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Textbook of Obesity

Unit One

QuestionAnswer
How is obesity defined in adults? Measurements of weight and height, and the use of these measures to calculate a value known as the body mass index, or BMI, to define obesity. BMI is calculated as the weight, expressed in kilograms, divided by the square of height
What is BMI and why is BMI valid for estimating obesity prevalence in a population? BMI is a ratio of weight to the square of height. Specifically, BMI is calculated as the weight, expressed in kilograms, divided by the square of height, expressed in meters.
How is obesity defined in children ages 2 to 20? For estimating obesity prevalence, the age- and sex-specific BMI percentile is used in children ages 2 to 20, and the 95th percentile or above is categorized as “obese”.
What is the estimated prevalence of obesity in adults (in approximately 2008)? The prevalence of obesity in U.S. adults is approximately 34% (“one out of three” adults is also an acceptable answer)
What is the estimated prevalence of obesity in children (in approximately 2008)? The prevalence of obesity in U.S. children is approximately 17% (17.1% or “one out of five” children is also an acceptable answer).
How is the prevalence of obesity in adults estimated in the United States? Obesity prevalence is estimated based on either self-reported data on height and weight as determined by national surverys
In most (but not all) minority populations in the United States, obesity prevalence is Higher than the national average
What is the single disease most closely associated (some argue it is causally connected) with obesity? Type 2 diabetes (insulin resistance is another acceptable answer).
List three other diseases associated with obesity. Cardiovascular Disease, Hypertension, Stroke, Certain Cancers, Osteoarthritis,Gallbladder Disease, Sleep Apnea/Obesity Hypoventilation Syndrome, Non-alcoholic Fatty Liver Disease, Metabolic Syndrome
From the broadest perspective, what causes obesity? Obesity is the result of a sustained imbalance between energy (or calorie) intake and energy (or calorie) expenditure but multiple factors contribute to this imbalance.
What characterizes a “comorbidity” of obesity? Obesity comorbidities are those disease conditions that develop or worsen as weight increases and that improve with weight loss.
Describe the prevalence and harmful effects of weight bias in Western society Prevalence rates of weight discrimination have been found to be as high as rates of racial discrimination, and among women, weight discrimination is higher than racial discrimination. The rates of weight discrimination increased 66% over the past decade.
Identify and use the main assessment tools of weight bias in adults and children weight bias is most often assessed using questionnaire methods. Several widely used questionnaires include subscales assessing dislike of obese people, character disparagement, or the extent to which obese people have different personalities.
Describe settings in which weight bias and discrimination occur and the major consequences to adults and children Negative attitudes towards overweight and obese adults occur in 1) employment, 2) health care, and 3) interpersonal settings.
Recognize gender and cultural differences in weight bias Research findings on gender differences in weight bias are mixed. Some studies have shown no differences in obesity stigma between males and females, particularly in children , but others have shown that girls dislike obese peers more than boys do.
Describe and use coping strategies that will enable them to assist people who experience weight bias Some individuals may cope with the negative emotional experiences of weight bias by turning to food. Several assertive coping strategies have been identified to respond to weight bias.
Explain causes of weight bias and describe the main approaches used to change bias Limited evidence suggests that parents may transmit negative beliefs about obese people to their children. The popular media may also contribute to the transmission of weight bias and stereotypes
Three bias-reduction strategies that have received attention in the literature are 1) methods to change attitudes by addressing attributions about the causes of obesity, 2) evoking empathy towards obese individuals, and 3) changing perceptions about the normative acceptability of weight-based stereotypes.
List three (3) major characteristics of a public health approach to a health problem. It devises population-wide strategies to prevent disease It relies on surveillance the collection of data to monitor and document t a public health problem.It focuses on prevention, rather than treatment, although for obesity.
provide four examples of major characteristics of a public health approach to a health problem Laws requiring seat belt use Vaccination programs to control infectious diseases. The establishment of rigorous safety standards for automobile construction Laws to prevent driving while under the influence of alcohol or drugs.
Smoking, drinking alcohol and eating are all behaviors that relate to health. From a public health standpoint, what is a crucial characteristic that distinguishes smoking and drinking of alcohol from eating? Smoking and drinking alcohol are optional behaviors whereas eating is not.
What is responsible for the majority (75%) of health care costs? How does this relate to obesity? The treatment of chronic diseases accounts for the majority (approximately 75%) of health care costs. Obesity contributes to most chronic diseases
Multiple factors contribute to chronic energy imbalance and obesity, thus a wide variety of strategies to promote reduced calorie intake, reduced sedentary behaviors and increased physical activity can be considered give 4 examples of health strategies Examples range from zoning for recreational greenspace, establishing zoning restrictions on the siting of fast food restaurants. Insuring that fresh fruit and vegetables are always available for snacks and meals at home, etc.
Five domains are considered relevant for the prevention of obesity. Name and briefly describe three of those five domains. The information environment. Access and opportunity. Economic factors.Legal and regulatory environment.Social environment
Identify five strategies that have contributed to successful public health initiatives and provide one example for each illustrating how that factor can be used to address obesity. Price and tax measures. b. Product labeling, including health or weight loss claims. Educational media campaigns.Curbs on marketing and advertising.Findings from clinical interventions.Product supply manipulation. Liability and corporate behavior.
Explain the issue of relapses in weight loss from the perspective of psychoanalytic theory the psychological approach focuses on the role the mind plays in obesity as a symptom of underlying psychic needs or conflicts.
Identify the various psychodynamic treatments in weight management. Whether it is an internal conflict based on sexual and aggressive drives, a problem in relationships, or compensation for a deficit, food, eating and weight may become symbols of underlying problems.
Describe how gender differences affect weight and self-esteem. Boys and girls have to separate from their mothers in order to gain independence and autonomy as they grow. For the boy child, the father, with whom he becomes identified, supports this differentiation from the mother.
Describe the prevalence of obesity in the US and globally. the heavy have gotten heavier, and a concomitant increase has occurred in an expanding list of co-morbidities, many of which were not previously reported in children. Globally, obesity affects nearly as many children as does under-nutrition.
Define overweight and obesity in children. the BMI percentile for age and sex is used in those 2 to 19 years old. A child with a BMI between the 85th and < 95th percentiles is classified as “overweight”; a child with a BMI at the 95th percentile or higher is “obese”.
Describe the main biological outcomes of obesity in children. Type 2 diabetes, acanthosis nigricans, metabolic syndrome, cardiovascular disease, polycystic ovary syndrome, nonalcoholic fatty liver disease (NAFLD), respiratory problems, orthopedic problems.
Explain the two main social outcomes of childhood obesity. childhood overweight often results in significant emotional difficulties; this includes bias and teasing.A high level of implicit anti-fat bias is observed among health professionals who treat obesity
Describe the two main cognitive and psychological outcomes of childhood obesity Childhood obesity is also linked directly to low academic performance in boys and to behavior problems in girls. An overweight child may be doing poorly in school owing to depression, difficulty learning of sleep apnea and emotional distress
What are 4 major diseases that are more common in the obese? Diabetes mellitus, cardiovascular disease, cancer, and stroke are major diseases associated with obesity. Hypertension and metabolic syndrome are also increased.
What are the characteristics that define the metabolic syndrome? large waist circumference, abnormal glucose metabolism with high fasting glucose or type-2 diabetes, high blood pressure, high blood triglycerides, low HDL-cholesterol. A variety of abnormalities of other blood components may also co-occur.
How can metabolic syndrome be managed? Weight loss, even if modest, can improve the condition; life-style changes to promote weight loss are used. These changes can include dieting, increasing exercise/physical activity, and behavior modification.
What are some of the beneficial health changes that occur when an obese person loses a modest amount of weight? Modest weight loss reduces progression to type 2 diabetes in those with impaired glucose tolerance, and lowers blood pressure. It also improves health in those with metabolic syndrome.
Although cancer risk is increased by obesity, some people have proposed that obesity itself may not be responsible. What would be an explanation for the association of cancer and obesity, if obesity was not causal? Some obese persons have low fruit and vegetable intake and are physically inactive. In addition, increased concentrations of blood glucose,insulin, the higher bioavailability of steroid sex hormones, chronic inflammation and oxidative stress,
7 Criteria for optimal health optimal cholesterol, Normal blood pressure, Not having diabetes, Lean BMI, Not being a smoker, Physical activity, and a Healthy diet.
Six Issues important to development of PH Approach to Preventing Obesity. Balance individual responsibility vs. collective action. Shape social norms. Consider other PH experiences. Consider marketing channels. collect evidence. Consider global dimensions.