    What is the current standing of obesity in the USA?

    <p>The second leading cause of preventable death</p> Signup and view all the answers

    What is the estimated number of people who were either overweight or obese in 2016, according to the World Health Organization (WHO)?

    <p>2.5 billion</p> Signup and view all the answers

    Overweight and obesity is a temporary condition that can be easily cured.

    <p>False</p> Signup and view all the answers

    What is the primary benefit of significant weight loss in individuals with overweight and obesity?

    <p>Far-ranging positive health effects and controlling or eliminating comorbidities</p> Signup and view all the answers

    Since 1975, obesity (BMI > 30) has ______________________ worldwide.

    <p>tripled</p> Signup and view all the answers

    Match the following statements with their corresponding effects of overweight and obesity:

    <p>Increased risk of disease and disability = Long-term health effect Discrimination and stigma = Social effect Short-term intervention with limited effectiveness = Treatment outcome</p> Signup and view all the answers

    Obesity is a moral or social issue that requires stigmatization.

    <p>False</p> Signup and view all the answers

    What is the role of ghrelin in the body?

    <p>To increase appetite</p> Signup and view all the answers

    Weight loss can decrease serum ghrelin levels.

    <p>False</p> Signup and view all the answers

    What is the effect of high protein diets on appetite-reducing peptide YY?

    <p>It is increased</p> Signup and view all the answers

    Neuropeptide Y and norepinephrine predominantly stimulate ______________________ intake.

    <p>carbohydrate</p> Signup and view all the answers

    Match the following peptides with their functions:

    <p>Ghrelin = Appetite stimulant Cholecystokinin = Satiety Peptide YY = Reduced food intake Serotonin = Depression treatment</p> Signup and view all the answers

    What is the importance of establishing where the patient is located on the Stages of Change Model?

    <p>To develop a tailored plan for the individual</p> Signup and view all the answers

    Most individuals seeking professional help with weight loss have a BMI of 25 or less.

    <p>False</p> Signup and view all the answers

    What is the initial step in the clinical evaluation of the obese patient?

    <p>Proper assessment of the barriers to, and benefits of, weight loss</p> Signup and view all the answers

    One of the major barriers to weight loss is that obesity and its common comorbidities are often ___________________.

    <p>silent</p> Signup and view all the answers

    Match the following stages of change with their corresponding actions:

    <p>Precontemplators = Educated about the health risks of being overweight Contemplators = Develop a tailored plan for weight loss Preparers = Ready to commence treatment</p> Signup and view all the answers

    Compassion and understanding are essential in building rapport with obese patients.

    <p>True</p> Signup and view all the answers

    What is the limitation of using a BMI > 30 to diagnose obesity?

    <p>It has low sensitivity but high specificity</p> Signup and view all the answers

    The majority of obese children will not carry their obesity into adulthood.

    <p>False</p> Signup and view all the answers

    What is the increased health risk associated with a BMI > 30?

    <p>obesity-related comorbidities, such as heart disease, diabetes, hypertension, dyslipidaemia, sleep apnoea, and GORD</p> Signup and view all the answers

    In Japan, overweight is defined as a BMI between __________ and __________.

    <p>23.0 to 24.9</p> Signup and view all the answers

    What is an alternative method for assessing body composition?

    <p>All of the above</p> Signup and view all the answers

    Childhood obesity is a rare occurrence worldwide.

    <p>False</p> Signup and view all the answers

    Match the following with the correct BMI threshold:

    <p>Overweight = 23.0 to 24.9 Obese = ≥ 24.9 Normal weight = 18.5 to 22.9</p> Signup and view all the answers

    What is the percentage of obesity that begins in adulthood?

    <p>70%</p> Signup and view all the answers

    What is the primary purpose of exercise testing in individuals who are overweight or obese?

    <p>To assess for the presence of coronary artery disease</p> Signup and view all the answers

    There are specific recommendations for assessing muscular strength, muscular endurance, and range of motion in individuals who are overweight or obese.

    <p>False</p> Signup and view all the answers

    What is the recommended initial weight loss goal for individuals who are overweight or obese?

    <p>10% weight loss within 4-6 months</p> Signup and view all the answers

    Energy balance must be negative and ______________ reduction is the essential first step to lower weight.

    <p>calorie</p> Signup and view all the answers

    What is the daily energy requirement for normal adults to maintain weight?

    <p>22 kcal/kg</p> Signup and view all the answers

    Match the following devices with their characteristics:

    <p>Upper body ergometers = Non-weight-bearing mode Stationary cycles = Preferred mode of exercise for testing Recumbent stepping machines = Excellent alternative for exercise testing Walking = Weight-bearing mode</p> Signup and view all the answers

    Patients commonly want to lose 10% of their weight to attain their dream weight.

    <p>False</p> Signup and view all the answers

    A bell-shaped curve describes a variation in average energy expenditure of about ______________%.

    <p>20</p> Signup and view all the answers

    What is the average weight loss achieved in trials of up to one year with surgical therapy?

    <p>4-5% of baseline weight</p> Signup and view all the answers

    Exercise alone can lead to significant weight loss without caloric reduction.

    <p>False</p> Signup and view all the answers

    What is the recommended duration of exercise per week for weight loss maintenance?

    <p>60 to 90 minutes on most days</p> Signup and view all the answers

    Surgery is typically restricted to those with a BMI ≥ _______________ or those with a BMI ≥ _______________ if they have obesity-related comorbid conditions.

    <p>40, 35</p> Signup and view all the answers

    Match the following with their descriptions:

    <p>Cardiorespiratory Exercise = Exercise for weight gain prevention High-Intensity Exercise = Exercise for weight loss Aerobic Exercise = Exercise for weight loss maintenance</p> Signup and view all the answers

    Bariatric surgery carries significant risks, including a 1% mortality rate.

    <p>True</p> Signup and view all the answers

    What is the estimated amount of exercise required for weight loss without caloric reduction?

    <p>over 3,000 kcal/week (225 – 420 minutes/week)</p> Signup and view all the answers

    What is the primary benefit of significant weight loss in individuals with overweight and obesity?

    <p>Reduced risk of chronic diseases</p> Signup and view all the answers

    How many kcal are required to lose 1kg of weight?

    <p>7,700 kcal</p> Signup and view all the answers

    Medically supervised very low-calorie diets are recommended for individuals with a BMI of 25 or higher.

    <p>False</p> Signup and view all the answers

    What is the primary benefit of significant weight loss in individuals with overweight and obesity?

    <p>Improved cholesterol levels and overall heart health</p> Signup and view all the answers

    The lowest calorie level for weight maintenance is approximately ___________ kcal daily, even for those at bed rest.

    <p>1,200</p> Signup and view all the answers

    Match the following medications with their use in weight loss:

    <p>Ozempic (Semaglutide) = Used to treat diabetes and promote weight loss Saxenda (Liraglutide) = Used to treat diabetes and promote weight loss Other medications = Not used for weight loss</p> Signup and view all the answers

    What is the benefit of regular aerobic exercise in weight loss?

    <p>It protects against potential negative effects on muscle and bone strength, cardiorespiratory capacity, and resting metabolic rate</p> Signup and view all the answers

    Resistance training is not recommended for weight loss programs.

    <p>False</p> Signup and view all the answers

    What is the effect of weight loss via caloric restriction on skeletal muscle, bones, heart, liver, and kidneys?

    <p>Undesirable effects</p> Signup and view all the answers

    Regular aerobic exercise has been shown to protect against potential negative effects on muscle and bone strength, ______________________ capacity, and resting metabolic rate.

    <p>cardiorespiratory</p> Signup and view all the answers

    Match the following types of exercise with their effects on weight loss:

    <p>Aerobic exercise = Reduces visceral fat even if there is no weight loss Resistance training = May offset potential losses in lean mass Combined aerobic and resistance training = Has a combined effect of aerobic and resistance training on fat mass and lean mass changes</p> Signup and view all the answers

    Weight loss via caloric restriction only affects fat tissue.

    <p>False</p> Signup and view all the answers

    What is the recommended range of intensity for resistance exercises in obese individuals?

    <p>60-80% of 1RM</p> Signup and view all the answers

    Increased levels of incidental physical activity should be encouraged in obese individuals.

    <p>True</p> Signup and view all the answers

    What is the primary focus of exercise training in overweight or obese individuals?

    <p>Caloric expenditure, which is best achieved with aerobic-based training</p> Signup and view all the answers

    The expectations for cardiorespiratory exercise training regarding haemodynamic and other physiologic system adaptations are similar to those for people who are ________________.

    <p>not obese or overweight</p> Signup and view all the answers

    Match the following with their corresponding benefits:

    <p>Aerobic-based training = Improves caloric expenditure Resistance exercise = Improves physical functioning Incidental physical activity = Increases total caloric expenditure</p> Signup and view all the answers

    What is the recommended duration of exercise for individuals with little or no previous recent exercise history?

    <p>20-30 minutes per day</p> Signup and view all the answers

    Exercise training is not important in the weight maintenance process of weight control.

    <p>False</p> Signup and view all the answers

    What is the effect of acute blood pressure following exercise in obese individuals?

    <p>Acute blood pressure declines</p> Signup and view all the answers

    The focus should be on ______________________ before intensity in exercise training for obese individuals.

    <p>duration</p> Signup and view all the answers

    Match the following with their corresponding exercise training frequencies:

    <p>Resistance exercise = 2-3 days/week Aerobic exercise = Every day of the week</p> Signup and view all the answers

    What is the recommended duration of moderate-intensity or vigorous-intensity dynamic physical activity per week?

    <p>150 to 300 minutes</p> Signup and view all the answers

    Resistance training alone may significantly improve blood lipid and lipoprotein concentrations.

    <p>False</p> Signup and view all the answers

    What is the primary benefit of significant weight loss in individuals with overweight and obesity?

    <p>Reduces the risk of developing diseases such as diabetes and cardiovascular disease</p> Signup and view all the answers

    ROM exercise provides no known benefit to lipid or ______________________ profiles.

    <p>lipoprotein</p> Signup and view all the answers

    Match the following components of exercise with their descriptions:

    <p>Cardiorespiratory Exercise = Targets large muscle groups and can be accumulated throughout the day Resistance Exercise = Prioritised for blood lipid and lipoprotein concentrations Range of Motion Exercise = No known benefit to lipid or lipoprotein profiles</p> Signup and view all the answers

    What should patients inform their AEP about?

    <p>All of the above</p> Signup and view all the answers

    Triglyceride levels are often higher in endurance athletes and physically active individuals compared to sedentary controls.

    <p>False</p> Signup and view all the answers

    What is the primary approach to managing obesity?

    <p>Exercise and diet modifications</p> Signup and view all the answers

    There is strong evidence for lower ______________________ and greater HDLc concentrations in physically active individuals.

    <p>triglyceride</p> Signup and view all the answers

    How often should leisure-time physical activity be practiced per week?

    <p>At least 3 days</p> Signup and view all the answers

    What is the primary function of lipids in the body?

    <p>To provide structure and function to cells</p> Signup and view all the answers

    Dyslipidaemia is a risk factor for cardiovascular disease.

    <p>True</p> Signup and view all the answers

    What are lipoproteins?

    <p>Lipid-protein complexes that transport cholesterol and triglycerides in the blood</p> Signup and view all the answers

    Triglycerides are major carriers of energy-containing ______________________.

    <p>fatty acids</p> Signup and view all the answers

    Match the following lipids with their functions:

    <p>Cholesterol = Essential component of cell membranes and several vital substances Triglycerides = Major carriers of energy-containing fatty acids Lipids = Provide structure and function to cells</p> Signup and view all the answers

    Hyperlipidaemia and dyslipidaemia are the same condition.

    <p>False</p> Signup and view all the answers

    What is the average reduction in lipid fractions after exercise training?

    <p>4-7%</p> Signup and view all the answers

    Resistance training has a more significant impact on blood lipid and lipoprotein concentrations than aerobic exercise.

    <p>False</p> Signup and view all the answers

    What is the range of increase in HDLc after exercise training?

    <p>4-22%</p> Signup and view all the answers

    A single aerobic exercise session of sufficient volume can raise serum ______________________.

    <p>HDLc</p> Signup and view all the answers

    Match the following types of exercise with their effects on triglyceride concentrations:

    <p>Aerobic exercise = Significant reductions ranging from 4-37% Resistance training = More modest reductions</p> Signup and view all the answers

    Exercise training only increases HDLc in men.

    <p>False</p> Signup and view all the answers

    What is the primary purpose of cardiovascular testing in an individual with dyslipidaemia?

    <p>All of the above</p> Signup and view all the answers

    Prescribed medications can alter anticipated exercise responses in individuals with dyslipidaemia.

    <p>True</p> Signup and view all the answers

    What is the potential harm of elevated levels of proteins in the blood, such as myoglobin, in individuals with dyslipidaemia?

    <p>Kidney failure and, in extreme cases, death</p> Signup and view all the answers

    The formation of tendon xanthomas can lead to biomechanical problems that contribute to reduced exercise performance in individuals with dyslipidaemia, due to _______________ levels.

    <p>chronically high cholesterol</p> Signup and view all the answers

    What type of test can be used to assess musculoskeletal function in individuals with dyslipidaemia?

    <p>1RM test</p> Signup and view all the answers

    Cardiovascular testing is only necessary for individuals with dyslipidaemia who are otherwise healthy.

    <p>False</p> Signup and view all the answers

    Why is it important to evaluate patients with dyslipidaemia for signs and symptoms of underlying CVD?

    <p>To stratify the patient's level of risk</p> Signup and view all the answers

    Match the following complications with their associated conditions:

    <p>Rhabdomyolysis = Lipid-lowering medications Tendon xanthomas = Chronically high cholesterol levels Kidney failure = Elevated levels of proteins in the blood</p> Signup and view all the answers

    What is a potential consequence of a diet with fat intake exceeding 35%?

    <p>Elevated LDLc</p> Signup and view all the answers

    Grapefruit chemicals interact directly with statin medications.

    <p>False</p> Signup and view all the answers

    What is the term for foods that contain biologically active substances that impart medicinal or health benefits beyond their basic nutritional components?

    <p>Functional Foods</p> Signup and view all the answers

    Soluble fibre, plant stanols and sterols, psyllium, flaxseed, and a variety of nuts are examples of _______________________ that may be effective for blood lipid management.

    <p>Functional Foods</p> Signup and view all the answers

    Match the following statins with their effect on blood levels when taken with grapefruit:

    <p>Atorvastatin = Blood levels are boosted more Simvastatin = Blood levels are boosted more Lovastatin = Blood levels are boosted more Fluvastatin = Blood levels are not significantly affected Pravastatin = Blood levels are not significantly affected Rosuvastatin = Blood levels are not significantly affected</p> Signup and view all the answers

    All statins are affected equally by grapefruit consumption.

    <p>False</p> Signup and view all the answers

    What is the recommended approach for patients who are responsible drinkers?

    <p>Encourage them to continue moderate alcohol use</p> Signup and view all the answers

    What is the primary benefit of functional foods in the prevention and treatment of ASCVD?

    <p>Imparting medicinal or health benefits beyond their basic nutritional components</p> Signup and view all the answers

    Study Notes

    Organisation of the Gastrointestinal System

    • The gastrointestinal tract is a tube that is specialised along its length for sequential processing of food.
    • It consists of a series of hollow organs (from mouth to anus) and accessory glands and organs that add secretions to the hollow organs.
    • Each hollow organ serves a specialised function, separated at key locations by sphincters.

    Functions of Gastrointestinal Organs

    • Mouth and Oropharynx: mechanical breakdown and lubrication of food, propulsion of food into the oesophagus, and initiation of fat and carbohydrate metabolism.
    • Oesophagus: conduit to the stomach.
    • Stomach: temporary food storage, churning, and secretion of proteases and acid to facilitate digestion.
    • Small intestine: continues digestion, primary site for nutrient absorption.
    • Large intestine: reabsorbs fluids and electrolytes (but no nutrient absorption), storage of faecal matter before expulsion.
    • Accessory glands include salivary glands, pancreas, and liver.

    Pancreas and Liver

    • Pancreas: secretes digestive enzymes, bicarbonate to neutralise gastric acid, and secretes into the duodenum via the major and minor duodenal papilla.
    • Liver: secretes bile (stored in the gallbladder between meals), bile acids within bile play a key role in fat digestion.

    Nutrient Digestion and Absorption

    • Digestion: enzymatic conversion of complex dietary substances to a form that can be absorbed.
    • Absorption: process of taking up nutrients into cells or across tissues and organs through diffusion or osmosis.

    Carbohydrate Digestion

    • Carbohydrates are classified into three major groups: monosaccharides, disaccharides, and polysaccharides.
    • The small intestine can directly absorb monosaccharides, but not polymers.
    • Dietary fibre is a non-digestible polymer found in fruits, vegetables, and cereals.
    • Glycogen is the storage form of carbohydrate in animals.

    Carbohydrate Digestion Steps

    • Intraluminal hydrolysis: starch to oligosaccharides by salivary and pancreatic enzymes.
    • Membrane digestion: oligosaccharides to monosaccharides by brush border disaccharidases.

    Intraluminal Hydrolysis

    • Salivary and pancreatic acinar cells synthesise and secrete alpha-amylases.
    • Salivary amylase initiates starch digestion in the mouth, but is inactivated by gastric acid.
    • Pancreatic alpha-amylase completes starch digestion in the small intestine.

    Membrane Digestion

    • Membrane digestion involves hydrolysis of oligosaccharides to monosaccharides by brush border disaccharidases.
    • The small intestine has three brush border oligosaccharidases: lactase, maltase, and sucrase-isomaltase.

    Carbohydrate Absorption

    • The three monosaccharide products of carbohydrate digestion are absorbed by the small intestine in a two-step process.
    • Uptake across the apical membrane into the epithelial cell, and coordinated exit across the basolateral membrane.

    Protein Digestion

    • Proteins must be digested into their constituent oligopeptides and amino acids before being taken up by the enterocytes.
    • Digestion-absorption of proteins occurs through four major pathways.

    Protein Digestion Pathways

    • Luminal enzymes hydrolyse proteins to peptides and amino acids, which are then absorbed.
    • Luminal enzymes digest proteins to peptides, which are then digested to amino acids by brush border peptidases.
    • Luminal enzymes digest proteins to peptides, which are taken up by enterocytes and further digested to amino acids by cytosolic enzymes.
    • Luminal enzymes digest proteins to oligopeptides, which are taken up by enterocytes and moved directly into the blood.

    Protein, Peptide, and Amino Acid Absorption

    • In adults, proteins are almost exclusively digested to their constituent amino acids and dipeptides, tripeptides, or tetrapeptides before absorption.
    • The absorption of amino acids across the small intestine requires sequential movement across both the apical and basolateral membranes of the villous epithelial cell.

    Lipid Digestion

    • Lipids are typified by their preferential solubility in organic solvents, compared with water.
    • The biological fate of lipids depends critically on their chemical structure and interactions with water and other lipids in aqueous body fluids.

    OVERWEIGHT & OBESITY

    • Overweight and obesity are associated with, if not the principal cause of, much disease and disability
    • Short-term interventions have limited effectiveness, and long-term success is rare without ongoing medical efforts
    • Obesity is a chronic illness, often with comorbidities that need to be considered
    • Significant weight loss has far-ranging positive health effects and can often control or eliminate comorbidities
    • Exercise and dietary changes are the main contributors to weight loss

    GLOBAL OBESITY EPIDEMIC

    • According to WHO, obesity (BMI > 30) has tripled worldwide since 1975
    • In 2016, at least 2.5 billion people were either overweight or obese, with 600 million categorized as obese
    • Overweight and obesity cause more deaths than being underweight
    • Obesity has led to discrimination in recent years, with many viewing it as a moral or social issue, stigmatizing its management

    HEALTH RISKS OF OBESITY

    • Obesity is associated with an increased rate of death from all causes, particularly cardiovascular disease
    • Obesity and sedentary lifestyle are considered the second leading cause of preventable death in the USA, and may overtake tobacco abuse within the next decade
    • For obese individuals, life expectancy decreases by about 7 years compared to normal-weight individuals

    OVERWEIGHT & OBESITY IN AUSTRALIA

    • In Australia, per capita spending is approximately $830 more for an obese individual versus someone of normal body weight
    • Obesity reduces life expectancy, and this effect is more powerful in those who develop obesity earlier in life
    • In 2016, life expectancy fell slightly for the first time, reflecting the effects of obesity-related chronic illness on society

    MANAGEMENT OF OBESITY

    • Exercise, diet modifications, and lifestyle changes are the foundation of a behavioral-based approach to the management of obesity
    • A long-term-horizon approach is imperative to success
    • Using a behavior change approach is critical

    ASSESSMENT OF BODY COMPOSITION

    • Body Mass Index (BMI) indicates overweight for height, but does not discriminate between fat mass and lean tissue
    • BMI has significant correlation with total body fat and is an acceptable clinical measure of overweight and obesity
    • BMI thresholds vary internationally by race
    • Other methods for assessing body composition include skinfolds, bioelectrical impedance, water or air displacement, and dual-energy x-ray absorptiometry (DEXA)

    CHILDHOOD OBESITY

    • 70% of all obesity begins in adulthood
    • There is a strong association between childhood obesity and the risk of adulthood obesity, affected by the severity of childhood obesity, age of onset, and whether the parents are also obese
    • Most obese children will carry their obesity into adulthood
    • Increasing childhood obesity is a worldwide issue

    CENTRAL ADIPOSITY

    • BMI > 30 carries increased health risk for obesity-related comorbidities, including heart disease, diabetes, hypertension, dyslipidaemia, sleep apnoea, and gastro-oesophageal reflux disease (GORD)
    • The pattern of fat distribution also affects risk

    PATHOPHYSIOLOGY OF OBESITY

    • Ghrelin, produced as the stomach empties, triggers the central nervous system appetite stimulant neuropeptide Y (NPY), growth hormone, and norepinephrine
    • Weight loss can increase serum ghrelin levels, which may explain part of the process that makes sustaining weight loss difficult
    • Cholecystokinin, serotonin, and peptide YY are among a group of central nervous system and gut peptides involved in satiety and reduced food intake

    Exercise Testing

    • Exercise testing is used to assess for coronary artery disease in overweight or obese individuals.
    • The test is also used to determine functional capacity and develop an exercise prescription based on heart rate.
    • Walking is the preferred mode of exercise, but it may not be practical for obese individuals.
    • Seated devices such as upper body ergometers, stationary cycles, or recumbent stepping machines can be used as alternatives.
    • A low-level protocol with small increments (e.g., 0.5-1.0 MET) may be preferred due to the potential for low peak exercise capacity.

    Treatment

    • Treatment goals should consider both medical benefits and patient expectations.
    • International guidelines recommend a 10% weight loss within 4-6 months and weight loss maintenance as an initial goal.
    • This amount of weight loss is associated with several health-related benefits.
    • Patients often want to lose 35% of their weight to attain their desired weight.

    Diet Therapy

    • To lower weight, energy balance must be negative, and calorie reduction is the essential first step.
    • For normal adults, 22 kcal/kg is required daily to maintain weight.
    • A bell-shaped curve describes a variation in average energy expenditure of about 20%.
    • The lowest calorie level for weight maintenance is about 1,200 kcal daily, even for those at bed rest.
    • Exercise and activity levels affect maintenance calorie levels by 25% or more.

    Diet Therapy - Rapid Weight Loss

    • A deficit of 7,700 kcal is needed to lose 1kg, so a typical diet can yield about 0.5kg of weight loss per week.
    • Low-fat diets are recommended due to the high calorie content of fat and the heart health benefits.
    • Higher-protein and lower-carbohydrate diets have been favored by patients due to greater weight losses and better satiety.
    • Higher-protein diets tend to promote satiety, and lower-carbohydrate levels can promote greater fat utilization.

    Medical Management

    • Medically supervised very low-calorie diets can be used for rapid weight loss.
    • Ozempic (Semaglutide) and Saxenda (Liraglutide) are injectable diabetes medications that can be used at higher doses for weight loss.
    • These medications can achieve modest weight loss in completers (~4-5% of baseline weight) in trials of up to one year.

    Surgical Therapy

    • Surgical procedures can restrict the stomach or cause malabsorption of food, or both.
    • Newer laparoscopic techniques can cause patients to lose one-third of their weight (>50% of their excess weight) within 18 months.
    • Research has confirmed improved mortality rates with weight loss surgery, but there are significant risks (up to 1% for death and 15% for morbidity).
    • Surgery is typically restricted to those with a BMI ≥ 40 or those with a BMI ≥ 35 if they have obesity-related comorbid conditions.

    Exercise Prescription

    • Exercise alone can achieve weight loss, but high amounts of total caloric expenditure are required (>3,000 kcal/week).
    • Exercise and caloric reduction can increase the weekly rate of weight loss by approximately 1kg over caloric reduction alone.
    • Regular exercise of 60-90 minutes on most days of the week is recommended for long-term weight loss maintenance.

    Cardiorespiratory Exercise

    • Initially, exercise and physical activity should focus on cardiorespiratory exercise.
    • Typical RPE values of 11-15 (6-20 scale) may be substituted when assessing heart rate is not convenient.
    • Interval training is not part of an initial exercise routine, but some individuals who establish and tolerate a regular exercise routine may enjoy this form of training.

    Exercise Duration

    • For those with little or no previous recent exercise history, beginning with 20-30 minutes each day is appropriate.
    • Breaking this exercise time into two or three sessions per day of shorter duration (5-15 minutes) may be required for extremely deconditioned people.
    • The focus should be on duration before intensity.
    • Accumulation of time over several sessions in a day is as beneficial as one continuous work bout with respect to total caloric expenditure.

    Resistance Exercise

    • The exercise prescription for obese people should include resistance intensity in the range of 60-80% of 1RM, performed for 8-12 reps and two sets (progressing to as many as four sets).
    • This plan will allow the person to perform 6-10 exercises in a 30-40 minute session.
    • Resistance exercises can be performed maximally on 2-3 days/week, ideally without working the same muscle groups on consecutive days.

    Range of Motion

    • Obese patients have a reduced range of motion primarily due to increased fat mass surrounding joints and a lack of movement and routine stretching.
    • ROM may improve spontaneously with weight loss.
    • Normal flexibility routines are recommended as tolerated.

    Exercise Training - Important Considerations

    • Low cardiorespiratory fitness adds to the risk of cardiovascular disease and mortality in overweight and obese people.
    • Ample evidence indicates that regular aerobic exercise training improves physical functioning, independent of weight loss, in those who are obese or overweight.
    • Exercise training is likely most important in the weight maintenance process of weight control.
    • Regular exercise training expending more than 2,000 kcal/week is a strong predictor of long-term weight loss maintenance.

    Hyperlipidemia and Dyslipidemia

    • Lipids are necessary for normal body functioning, including cholesterol, triglycerides, and lipoproteins.
    • Abnormal lipid levels, particularly of cholesterol, triglycerides, and lipoproteins, are modifiable CVD risk factors.
    • Dyslipidemic patients have an elevated risk of CVD.

    Cardiovascular Testing

    • The purpose of cardiovascular testing in individuals with dyslipidemia is to help diagnose CAD, determine functional capacity, and determine an appropriate exercise intensity range.
    • Prescribed medications can alter anticipated exercise responses, such as lipid-lowering medications like statins and fibric acid, which can cause muscle damage and reduce exercise performance.

    Musculoskeletal Testing

    • 1RM tests can be used, and patients who are responsible drinkers should be encouraged to continue moderate alcohol use.

    Diet

    • Diets with fat intake exceeding 35% are likely to include too much saturated fat, contributing to elevated LDLc, insulin resistance, and weight gain.
    • Low-fat, high-carbohydrate diets promote features of atherogenic dyslipidemia, such as elevated triglycerides and lower HDLc.
    • Functional foods, including soluble fiber, plant stanols and sterols, psyllium, flaxseed, nuts, omega-3 fatty acids, garlic, flavonoids, and soy protein, may be effective for blood lipid management.

    Effects of Grapefruit

    • Grapefruit chemicals do not interact directly with statin medications, but rather bind to an intestinal enzyme, blocking its action and making the passage of the medication easier from the gut to the bloodstream.
    • As a result, blood medication levels may rise faster and remain at higher-than-normal levels, which can be dangerous in some cases.

    Cardiorespiratory Exercise

    • People should accumulate 150-300 minutes of moderate-intensity or 75-150 minutes of vigorous-intensity dynamic physical activity using large muscle groups, or some combination of the two, throughout each week.
    • To optimize lipid and lipoprotein changes, clients are encouraged to progress to the upper end of the exercise dose range.
    • Leisure-time physical activity should be practiced on at least 3 days through the week, and 5 or more days are required for most people to meet the dose recommendations.

    Resistance Exercise

    • Resistance training alone may have very limited effect on improving blood lipid and lipoprotein concentrations.
    • Since cardiorespiratory exercise should be prioritized, more than one set per resistance training exercise is not recommended unless the client is clearly motivated to be compliant with both cardiorespiratory and resistance exercise.

    Range of Motion Exercise

    • ROM exercise provides no known benefit to lipid or lipoprotein profiles.
    • Unless certain comorbidities exist, there are no special considerations for dyslipidemic patients with respect to ROM exercise.

    Exercise Considerations

    • Patients should be instructed to inform their AEP whenever their medications are changed, or the dosages are increased.
    • In such cases, increases in exercise volume should be withheld for a couple of weeks, and any unusual muscle soreness should be noted.
    • Any sudden or severe muscle pain that cannot be logically explained by a recent increase in physical activity should be brought to the attention of the patient’s GP.

    Exercise Prescription Summary

    • There is strong evidence for lower triglyceride and greater HDLc concentrations in physically active individuals.
    • Triglyceride levels are almost always lower in endurance athletes, aerobically trained people, and physically active individuals when compared with sedentary controls.
    • Blood levels of HDLc are between 9% and 59% higher in those having physically demanding jobs and in individuals engaged in endurance exercise compared with their less active counterparts.
    • There is only limited evidence to suggest that people who are physically active exhibit lower concentrations of total cholesterol and LDLc than those who are less active.

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    Related Documents

    Week 1 - Metabolic Physiology PDF
    Week 2 - Overweight and Obesity - Part 1 PDF
    Week 2 - Overweight and Obesity - Part 2 PDF
    Week 3 - Hyperlipidaemia and Dyslipidaemia PDF

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    This quiz covers the organisation of the gastrointestinal system, including the structure and function of the gastrointestinal tract and accessory glands and organs.

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