Quiz 1
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The document contains a quiz with 9 true/false questions about facts related to obesity, physical activity, nutrition, and weight management. Each question is followed by an explanation of the answer. Some key facts covered include: obesity is a chronic disease similar to diabetes; muscle weighs the same as fat despite taking up less space; physical activity provides health benefits regardless of weight loss; and regular weighing can be a sign of an eating disorder rather than a cause. The document encourages discussion of challenges to health promotion in the areas of nutrition, physical activity, and obesity.
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Quiz 1
- 1. Time for a quiz!
- 2. Fact or fiction …? True or false …?
- 3. 1. Obesity is a chronic disease much like diabetes or high blood pressure.
- 4. 1. True – obesity is a chronic disease that requires long-term management. Managing excess body weight (obesity) is similar to managing high blood pressure or diabetes – left unmanaged, these conditions get worse, and when treatments stop, the problem comes back. This is why weight management strategies have to be realistic and sustainable. Short-term “quick fix” solutions are not sustainable, which is why weight usually comes back.
- 5. 2. Muscle weighs more than fat.
- 6. 2. False – a kilogram is a kilogram! • A kg is a kg regardless of whether the kg is fat or muscle. Converting a kg of fat to a kg of muscle – or vice versa – will not alter weight. Muscle is slightly denser than fat and takes up a smaller amount of space in the body.
- 7. 3. Weight loss is the most important goal of fitness and exercise.
- 8. 3. False – many benefits arise from PA independently of weight loss. • The widespread health benefits from improved fitness will accrue even if weight does not change. These include reduced risk of cardiovascular disease, type 2 diabetes, and breast and colon cancer, and often an improvement in mental well-being. • Weight loss can be an important benefit from a fitness regime but is only likely if accompanied by a degree of calorie restriction.
- 9. 4. Older adults are least likely to benefit from physical activity.
- 10. 4. False – regular physical activity can benefit everyone. • Nobody is too old to enjoy the benefits of regular PA, although when recommending activities you should bear in mind a person’s abilities, interests and limitations. • The health benefits gained by an elderly person may differ from the benefits noticed by a young person because their health needs and priorities are likely to be different. • PA is a crucial measure to prevent frailty and sarcopenia in the elderly.
- 11. 5. Active people need extra protein or protein supplements to build muscles.
- 12. 5. False – muscles develop from training and exercise. • A person’s muscle make-up reflects their muscle usage rather than their protein intake. • Additional protein that is consumed over normal functional requirements is converted to energy for storage – it is not stored as additional muscle. • Although protein supplementation is not needed to build muscle mass, it is proven to enhance muscle hypertrophy.
- 13. 6. Energy drinks are an important way to achieve improved sporting performance in children.
- 14. 6. False – water is the best way to rehydrate the body after exercise. • The body is better able to regulate energy intake from solid foods than from sugary drinks, which have been strongly linked to obesity and tooth decay.
- 15. 7. Regular daily weighing (self- monitoring) is a cause of anorexia nervosa.
- 16. 7. False – regular weighing (self-monitoring) is an important predictor of weight stability. • Anorexia nervosa is a complex psychiatric disorder relating to a combination of factors such as body image disorder, low self- esteem and some environmental factors. • In the case of a child or young person, reports of frequent self-weighing should trigger further exploration of body image dissatisfaction and/or eating disorder, as weighing may be a symptom – rather than a cause – of an eating disorder.
- 17. 8. Making a child clear the plate is a good way to ensure the vegetables get eaten.
- 18. 8. False – “clearing the plate” is an outdated concept. • Forcing food is more likely to generate a strong dislike of that food and lead to mealtime battles. “Generating a liking” for a food stems from positive associations and seeing other people enjoy that food. • Eating to please others teaches children to ignore their own hunger signals.
- 19. 9. If a person with overweight or obesity gets breathless when exercising, they should stop.
- 20. 9. False – building up fitness and stamina takes effort and time. • For someone not used to exercising, it is important to have reassurance that feeling breathless and minor aches and pains are a normal part of building up stamina. • Recommend a gradual programme of increasing duration and intensity of activity as stamina and confidence increase. • However, be careful with children known to have respiratory diseases such as asthma.
- 21. Review of current local tools and practice Understanding nutrition, physical activity and obesity in your country • Why discuss • How to influence • What to explain • Which goals and how to measure • Where to get help
- 22. Questions to participants – open discussion • What are the particular challenges facing health systems in the region? • What common barriers to health promotion and behaviour change have you identified in the area of nutrition, physical activity and obesity? • What are the common challenges experienced by your patients in changing behaviour? • In which settings and types of consultation would these issues be raised?
- 23. Understanding the local context for you personally • What are the key factors? • Which patients are the most engaged? • What are the barriers and enablers for integrating lifestyle counselling in your practice? • Do you have adequate tools? • Are you able to signpost your patients to suitable help?
- 24. Group discussion summary: addressing barriers Provider barriers (e.g. education, competencies, roles, professional identity) Patient barriers (e.g. obesity and weight bias impact on self- esteem, gender roles affecting physical activity) Structural barriers (e.g. obesogenic environment, physical inactivity not high priority for political or health system agenda) Enablers Blockers Opportunities
Notas do Editor
- Speaker notes The aim of this quiz is to challenge some of the common myths and misconceptions that many people – health professionals and patients alike – believe. Encourage the group to participate and to give reasons for either true or false responses, so that common misconceptions can be aired.
- Speaker notes Ask for show of hands, encourage group responses.
- Speaker notes This might explain reported findings of narrower waist circumference despite no change in weight from some lifestyle improvement attempts. However, if a person gains weight from their lifestyle change, then that probably reflects overcompensation for the activity done – whether the weight increase reflects increased muscle or fat. When following a physical activity (PA) programme, it is better to look for broader health gains rather than focusing exclusively on weight or BMI change.
- Speaker notes This is an important concept to convey to patients – weight loss is simply the WRONG measure of PA benefits. The body will always autoregulate for calories used up in PA by increasing appetite, so the energy gap is made up – unless there is accompanying calorie restriction. Which means feeling a bit hungrier… Avoid using weight loss as the main measure of benefit from a fitness regime – otherwise, there is a danger that people will give up because of a false impression that PA is having no effect.
- Speaker notes You could ask the group to compare likely PA benefits to be gained by someone in their 40s and someone in their 80s. For instance: 40s – reduction in risk of CVD and diabetes, improved self-esteem, motivation. 80s – reduced risk of falls, independence, social engagement, pain control.
- Speaker notes Dietary protein content may be relevant to elderly people who increase PA, if their protein intake is currently low, particularly if there is evidence of sarcopenia (loss of skeletal muscle mass and strength as a result of ageing). High-performance athletes may also need to consume additional protein to match their muscle turnover and muscle repair needs.
- Speaker notes Calories in drinks should be included in the total calorie intake when assessing nutritional intake. Children doing high levels of sport could include “energy drinks” as long as these calories are considered alongside total dietary intake. Children doing average levels of activity do not need energy drinks. The term “isotonic” has been used as a powerful marketing tool, but it is based largely on pseudoscience. The body is capable of adjusting fluid balance whatever fluid is consumed, by adjusting the sense of thirst. There is no convincing evidence that consuming calories in sugary drinks improves sporting performance.
- Speaker notes Frequent self-monitoring of weight is not recommended for children and young people, because of the need to relate weight to reference ranges and interpret BMI centile changes. Where appropriate, this should be done by a health professional. It is possible that some slimming clubs may try to discourage regular self-weighing in order to retain their central function of attending for the “weekly weigh-in”. Daily weighing is an important predictor of weight stability – particularly for people reaching the maintenance phase of a weight loss programme.
- Speaker notes Forcing children to “eat their greens” may be one reason why so many children appear reluctant to eat them. The misconception that “children hate vegetables” has become so embedded in Western cultural norms that many “children’s menus” may not feature any green vegetables at all. These concepts will be discussed in a later workshop in this course.
- Speaker notes This is an understandable belief, particularly in patients who have cardiovascular or respiratory problems such as angina or COPD. Graded exercise programmes are recommended for patients beginning an activity programme in response to a recent diagnosis. Consider a medication review if someone is symptomatic because of inadequate treatment. Give reassurance that breathlessness is expected and will recede with perseverance.
- Speaker notes Explain to delegates that this session will consider any examples of local tools or good practice that they have brought or are aware of. The aims of the session are to review existing tools, highlight gaps, and share awareness of local resources and good practice. Networking between colleagues can inspire engagement and a sense of a shared agenda.
- Speaker notes Use a flip chart or type on screen to record comments and suggestions. Begin by encouraging reflection over wider service provision across the local/regional health system. Look for emerging themes and consensus over: positive examples of provision and ideas that could be shared; gaps in knowledge, confidence, tools or wider service options. Think about how you will note down comments – see box suggestion on the final slide in the presentation
- Speaker notes Move the discussion towards encouraging reflection on personal considerations – e.g. strengths, weaknesses and barriers to discussing lifestyle, activity and weight issues with patients. Encourage any suggestions or examples of how barriers can be overcome.
- Speaker notes Template suggestion for recording or organizing group comments. You could suggest that a summary of the discussion will be pulled together using this template and circulated once comments have been formatted. Who else might find this summary of suggestions useful? For example, public health colleagues? Service commissioners?