Epidemiology/
Definition
Definition
What is the age range for using BMI on children?
2 - 18 years old
What are some of the diets that has no scientific evidence?
Low-carb ketogenic and Atkins diet
Low-carb paleo
Detox/ cleanse
Body type - blood type, somatotyping, DNA
Supplements - Diet pills, diuretics, HCG injections
Low-fat - Pritikin programme, dash diet
Health risks associated with obesity shows us a need to consider health promotion in a holistic way. What are some of the factors you need to consider?
Healthy literacy
Culture
Political
Economic
Society
Emotional
Obesity is a complex multifactorial issue, what are the two factors involved and give an example for each?
Proximate: causal factors; the way an individual behaves in their lifetime (lifestyle)
Evolutionary: factors influencing survival; [are heritable traits] (genetics)
BUT, life style can override those genetics
What is the only drug that is available in the UK for the management of obesity?
Orlistat
In England, what was the prevalence of obesity in Reception children between 2018-2019?
9.7%
10.0%
20.2%
22.5%
Reception = 9.7, Year 6 = 6 20.2%
Give some examples of long-term effect of obesity:
Hypertension, arteriosclerosis and heart disease
Diabetes mellitus
Venous stasis disease and venous ulcers
Stroke
Osteoarthritis
Pulmonary conditions like chronic obstructive pulmonary disease (COPD)
Sleep disorders like sleep apnea
Digestive disorders like gastro-esophageal reflux disease (GERD)
Gall bladder disorders
Nonalcoholic steatohepatitis, or nonalcoholic fatty liver disease
Incontinence
Cancer, particularly of the colon, kidneys, gall bladder, breast and uterus
Depression
Social isolation and discrimination
10 to 15-year decrease in lifespan
What are some of the psychological and health related consequences of obesity stigmatisation?
increased depression
anxiety
decreased self-esteem
It can also lead to disordered eating
avoidance of physical activity
avoidance of medical care
Obesity stigma hits children especially hard:
Studies indicate that school-aged children with obesity experience a 63% higher chance of being bullied. When children and youth are bullied or victimized because of their weight by peers, family and friends, it can trigger feelings of shame and lead to depression, low self-esteem, poor body image and even suicide.
Weight-biased attitudes from teachers can involve lower expectations from students, which can lead to low education outcomes for children and youth with obesity.
How does thrifty genotype work?
Prevents muscle breakdown.
Brain needs glucose, and when dietary glucose is absent and glucose and glycogen reserves are depleted, muscle proteins are broken down.
If other organs minimized their glucose consumption, protein breakdown would not occur as soon into starvation. [means you can survive a bit longer in difficult environment]
Insulin resistance facilitates this: it makes muscles and other organs reject insulin [therefore more glucose is available for brain and the brain does not need insulin to absorb glucose).
Insulin resistance combined with a predisposition for fat deposition [i.e. more stored fat on the body] could aid survival [in feast/ famine environment]
In famine part, you will have more bodily reserves to draw upon and you will also be slightly insulin resistance which means your organs and muscle are minimising their glucose consumption to allow the brain enough glucose to survive, helping you to survive for a longer period of time without food
When is the only drug available in the UK prescribed to children?
The use of this drug in children is only recommended in exceptional circumstances, such as if a child is severely obese and has an obesity-related complication.
Is obesity rates higher in boys or girls when:
A) They are in Reception
B) They are in Year 6
10.0% of boys in reception were obese compared to 9.4% of girls
22.5% of boys in year 6 were obese compared to 17.8% of girls
Give some examples of short-term effect of obesity
Shortness of breath during easy or routine activities
High cholesterol
High blood pressure
Prediabetes—blood glucose levels are elevated but not yet to diabetic levels
Joint pain and inflammation, especially in the knees
Aches, headaches, vague pains and physical discomfort
Indigestion and digestive problems
Infertility and complications during pregnancy like gestational diabetes and blood clots
Restricted mobility
Fatigue
Psychological distress
Physical incompatibility with surroundings
What are some of the ways people respond to stigmatisation?
To disclose information about stigma is to disclose a potentially damaging aspect of one’s identity – may lead to discrimination
Passing:
Passing oneself off without acknowledging symptoms (e.g. being ‘normal’).
Can still experience ‘felt stigma’, feel inferior, as hiding a discreditable part of their character from the world outside.
May involve a high psychological cost – stress to pretending to be something one is not – risk of being found out.
Covering:
Avoiding situations, reducing visibility
‘Covering’ involves not disclosing for example - a blind person wearing sunglasses, using cream to hide eczema.
Withdrawal from social life:
Acknowledging condition/symptoms but withdrawing from generally expected social interactions and relationships into a social world where others have similar or related symptoms.
This can come with a high psychological cost of stress and depression
Resisting: Contesting the stigma-related outcomes
What is one evidence for and against thrifty genotype?
Evidence for:
Twin and family studies demonstrate a genetic component to type II diabetes.
‘Modernized’ Pima in Arizona have higher rates of Type II diabetes [than those living a more sedentary urbanised lifestyle
Mt16189: associated with low body mass at birth, insulin resistance and diabetes. Found in 10% of the British population and nearly 100% in some populations of Pacific Islanders.
Haplotype combination 112/121 and its variants within the calpain 10 gene are associated with increased risk of type II diabetes in Mexican-Americans. But the ‘at risk’ combinations are at low frequency in the population.
Bottom line: very little hard genomic evidence at present.
Evidence against:
Very difficult to test the hypothesis: many explanations are post hoc. [i.e. they are after the fact. Already happened]
Traits that run in families may be environmental, not just genetic (see thrifty phenotype). [family tend to experience the same sort of environment, diet and exercise levels etc]
Would expect greater insulin resistance in colder climates [longer winters with not much food available] – actually highest incidence of type II diabetes in tropical populations, lowest in colder habitats (opposite to type I diabetes).
Improvements to diet and increasing physical activity is recommended for children. What is the recommendation of physical activity for children over 5?
Children over the age of 5 should ideally get at least 60 minutes of vigorous-intensity exercise a day, such as running or playing football or netball.
What are the four things children's BMI takes into account?
Age
Gender
Height
Weight
Adults BMI only take into consideration height and weight
What advice is included in the 'best diet'?
Eat a sensible amount of calories [intake a suitable amount of energy for the amount of energy you expend – energy balance]
Eat plenty of food rich in starch and fibre [complex carbohydrate here]
Eat a variety of foods [will cover the different micronutrients, essential AA, essential FAs you need]
Eat plenty of fruit and vegetables [variety of fruit and vegetables] [micronutrients here]
Health promotion ecosystem can be broken down into these three interrelated units:
Individual - Society - Government
Give an example of how each of these categories can reduce obesity
Individual: Health literacy, Food literacy, Financial support
Society: Community eating, Local restaurants, School dinners
Government: Taxation, Legislation, Availability, Advertising
Food literacy - there are people who probably don’t know how to eat healthily
Socioeconomic factor - well documented that, eating healthily is more expensive than eating unhealthily
School dinners - we should probably be starting young and school dinners have got quite a lot of attention in terms of healthy eating, where childhood obesity being of particular concern. Evidence shows that children that leave childhood overweight are likely to remain overweight for the rest of their lives
Taxation - how can you encourage healthy eating through taxation? Is the notion of a tax on unhealthy foods or on sugar, are they achievable?
How can the government control the availability of foods, the advertising of unhealthy foods?
Apart from thrifty genotype, what is another genetic theory?
Not due to positive selection, but due to genetic drift
As we have increased abilities to deal with these kind of conditions and people can survive longer with these kind of conditions, then maybe the selective pressures are much less and therefore we are just seeing a wider range of obese (and hence type 2 diabetic) people in the population
When is bariatric surgery considered for children?
NHS:
Bariatric surgery isn't generally recommended for children, but may be considered for young people in exceptional circumstances, and if they've achieved, or nearly achieved, physiological maturity.
US:
Children are eligible for surgery if their body mass index (BMI) is 40 or higher, or at least 35 if they have comorbidities such as fatty liver disease and diabetes.
What is the full classification of children BMI?
underweight – on the 2nd centile or below
healthy weight – between the 2nd and 91st centiles
overweight – 91st centile or above
very overweight – 98th centile or above
In crash diet, why do you lose a significant amount of weight in the first week?
Glycogen is used up first
Glycogen features water molecules (about 2kg) conjugated to each glucose residue in the chain
Hence we lose that in the first week
Health promotion ecosystem can be broken down into these three interrelated units.
Individual - Society - Government
Give an example of barriers that each of these unit can face when trying to reduce obesity
Individual - Unhealthy food is tasty, Hard to reach groups, Happy versus healthy life, Desensitisation
Society - Cultural norms, Societal normalisation - clothes sizes, Victimisation
Government - Nanny state, Difficult to enact, Unpopular, Food lobby
Hard to reach groups: association particularly with social deprivation, both in terms of education and the financial ability to afford to eat healthily
Happy vs healthy life: philosophical issues about whether we should be pursuing a happy life or a healthy life
Desensitisation: perhaps reflected in the media with the obsession with the obesity epidemic and a backlash of representation in terms of different views of body image
Cultural norms: different groups of people have different ideas about what normal body image is and this may not always be connected with a healthy lifestyle
Societal normalisation: normalisation of increasing body size. The size of clothes have gradually increased over time.
Victimisation: closely related to desensitisation in terms of victimisation really not having the desired outcome, driving people away from health promotion rather than bringing people into it
Nanny state: even more prominent here than it is with smoking. Given the close association between food and enjoyment. Are government sensitive to accusations of being part of a nanny state i.e. concerned that they will be seen as nannying their people. People generally do not like being told what to do.
Difficult to enact: legislation to encourage healthy living in the context of obesity is particularly difficult to enact because of difficulties for example around picking apart taxation
Food lobby remains powerful politically
A) Mutations in the LEP gene causes congenital leptin deficiency therefore, mutations in the what genes can cause leptin receptor deficiency?
B) What happens in both of these conditions?
A)
LEPR gene
B)
Leptin is a hormone that inhibits hunger. Constantly hungry and quickly gain weight. Without treatment, the extreme hunger continues and leads to chronic excessive eating (hyperphagia) and obesity.
Lack the receptors for leptin so you are constantly hungry and gain weight quickly leading to hyperphagia and obesity.
What are some strategies you can use alongside diet and lifestyle changes to reduce obesity?
Evidence has shown that weight loss can be more successful if it involves other strategies, alongside diet and lifestyle changes. This could include things like:
Setting realistic weight loss goals – if you're obese, losing just 3% of your original body weight can significantly reduce your risk of developing obesity-related complications
Eating more slowly and being mindful of what and when you're eating – for example, not being distracted by watching TV
Avoiding situations where you know you may be tempted to overeat
Involving your family and friends with your weight loss efforts – they can help to motivate you
Monitoring your progress – for example, weigh yourself regularly and make a note of your weight in a diary
Getting psychological support from a trained healthcare professional may also help you change the way you think about food and eating. Techniques such as cognitive behavioural therapy (CBT) can be useful.