STATE OF SHOCK AND INJURY: A release of the catecholamine epinephrine suppresses response to insulin.
Basal metabolic rate increases 7% for every degree rise in fever.
OBESITY: Obesity starts at a BMI of 30kg/m^2 (3 classes of obesity. BMI of 40kg/m^2 or > is Class III obesity). There are 3,500 calories per pound of body fat, so start with a deficit of 500cal/day for weight loss of 1 pound per week.
Initial rapid weight loss is water weight, due to glycogen stores pulled out from the liver (for every gram of carbohydrate stored, 3g of H2O are stored w/it)
You cannot spot lose fat. Plateau (can't continue to lose weight) occurs because BMR has dropped in order to match loss of weight.
DEFICIENCIES: stomatitis due to riboflavin (B2) deficiency
PREGNANCY: Pregnancy-induced hypertension begins at 20th week. But sodium restriction NOT recommended as the intervention.
TUBE FEEDS: Deadly to feed into an ileus. Elemental formulas = more expensive.
4-hour hang time for open systems (concern for pathogenic activity/growth). 24-48 hours for closed systems.
Nasogastric tube for short-term enteral access (for those with NORMAL GI function who require nutrition support for 3-4 weeks). Bolus, intermittent, or continuous infusions.
Naso-duodenal OR naso-jejunal feeds for those unable to tolerate gastric tube feed (recall it is best to do gastric if possible to mimic body's natural eating functions).
Give 1cc of H2O per calorie ingested. Formulas that are 1 calorie per cc are 80-86% water.
Peripheral parenteral nutrition (AKA total parenteral nutrition/TPN -- LAST resort due to the fact that it is like foie gras to the body, with implications of liver issues developing) is via small surface veins, which is short-term nutrition support. Includes protein and fat (a 10% solution of intravenous fat provides 1.1 calories per cc. A 20% solution provides 2.0 calories per cc. Think about propofol, delivered in a fat medium).
Solutions have dextrose, which provides 3.4 cal/g.
# of calories from a volume of dextrose = mL provided × % dextrose × 3.4
PPN/TPN is used to achieve anabolism when patients cannot eat by mouth and you cannot do an enteral tube feed.
Long-term central access occurs via cephalic, subclavian, or internal jugular vein and feed ls into superior vena cava.
PPN/TPN concerns: Bacterial translocation because you are bypassing the gut, which would normally kill bacteria that is ingested per os. Bacteria can travel through bloodstream and lead to SEPSIS.
In TPN, protein is provided for anabolism at 1g of nitrogen for every 150 calories ingested. The percent concentration tells you # of grams of protein per in 100mL of TPN solution (a 3% solution provides 3g of protein in 100mL of TPN solution).
Glucose infusion rate for dextrose in TPN should not exceed 4-5mg/kg/min for hyperglycemia prevention.
Fat is added to prevent essential fatty acid deficiency.
Begin tapering TPN for EN slowly, when enteral feeds provide 1/3 to 1/2 of nutrient requirements. When 60% of needs can be tolerated enterally, discontinue TPN.
BEWARE OF REFEEDING SYNDROME (starved cells take up nutrients, shifting K+, phos, and magnesium into the cell, causing HYPOKALEMIA, HYPOPHOSPHATEMIA, and HYPOMAGNESEMIA).
Overfeeding dextrose can lead to hyperglycemia
Dietary Reference Intake (DRI) reflects current population needs.
Recommended Dietary Allowance (RDA) is goals for healthy individuals.
Estimated Average Requiremenr (EAR) assesses group nutritional adequacy.
Upper Limit (UL) offers guidance on safe upper limits for nutrients such as vitamins.
Dietary Guidelines made to prevent chronic disease. DG written by USDA and HHS. Community nutrition programs use Dietary Guidelines to develop their plans (variety in eating, nutrient density, serving sizes, limit calories from saturated fats and added sugars, reduce sodium intake.
Healthy Eating Index (by USDA) is a measure of overall diet quality. Measures how well we follow the recommendations.
My Plate (USDA) shows essential food groups. Recommendations: balancing calories, foods to increase in the diet, foods to reduce.
Healthy People Program (HHS) identifies broad goals and specific objectives for improving health of the public. Focuses on disease prevention by changing behaviours.
The three steps in planning programs:
1) Mission Statement - describes the philosophy of the program. Need/Problem Statement describes the current situation, who says it's a problem, and what will occur if nothing is done.
2) Goals - goals are statements of broad direction and general purpose. Determine which health problems have nutritional implications. Determine what the high risk groups are. Determine what the most critical needs are.
3) Objectives - must be measurable. Objectives are more specific and defined than goals. Include specific target dates for completing specific projects. Evaluate alternative strategies available using cost effectiveness analysis.
Budget controls and coordinates activities. Indicates how and at what rate money should be expended.
Public health departments derive a portion of their income from general revenue taxes. Federal, local, and foundation grants are other sources of income.
Intervention via community nutrition programs relates to the 3 domains of learning: Cognitive, Affective, and Psychomotor.
Enabling makes it easier for people to act. Use the 4 Ps of marketing: Product, Price, Place, Promotion.
A strategy which involves psychomotor learning is helping people develop the skills needed to make and sustain new habits (e.g. how to budget, how to find the services they need.
Monitoring and Evaluation = the 4th step in the Nutrition Care Process (NCP)
Nutrition care outcomes represent results that the practitioner and nutrition care impacted individually. They can be linked to nutrition intervention goals. They're measurable and occur in a reasonable time period. They are attributed to the nutrition care provided. They're logical stepping stones to other health care outcomes.
Nutrition care outcomes are distinct from other health care outcomes b/c they represent the nutrition practitioner's specific contribution to care. They are grouped into 4 categories:
1) Food and Nutrition Related History
2) Lab Data and Medical Tests
3) Anthropometrics
4) Nutrition-Focused Physical Findings
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they have a point though. you wouldn't need everyone to accommodate you if you just lost weight, but you're too lazy to stick to a healthy diet and exercise. it's that simple. I'd like to see you back up your claims, but you have no proof. you have got to stop lying to yourselves and face the facts
Must I go through this again? Fine. FINE. You guys are working my nerves today. You want to talk about facing the facts? Let's face the fucking facts.
In 2022, the US market cap of the weight loss industry was $75 billion [1, 3]. In 2021, the global market cap of the weight loss industry was estimated at $224.27 billion [2].
In 2020, the market shrunk by about 25%, but rebounded and then some since then [1, 3] By 2030, the global weight loss industry is expected to be valued at $405.4 billion [2]. If diets really worked, this industry would fall overnight.
1. LaRosa, J. March 10, 2022. "U.S. Weight Loss Market Shrinks by 25% in 2020 with Pandemic, but Rebounds in 2021." Market Research Blog.
2. Staff. February 09, 2023. "[Latest] Global Weight Loss and Weight Management Market Size/Share Worth." Facts and Factors Research.
3. LaRosa, J. March 27, 2023. "U.S. Weight Loss Market Partially Recovers from the Pandemic." Market Research Blog.
Over 50 years of research conclusively demonstrates that virtually everyone who intentionally loses weight by manipulating their eating and exercise habits will regain the weight they lost within 3-5 years. And 75% will actually regain more weight than they lost [4].
4. Mann, T., Tomiyama, A.J., Westling, E., Lew, A.M., Samuels, B., Chatman, J. (2007). "Medicare’s Search For Effective Obesity Treatments: Diets Are Not The Answer." The American Psychologist, 62, 220-233. U.S. National Library of Medicine, Apr. 2007.
The annual odds of a fat person attaining a so-called “normal” weight and maintaining that for 5 years is approximately 1 in 1000 [5].
5. Fildes, A., Charlton, J., Rudisill, C., Littlejohns, P., Prevost, A.T., & Gulliford, M.C. (2015). “Probability of an Obese Person Attaining Normal Body Weight: Cohort Study Using Electronic Health Records.” American Journal of Public Health, July 16, 2015: e1–e6.
Doctors became so desperate that they resorted to amputating parts of the digestive tract (bariatric surgery) in the hopes that it might finally result in long-term weight-loss. Except that doesn’t work either. [6] And it turns out it causes death [7], addiction [8], malnutrition [9], and suicide [7].
6. Magro, Daniéla Oliviera, et al. “Long-Term Weight Regain after Gastric Bypass: A 5-Year Prospective Study - Obesity Surgery.” SpringerLink, 8 Apr. 2008.
7. Omalu, Bennet I, et al. “Death Rates and Causes of Death After Bariatric Surgery for Pennsylvania Residents, 1995 to 2004.” Jama Network, 1 Oct. 2007.
8. King, Wendy C., et al. “Prevalence of Alcohol Use Disorders Before and After Bariatric Surgery.” Jama Network, 20 June 2012.
9. Gletsu-Miller, Nana, and Breanne N. Wright. “Mineral Malnutrition Following Bariatric Surgery.” Advances In Nutrition: An International Review Journal, Sept. 2013.
Evidence suggests that repeatedly losing and gaining weight is linked to cardiovascular disease, stroke, diabetes and altered immune function [10].
10. Tomiyama, A Janet, et al. “Long‐term Effects of Dieting: Is Weight Loss Related to Health?” Social and Personality Psychology Compass, 6 July 2017.
Prescribed weight loss is the leading predictor of eating disorders [11].
11. Patton, GC, et al. “Onset of Adolescent Eating Disorders: Population Based Cohort Study over 3 Years.” BMJ (Clinical Research Ed.), 20 Mar. 1999.
The idea that “obesity” is unhealthy and can cause or exacerbate illnesses is a biased misrepresentation of the scientific literature that is informed more by bigotry than credible science [12].
12. Medvedyuk, Stella, et al. “Ideology, Obesity and the Social Determinants of Health: A Critical Analysis of the Obesity and Health Relationship” Taylor & Francis Online, 7 June 2017.
“Obesity” has no proven causative role in the onset of any chronic condition [13, 14] and its appearance may be a protective response to the onset of numerous chronic conditions generated from currently unknown causes [15, 16, 17, 18].
13. Kahn, BB, and JS Flier. “Obesity and Insulin Resistance.” The Journal of Clinical Investigation, Aug. 2000.
14. Cofield, Stacey S, et al. “Use of Causal Language in Observational Studies of Obesity and Nutrition.” Obesity Facts, 3 Dec. 2010.
15. Lavie, Carl J, et al. “Obesity and Cardiovascular Disease: Risk Factor, Paradox, and Impact of Weight Loss.” Journal of the American College of Cardiology, 26 May 2009.
16. Uretsky, Seth, et al. “Obesity Paradox in Patients with Hypertension and Coronary Artery Disease.” The American Journal of Medicine, Oct. 2007.
17. Mullen, John T, et al. “The Obesity Paradox: Body Mass Index and Outcomes in Patients Undergoing Nonbariatric General Surgery.” Annals of Surgery, July 2005. 18. Tseng, Chin-Hsiao. “Obesity Paradox: Differential Effects on Cancer and Noncancer Mortality in Patients with Type 2 Diabetes Mellitus.” Atherosclerosis, Jan. 2013.
Fatness was associated with only 1/3 the associated deaths that previous research estimated and being “overweight” conferred no increased risk at all, and may even be a protective factor against all-causes mortality relative to lower weight categories [19].
19. Flegal, Katherine M. “The Obesity Wars and the Education of a Researcher: A Personal Account.” Progress in Cardiovascular Diseases, 15 June 2021.
Studies have observed that about 30% of so-called “normal weight” people are “unhealthy” whereas about 50% of so-called “overweight” people are “healthy”. Thus, using the BMI as an indicator of health results in the misclassification of some 75 million people in the United States alone [20].
20. Rey-López, JP, et al. “The Prevalence of Metabolically Healthy Obesity: A Systematic Review and Critical Evaluation of the Definitions Used.” Obesity Reviews : An Official Journal of the International Association for the Study of Obesity, 15 Oct. 2014.
While epidemiologists use BMI to calculate national obesity rates (nearly 35% for adults and 18% for kids), the distinctions can be arbitrary. In 1998, the National Institutes of Health lowered the overweight threshold from 27.8 to 25—branding roughly 29 million Americans as fat overnight—to match international guidelines. But critics noted that those guidelines were drafted in part by the International Obesity Task Force, whose two principal funders were companies making weight loss drugs [21].
21. Butler, Kiera. “Why BMI Is a Big Fat Scam.” Mother Jones, 25 Aug. 2014.
Body size is largely determined by genetics [22].
22. Wardle, J. Carnell, C. Haworth, R. Plomin. “Evidence for a strong genetic influence on childhood adiposity despite the force of the obesogenic environment” American Journal of Clinical Nutrition Vol. 87, No. 2, Pages 398-404, February 2008.
Healthy lifestyle habits are associated with a significant decrease in mortality regardless of baseline body mass index [23].
23. Matheson, Eric M, et al. “Healthy Lifestyle Habits and Mortality in Overweight and Obese Individuals.” Journal of the American Board of Family Medicine : JABFM, U.S. National Library of Medicine, 25 Feb. 2012.
Weight stigma itself is deadly. Research shows that weight-based discrimination increases risk of death by 60% [24].
24. Sutin, Angela R., et al. “Weight Discrimination and Risk of Mortality .” Association for Psychological Science, 25 Sept. 2015.
Fat stigma in the medical establishment [25] and society at large arguably [26] kills more fat people than fat does [27, 28, 29].
25. Puhl, Rebecca, and Kelly D. Bronwell. “Bias, Discrimination, and Obesity.” Obesity Research, 6 Sept. 2012.
26. Engber, Daniel. “Glutton Intolerance: What If a War on Obesity Only Makes the Problem Worse?” Slate, 5 Oct. 2009.
27. Teachman, B. A., Gapinski, K. D., Brownell, K. D., Rawlins, M., & Jeyaram, S. (2003). Demonstrations of implicit anti-fat bias: The impact of providing causal information and evoking empathy. Health Psychology, 22(1), 68–78.
28. Chastain, Ragen. “So My Doctor Tried to Kill Me.” Dances With Fat, 15 Dec. 2009. 29. Sutin, Angelina R, Yannick Stephan, and Antonio Terraciano. “Weight Discrimination and Risk of Mortality.” Psychological Science, 26 Nov. 2015.
There's my "proof." Where is yours?
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