Sports Nutrition and Obesity Quiz

Special Topics in Nutrition

• Course code: FN 1070
• Developed by: Leila McBeth, BScFN, MScFN (c) and Rebecca Whitehead BASc, MScFN (c)

Table of Contents

• Maternal Nutrition: Covers topics related to nutrition during pregnancy.
• Weight Bias: Discusses weight bias and discrimination.
• Sports Nutrition: Covers topics related to nutrition for athletes.

Maternal Nutrition

• "Eating for Two":
  • First trimester: no increase in daily calorie intake.
  • Second trimester: +340 calories daily.
  • Third trimester: +450 calories daily.
  • Protein increase: +25g per day.
• Unsafe Foods During Pregnancy:
  • Avoid unpasteurized milk and milk products, juices.
  • Avoid undercooked eggs, meat, or poultry.
  • Avoid raw sprouts.
  • Avoid deli meats and hot dogs that haven't been reheated to steaming hot temperatures.
  • Limit high mercury seafood consumption.
• Pregnancy Multivitamin:
  • 400 mcg of folic acid.
  • 16-20 mg of iron.
• Neural Tube Development:
  • Critical period: 17-30 days of gestation (before most women know they're pregnant).
  • Deficiencies in folic acid, toxins (alcohol), preformed vitamin A can cause neural tube defects.
  • Wheat flour fortification in 1998 reduced neural tube defects.
  • Common result of neural tube defects: abortion or stillbirth.
  • Spina bifida and anencephaly are neural tube defects.

Pregnancy Weight Gain Recommendations

• Pre-pregnancy underweight BMI: 12.5-18 kg (twins unknown)
• Pre-pregnancy average BMI: 11.5-16 kg (twins - 17-25 kg)
• Pre-pregnancy overweight BMI: 7-11.5 kg (twins -14-23 kg)
• Pre-pregnancy obese BMI: 5-9 kg (twins- 11-19 kg).

Weight Gain Pattern

• First Trimester:
  • Underweight: 2.5 kg
  • Average weight: 1.5 kg
  • Overweight: 1 kg
• After first trimester:
  • Underweight: >0.5 kg/week gain
  • Average weight: <0.5 kg/week gain
  • Overweight: 1/3 kg/week gain

If Women Gain Excessive Weight

• Increased risk of LGA infants
  • Longer labor and birth
  • Birth trauma
  • Birth asphyxia
  • Cesarean birth
  • Increased perinatal mortality
  • Infant developing type 2 diabetes later in life
  • Infant becoming overweight
  • Weight retention up to 3 years post-partum.

If Women Gain Inadequate Weight

• Increased likelihood of SGA infants
  • Health complications after birth (hypothermia, hypoglycemia, respiratory distress, jaundice).
  • Neonatal mortality
  • Physical disabilities
  • Cognitive disabilities
  • Chronic health problems (type 2 diabetes, CVD, HTN) later in life.
• Malnutrition during pregnancy can cause:
  • Low birth weight infants
  • Type 2 Diabetes in infants
  • Low birth weight and high growth in young (childhood) → high blood pressure and heart disease.

Harmful Pregnancy Practices

• Herbal supplements
• Vitamin/mineral overdoses
• Tobacco
• Illicit drugs
• Alcohol
• Caffeine (>500 mg/day)
• Sugar substitutes
• Lead/mercury

Diabetes in Pregnancy

• Pre-existing diabetes concerns:
  • Severe hypoglycemia and hyperglycemia
  • Preterm birth
  • Hypertension during pregnancy
  • LGA infants
• Gestational diabetes concerns:
  • Labor complications
  • Infant heart damage
  • Infant limb deformities
  • Neural tube defects

Hypertension in Pregnancy

• Pre-existing hypertension concerns:
  • Low birth-weight infants
  • Stillbirth from placenta separation from uterus wall
• Gestational hypertension concerns:
  • Sometimes pre-eclampsia
  • Pre-eclampsia symptoms:
    • Protein in the urine
    • Swelling of hands, feet, face
    • Delayed fetal growth
  • Risk: Organ damage and eclampsia (seizures & possible death).

Maternal Discomfort Strategies

• Nausea:
  • Rise from sleep slowly
  • Eat dry toast or crackers
  • Eat small, frequent meals
  • Chew gum or suck hard candies
  • Carbonated beverages
• Heartburn:
  • Eat slowly and chew well
  • Eat small, frequent meals
  • Drink liquids between meals
  • Avoid spicy or greasy foods
  • Eat 3 hours before lying down or 2 hours before exercising
• Constipation:
  • Eat high-fibre foods
  • Exercise often
  • Drink 8 cups or more liquid daily

Food Cravings

• Do not reflect nutritional needs.

Breastfeeding

• Prolactin: for milk production
• Oxytocin: for let-down reflex

Breastfeeding Goals

• 6 months exclusively
• Up to 2 years partially

Breastfeeding Benefits

• Immunity against common childhood illnesses
• Higher intelligence infants
• Infants less prone to be overweight/obese.
• Infants less prone to diabetes
• Mothers less prone to breast and ovarian cancers
• Weight loss for mother

Lactation Nutrition

• First 6 months: +330 kcal/day
• Second 6 months: +400 kcal/day
• Drink ~13 cups of water

Sports Nutrition

• Benefits of Fitness:
  • Restful sleep
  • Enhanced body composition
  • Bone density improvement
  • Immunity
  • Better circulation
  • Better lung function
  • Lower risk of cardiovascular disease, some cancers, type 2 diabetes, and gallbladder disease
  • Mood improvement.
  • Longevity and quality of life.
• Physical Activity Processes:
  • During rest: ATP + creatine → creatine phosphate
  • During activity: Creatine phosphate → ATP + creatine
  • Fuel use depends on training status, diet, activity intensity/duration
• Diet and Endurance:
  • Fat and protein diet: 57 minutes
  • Normal mixed diet: 114 minutes
  • High-carbohydrate diet: 167 minutes
• Macronutrient Use in Exercise:
  • Glucose: first 20 minutes of moderate activity – more glycogen use
  • Fat: >20 minutes of moderate activity – more fat use, less glycogen use
  • Protein: Athletes use more protein for fuel (muscle building)

Protein Recommendations for Active People

• RDA for adults: 0.8 g/kg/day
• Power athletes (strength/speed): 1.2-1.7 g/kg/day
• Endurance athletes: 1.2-1.4 g/kg/day

Iron

• Oxygen transport
• "Sports anemia"
• Extra iron loss from physical activity
• Higher risk groups for iron deficiency anemia (IDA)

Calcium & Vitamin D

• Bone health
• Muscle contraction
• Stress fracture risk

Other

• B vitamins for creating energy from macronutrients.
• Antioxidants to help combat high intensity free radical levels.

Fluid Replacement via Hydration

• Athletes lose 1.5L+ per hour of physical activity.
• Hot weather slows water absorption.
• Athletes should hydrate days in advance.
• Drink plain and cool water.
• 2-3 cups 2-3 hours before activity.
• 1-2 cups 15 minutes before activity
• 0.5-1 cup for every 15 minutes during activity.
• 2 cups every 20-30 minutes post-exercise for every 0.5kg lost

Electrolyte Losses

• Training improves electrolyte retention
• Sweat causes loss of sodium, potassium, chloride, and magnesium.
• Caution on salt tablets.
• Regular diet is sufficient to replenish electrolytes.
• Hyponatremia: decreased blood sodium concentration (higher sweat loss, overhydration).
• Don't restrict salt before an event.

Sports Drinks

• Hypotonic: Quickly replenishes fluids lost during exercise, low carbohydrate content and lower salt/sugar content than body's natural concentration.
• Isotonic: Concentrations of salt and sugar similar to human body. Designed to replace fluids and boost carbohydrates quickly during exercise.
• Hypertonic: Carbohydrate content high and designed for intake during exercise to maximise energy absorption, best drunk after exercise, higher concentration of salt/sugar than body.

Enhanced Water

• Fortified with electrolytes, vitamins, minerals, natural/artificial flavors, botanicals and sweeteners to improve taste and nutritional profile.

Caffeine in Sports

• Quickly absorbed into bloodstream (peak levels after 30-120 minutes), levels remain elevated for 3-4 hours.
• Enhances body's ability to breakdown fat (lipolysis)
• May boost muscle functions by stimulating central nervous system.

Pre-Game Meals

• 4 hours before game: High in whole grains, lean protein, healthy fats (ex: grilled chicken, sweet potato, vegetables)
• 1 hour pre game: Snacks high in carbohydrates, avoid high protein or fat foods (ex: fruit, granola bar, pretzels)

Post-Game Meals

• Replenish glycogen stores and electrolytes.
• Eat 15-30 minutes after the game finishes (body most receptive to energy replacements)
• Meal should be high in carbohydrates, but include protein and fats.
• Calories needed depends on duration, body size, and energy expenditure.

Weight Bias

• Weight bias defined as negative weight-related attitudes, beliefs, and assumptions and judgements towards overweight or obese individuals.
• Weight bias extends to individuals of low body weight.

Weight Stigma

• Refers to social stereotypes and misconceptions about obesity. Suggests people with obesity are awkward, unintelligent, unsuccessful, and lack self-control.

Weight Discrimination

• Actions based on weight bias – verbal/emotional, physical barriers to daily life, denial of healthcare access.
• Consequences – limit to education, employment, medical access.

Causes of Weight Bias

• Many factors in education, workplace, personal relationships and media contributing to weight bias.
• Examples: bullying from peers/teachers, harsher workplace discipline and higher contract termination rates, negative media portrayal (underrepresentation, etc.), comments.
• Common beliefs include judgment based on appearance (lazy, unmotivated, undisciplined, lacking willpower)

Factors Contributing to Obesity

• Genetic factors: genes impact appetite, satiety, food cravings, and body fat distribution.
• Environmental & social factors: physical activity, food accessibility, and socioeconomic status.

Weight Bias Activity

• Instructions for completing a Harvard implicit association test about weight.

Activity Reflection

• Reflect on completing the weight bias test and the results.

Impact of Weight Bias on Health

• Physical consequences: Reduces confidence in losing weight, increased risk of health conditions (heart disease, diabetes).
• Psychological consequences: Increased risk of depression, anxiety, suicidal thoughts, and low self-esteem.

Weight Bias in Healthcare

• Patient perspective: Increased likelihood of cancelling appointments, avoiding preventative care, less likely to be up-to-date on procedures (pap smears, mammograms).
• Healthcare professional perspective: Strong negative attitudes/stereotypes towards obese people, impact on care provided, poor treatment/judgement.

Body Mass Index (BMI)

• BMI is a screening tool that measures the ratio of height to weight, estimating body fat.
• Doesn't consider muscle mass, bone density, individual consumption, racial/sexual differences.

BMI Ranges

• Underweight <18.5
• Healthy weight 18.5-24.9
• Overweight 25-29.9
• Class 1 Obesity 30-34.9
• Class 2 Obesity 35-39.9
• Class 3 Obesity >40

Calculating BMI

• BMI formula: kg/m²

Example: Calculating BMI

• Example calculation provided with weight (70 kg) and height (1.75 m)

Addressing and Reducing Weight Bias

• What can you do?: Use respectful language, speak up if witnessing teasing, educate others.
• What is being done in practice?: Provide education on the various causes of obesity (complex), increase empathy and understanding of different perspectives, change healthcare providers' ideas and beliefs about how to care for patients.

Weight-Inclusive Approach in Healthcare

• Recognize health outcomes aren't solely based on someone's body weight.
• Promote health without focusing on weight.
• Understand BMI is influenced by many things.

Case Study

• Sarah, a 35-year-old woman struggling with weight, saw her first doctor for knee pain—doctor dismissed her pain as weight-related.
• Later, she saw another doctor, who listened carefully to her, diagnosed the pain, and recommended therapy. The gap was how the first doctor gave her judgement and didn't perform patient-centred care.

Reflection Questions

• Identify examples of weight bias in the case study.
• Discuss how the doctor's assumptions impacted Sarah's care.
• Suggest how the doctor could have provided patient-centered, unbiased care.
• Discuss how a weight-inclusive approach might have changed the outcome for Sarah.

Summary

• Weight bias are negative attitudes, beliefs or stereotypes toward individuals based on body weight.
• Weight bias is widespread – prevalent in personal relationships and healthcare settings.
• Promote education about the complexities and causes of obesity.
• Empathy & understanding diff. perspectives on weight & health can reduce weight bias.

References

• Extensive list of references related to the listed information, mostly articles/websites (note: details of the references are excluded per the instructions).