Term
| Effects of weight loss counseling |
|
Definition
Intensive counseling: limited direct evidence for reduction in clinical events
-indirectly, counseling reduces risk factors and risk factor control lowers events
- sustainable weight loss is goal
-In person vs remote counseling = similar trajectories of weight loss |
|
|
Term
| What are the steps of clinical strategies we take to treat obesity? (think of the pyramid) |
|
Definition
| Brief advise, intensive counseling, obesity medications, bariatric surgery at the tip |
|
|
Term
| Strategies for weight loss counseling |
|
Definition
Control unrealistic expectations
Focus on identifiable health behaviors
Tailor information based on readiness to change
Let patients set their own priorities
Simple is better |
|
|
Term
| Key messages about weight loss |
|
Definition
-Prevent further weight gain first
-substantial short and long term benefits on health
-even if there isn't weight loss, improved diet and physical activity are beneficial
-setbacks are usual, think long term
-even modest weight loss can improve heart disease risk factors |
|
|
Term
|
Definition
-"alter" eating patterns, don't "diet"
-always okay to increase veggie intake
-don't avoid favorite foods entirely
-find enjoyable and healthy foods
-involve food preparer in discussion
-stress plant sources of protein and fat
-all "diets" cut out simple carbohydrates
-structured eating times work best
-change both quality and quantity |
|
|
Term
| Key messages about physical activity |
|
Definition
-multiple episodes per day is okay
-increase intensity and duration slowly
-make exercise an everyday routine
-ultimate target is 1 hour per day
-make part of daily, social routine
-low intensity exercise --> health benefits |
|
|
Term
| Guidelines for antiobesity drugs |
|
Definition
BMI >30 or >27 with comorbidity
-in conjunction with counseling
BUT: long history of side effects that offset weight loss benefits |
|
|
Term
| What are types of antiobesity drugs? Which drug is currently approved? |
|
Definition
Serotonin reuptake inhibitor (sibutramine)
Amphetamine- related appetite suppressant (Qnexa, ephedrine)
Lipase inhibitor - Orlistat (approved)
-drug enhanced counseling greater weight loss than counseling by itself |
|
|
Term
| Mechanisms of action for orlistat |
|
Definition
Orlistat
• Lipids just get excreted instead of digested
• Side effects: diarrhea, leakage |
|
|
Term
| Guidelines for surgery and cost |
|
Definition
BMI >40 or between 35 and 40 with disease, careful selection, used as a "last measure"
Cost: $18,000-$40,000 |
|
|
Term
| Mechanism of bariatric surgery (what does it do? |
|
Definition
reduce stomach reserve
induce malabsorption |
|
|
Term
| Enhanced counseling (drug + counseling) |
|
Definition
Enhanced – drug + packaged food
-Lost the most weight but still have some weight gain back |
|
|
Term
| Comparison of effectiveness of counseling vs medication vs bariatric surgery. |
|
Definition
Counseling requires skill and commitment.
Medications are moderately effective but poor track record regarding complications.
Surgery is costly but effective |
|
|
Term
| Types of observational studies? |
|
Definition
Ecological studies (good to look at environmental exposure)
Cross sectional studies
Cohort studies (good to follow group to see causality)
Case control studies |
|
|
Term
| Types of experimental studies? |
|
Definition
Intervention trials
Clinical trials
Randomized trials |
|
|
Term
| What is the difference between observational and experimental studies? |
|
Definition
Observation - external validity, can look at associations, and broad populations
Experiments - internal validity, can control variables to determine causality |
|
|
Term
| Internal vs external validity |
|
Definition
Internal: can control variables
requires proper selection of study groups and lack of error in measurement
External: mirror real life
ability to repeat the experiment, extrapolate from sample population to target population |
|
|
Term
| Randomized controlled trial and advantages/disadvantages |
|
Definition
Randomly assign individuals to a treatment
Considered ideal design to evaluate effectiveness and side effects of new treatments
Advantages: strongest evidence of causality, selection and confounding bias removed
Disadvantages: not "real life", high cost, unethical in some cases, poor compliance |
|
|
Term
| What are the positives of randomization? |
|
Definition
Decreases selection bias
Equalizes differences between groups (takes out variables)
Removes investigator bias in allocation of participants |
|
|
Term
| When does error occur? Who gives error? |
|
Definition
1) in selecting the study sample
2) in measuring exposure and outcome
3) interpreting relationship between exposure and outcome
Study observer/investigator; study participant; study instrument |
|
|
Term
| What are the types of error? |
|
Definition
-random error: random fluctuations around a true value
(because of sampling variability, poor precision, measuring error)
-systematic error: reflects deviation of results from truth (something wrong in process leading to the deviation) |
|
|
Term
| What are the 2 main categories of bias that can lead to nonrandom error? |
|
Definition
-selection bias: related to how subjects get in (or stay in) the study
-information bias: related to how information is collected once subjects are in the study (i.e. if you have interviewers who are not blinded, they may affect what information is receive) |
|
|
Term
| What is the difference between precision and accuracy? |
|
Definition
Precision = reliability (same value when measured several times)
Accuracy = validity (the variable represents what it's actually supposed to do |
|
|
Term
| How to reduce random error in sampling variability |
|
Definition
Use population base to draw sample
Aim for high response rates
Include a large study group
Assess intended sample with actual sample |
|
|
Term
| How to reduce random error in measurement |
|
Definition
Standardize collection of measurements
Train, certify, and monitor observers
Test and refine instrument
Collect repeat measures |
|
|
Term
| How to reduce selection bias |
|
Definition
Repeated attempts to enroll and follow everyone
Provide incentives
Collect data on non-respondents
Same strategies as for sampling variability |
|
|
Term
| How to reduce information bias |
|
Definition
Make unobtrusive measures
Blind participant and observer
Calibrate instruments
Same strategies as for measurement error |
|
|
Term
| What is behavior therapy? |
|
Definition
Psychological therapies to overcome barriers to compliance to dietary and physical activity therapy
things like self-management, contingency contracting, stress management |
|
|
Term
|
Definition
Eating and physical activity.
Usually things like a food/exercise diary |
|
|
Term
| Stress management and stimulus control |
|
Definition
Stress: learning coping strategies like meditation and relaxation
Stimulus: reduce the amount of exposure to bad conditions |
|
|
Term
| Problem solving and contingency management |
|
Definition
Taking an active role in self-management
Contingency: use of rewards for specific actions, such as increasing time spent walking or reducing consumption of specific foods |
|
|
Term
| Study of obesity and friend groups (Framingham study) |
|
Definition
| More likely to be obese if you have an obese friend |
|
|
Term
| Cost of chronic diseases in the US |
|
Definition
HUGGEE. From 18-53 million dollars for each chronic condition.
Bariatric surgery is a possible option because it is expensive but investment to produce costs from living with chronic condition. |
|
|
Term
| Types of bariatric surgery |
|
Definition
Gastric bypass
Lap-band
Roux-en-y gastric bypass
Sleeve gastrectomy
Stomaphyx |
|
|
Term
| Does bariatric surgery affect alcohol metabolism? |
|
Definition
|
|
Term
| Is gastric bypass a better option than prevention? |
|
Definition
Prevention is really important but it takes time to change and there are people that are sick now
Gastric bypass is good for the 1% of population that are morbidly obese and are not successful at traditional lifestyle modification interventions |
|
|
Term
| The halo effect of bariatric surgery |
|
Definition
| Produces improved outcome for other family members |
|
|
Term
|
Definition
| Put belt around stomach that can be slightly adjusted |
|
|
Term
|
Definition
| Makes stomach from size of football to size of banana (takes our portion of stomach that secretes ghrelin) |
|
|
Term
|
Definition
| Bypass most of stomach (necessary to take vitamins everyday) |
|
|
