York University - KINE 4020

Chapter 9 Weight Management: Overweight, Obesity, and Underweight

MULTIPLE CHOICE

1)According to body mass index values, the percentage of the Canadian adult population that is con- sidered overweight or obese is which of these?

1. 1. 30 percent
   2. 40 percent
   3. 50 percent
   4. 60 percent

2. According to body mass index figures, what percentage of people aged 2–19 years are overweight or obese?
   1. 12 percent
   2. 26 percent
   3. 48 percent
   4. 68 percent

3. Which of these is the classification of a person who is 193 centimetres tall and 92 kg?
   1. underweight
   2. healthy weight
   3. overweight
   4. obese

4. Which of the following describes a trend of worldwide obesity?
   1. Nowadays, obesity is not seen in developing countries.
   2. Prevalence of obesity is at an epidemic level.
   3. The cutoff figure of the BMI for obesity varies from country to country.
   4. The obesity in other countries does not seem to increase risks for chronic diseases.

5. Which of the following statements demonstrates the relationship between fat cell development and weight?
   1. The amount of fat in the body is substantially determined by the size of the fat cells.
   2. More and larger fat cells are found in obese people compared with healthy-weight persons.
   3. Fat cell number increases most readily during early adulthood, when energy expenditure declines.
   4. Fat cells may enlarge but not increase in number upon reaching the age of 50 in males and reaching menopause in women.

6. Which one of the following describes the behaviour of fat cells?
   1. The number decreases when fat is lost from the body.
   2. The size is smaller in obese people than in normal-weight people.

1. 3. The storage capacity for fat depends on cell type.
   4. The number increases several-fold during the growth years and tapers off when adult status is reache

7. Tom was overweight when he was 13. During puberty he continued to gain weight steadily until at age 23, when he decided to lose weight. Tom successfully lost 22.7 kg. Which of the following most likely happened to Tom’s fat cells?
   1. They shrank in size but did not decrease in number.
   2. They melted away when he burned all the excess fat.
   3. They decreased in number but did not decrease in size.
   4. They changed very little since fat cells shrink only with a weight loss greater than 45.5 kg

8. From which of the following areas of the body do women have the most difficulty in losing weight?
   1. breasts
   2. stomach
   3. legs
   4. hips

9. The most likely explanation for why women readily store fat around the hips whereas men readily store fat around the abdomen is gender differences in which of the following?
   1. blood insulin levels
   2. the activity of lipoprotein lipase
   3. circulating lipid transport proteins
   4. the activity of lipoprotein synthetase

10. Which of these is the rationale for the fat cell theory of obesity?
    1. Fat cell number increases dramatically after puberty.
    2. Fat cell number in an adult can decrease only by fasting.
    3. Fat cell number increases most readily in late childhood and early puberty.
    4. Weight gain from overeating in adults takes place primarily by increasing the number of fat cells.

11. Which of the following enzymes is known to promote fat storage in adipocytes?
    1. adipose tissue lipase
    2. lipoprotein lipase
    3. cellulite synthetase
    4. lipoprotein synthetase

12. Which of the following terms is used to describe fat cell death?
    1. apoptosis
    2. autophagy
    3. necrosis
    4. cell morphology

13. The concept which suggests that those individuals who use energy sparingly will store fat more read- ily, thus increasing his/her chances of weight gain, is known as which of the following?
    1. fat cell theory
    2. thrifty adipose theory
    3. thrifty gene theory
    4. set point theory

14. Obesity resulting from an increase in the size of fat cells is termed which of the following?
    1. hyperplastic obesity
    2. hypertrophic obesity
    3. idiopathic leptinemia
    4. anaplastic hypometabolism

15. Adverse effects on organs such as the liver from the presence of excess body fat is known as which of these?
    1. lipotoxicity
    2. hyperplastic lipase
    3. set point susceptibility
    4. hyper-responsive ghrelin

16. Hyperplastic obesity is related to which of the following changes?
    1. an increase in fat absorption
    2. a decrease in ketone formation
    3. an increase in the size of fat cells
    4. an increase in the number of fat cells

17. Obesity resulting from an increase in the number of fat cells is termed which of these?
    1. hyperplastic obesity
    2. hypertrophic obesity
    3. idiopathic leptinemia
    4. anaplastic hypometabolism

18. Which of the following defines the body’s set point?
    1. minimum weight of a person
    2. maximum weight of a person
    3. point at which a person’s weight plateaus before dropping again quickly
    4. point above which the body tends to lose weight and below which it tends to gain weight

19. Which of these is Prader-Willi syndrome?
    1. altered receptor activity for leptin
    2. a genetic disorder resulting in obesity
    3. fat accumulation in the liver of gastric bypass patients
    4. a failure to adapt to alternating periods of excess and inadequate energy intake

20. Which of the following measures can have a dramatic impact on minimizing the genetic influence on BMI?
    1. childhood appetite control
    2. drug therapy
    3. increased sleep
    4. vigorous exercise

21. On which organ or tissue does leptin primarily act?
    1. pancreas
    2. intestines
    3. adipocytes
    4. hypothalamus

22. Which of the following is known to cause a reduction in fat cell number in mice?
    1. injection of leptin
    2. supplements of ghrelin
    3. long-term resistance exercise
    4. consumption of high-protein diets

23. Why is a leptin-deficient mouse much larger than its leptin-sufficient counterpart?
    1. Leptin deficiency causes lower levels of ghrelin.
    2. Leptin deficiency enhances appetite and decreases energy expenditure.
    3. Leptin deficiency causes psychological depression, which leads to increased food intake.
    4. Leptin deficiency reduces the desire to do physical activity, resulting in more excess en- ergy available for fat storage.

24. Which of the following describes a relationship between leptin and energy balance?
    1. Fat cell sensitivity to leptin is higher in obese people.
    2. A deficiency of leptin is characteristic of all obese people.
    3. Blood levels of leptin usually correlate directly with body fat.
    4. Major functions of leptin include an increase in hunger and a decrease in metabolic rate.

25. From which of the following body parts is leptin secreted?
    1. stomach
    2. adipose tissue
    3. small intestine
    4. bone marrow

26. Which of the following is a function of ghrelin?
    1. inhibits inflammation
    2. stimulates appetite and energy storage.
    3. stimulates growth of new blood cells
    4. protects against insulin resistance

27. Which of the following proteins protects against type 2 diabetes?
    1. PYY
    2. leptin
    3. ghrelin
    4. adiponectin

28. Which of these is the observed effect of sleep deprivation on leptin and ghrelin?
    1. Leptin and ghrelin both increase.
    2. Leptin and ghrelin both decrease.
    3. Leptin decreases while ghrelin increases.
    4. Leptin increases while ghrelin decreases.

29. Why is weight loss, in part, more successful with exercise and also after bypass surgery?
    1. Ghrelin levels are relatively low.
    2. Adiponectin levels are relatively high.
    3. PYY release from the hypothalamus is suppressed.
    4. Leptin release from subcutaneous fat stores is enhance

30. Which of the following proteins decreases after a meal?
    1. oxyntomodulin

1. 2. pancreatic peptide
   3. PYY
   4. ghrelin

31. Which of the following hormones stimulates appetite?
    1. PYY
    2. leptin
    3. ghrelin
    4. cholecystokinin

32. Which of the following proteins mimics the glucose-lowering effects of insulin?
    1. PYY
    2. resistin
    3. leptin
    4. visfatin

33. Which of these serves as the body’s chief storage site for lipids?
    1. yellow fat
    2. brown adipose tissue
    3. white adipose tissue
    4. high-density lipoproteins

34. Which of the following is the significance of the uncoupling proteins in adipose tissue?
    1. increased loss of body heat
    2. reduction of fat cell number
    3. lowering of basal metabolism
    4. proliferation of fat cell number

35. What type of adipose tissue is most effective at helping someone to maintain warm body temperatures during the coldest parts of the year?
    1. black
    2. white
    3. brown
    4. yellow

36. In which of the following groups of individuals is brown fat especially important?
    1. newborns
    2. adolescents

1. 3. middle-aged adults
   4. the elderly

37. What is the chief factor that determines a person’s susceptibility to obesity?
    1. heredity only
    2. environment only
    3. fat content only
    4. heredity and environment

38. Which of the following is the best evidence that environment must play a role in obesity?
    1. the rate of obesity has been rising while the gene pool has remained relatively constant
    2. the recognition that identical twins reared apart have body weights similar to their biolo- gical parents
    3. the development of precise body composition methodologies that define adipose storage sites based on gender
    4. the discovery of uncoupling proteins that explain the variations in energy metabolism among lean and overweight people

39. Suzanne is at a fast-food restaurant and she agrees to "supersize" her meal. Approximately how many more kcalories will Suzanne now consume?

a.    400

b.   500

c.     600

d.   700

40. Which of the following is lower in obese people compared to non-obese people?
    1. basal metabolic rate
    2. thermic effect of food
    3. physical activity level
    4. metabolic response to exercise

41. Which of the following statements illustrates the relationship between physical activity and energy bal- ance?
    1. There is a strong genetic component to reduced physical activity of overweight people.
    2. Differences in the time obese and lean people spend lying, sitting, standing, and moving account for about 350 kcalories per day.
    3. Although watching television correlates with weight gain, playing video games does not, presumably due to the heightened excitement engendered by action games.
    4. Extraordinarily inactive people who lower their food intakes below that of their lean coun- terparts activate brown adipose tissue uncoupling proteins that stimulate hyperthermic

weight loss.

42. The term that describes the energy expenditure associated with everyday spontaneous activities is known as which of the following?
    1. physical inactivity
    2. sedentary thermogenesis
    3. nonexercise activity thermogenesis
    4. inactive caloric expenditure

43. To help prevent body fat gain, the DRI suggests daily, moderately intense, physical activities totalling how much time?
    1. 20 minutes
    2. 60 minutes
    3. 1½ hours
    4. 3 hours

44. At any given time, approximately what percentage of all Canadian adults are attempting to lose weight?
    1. 14 percent
    2. 25 percent
    3. 37 percent
    4. 44 percent

45. Aggressive treatment should be introduced in obese people if they have which of the following risk factors?
    1. hypertension only
    2. cigarette smoking only
    3. high LDL and low HDL
    4. impaired glucose tolerance only

46. The three indicators used by healthcare professionals to evaluate risks to health from obesity include disease risk profile, BMI, and which of the following?
    1. BMR
    2. waist-hip ratio
    3. physical inactivity levels
    4. waist circumference

47. What percentage of people in Canada who use non-prescription weight-loss products have a normal weight?
    1. 5 percent
    2. 10 percent
    3. 20 percent
    4. 35 percent

48. A popular eating plan that promises quick weight loss is known as which of the following?
    1. a fad diet
    2. a discretionary diet
    3. a spot reduction program
    4. an aggressive bariatric program

49. What is the principal reason that Health Canada has banned the sale of products containing ephedrine?
    1. The costs are prohibitive.
    2. The products were found to be ineffective for weight loss.
    3. The products were implicated in several cases of heart attacks and seizures.
    4. The products were found to contain contaminants that were believed to be responsible for inducing liver failure.

50. When consumed in high doses, which of the following compounds is associated with modest weight loss in people?
    1. chitosan
    2. pyruvate
    3. yohimbine
    4. conjugated linoleic acid

51. Which of the following weight-loss products has Health Canada placed a partial ban on its sale?
    1. ephedrine
    2. yohimbine
    3. chromium
    4. chitosan

52. What is the primary reason that laxatives are generally ineffective agents for losing weight?
    1. They have little, if any, effect on appetite.
    2. They have a low binding activity to dietary fat.
    3. They act on the large intestine rather than the small intestine.
    4. They often induce abdominal cramping and intestinal gas, thereby encouraging rejection and noncompliance.

53. Over-the-counter products labelled as “dieter’s tea” are reported to lead to which of these symptoms?
    1. leptin resistance
    2. ketone poisoning
    3. cravings for protein
    4. nausea and diarrhea

54. Fraudulent weight reduction literature refers to visually apparent, lumpy forms of body fat as which of these terms?
    1. lipomas
    2. lipidosis
    3. cellulite
    4. hyperphagic deposits

55. Clinically severe obesity is also known as which of these terms?
    1. morbid obesity
    2. metabolic syndrome
    3. leptin-resistant obesity
    4. psychological-resistant syndrome

56. Bariatrics is a field of medicine that specializes in the treatment of which of these states?
    1. obesity
    2. addiction to weight-loss drugs
    3. severe underweight
    4. anorexia and bulimia

57. Which one of the following criterion would allow a patient to become a candidate for weight-loss sur- gery?
    1. BMI higher than 40
    2. a medical condition such as seizures or a heart attack
    3. BMI higher than 30
    4. drug therapy has been unsuccessful

58. Which of the following neurotransmitters is released by the weight-loss drugs phentermine and di- ethyproprion?
    1. epinephrine
    2. dopamine

1. 3. serotonin
   4. norepinephrine

59. Mr. Sinclair has a BMI of 43 and is taking drugs to lose weight. He has heard that some drugs cause lots of gastrointestinal discomfort and he wants a drug with fewer side effects. Which of the following drugs should be prescribed for Mr. Sinclair?
    1. olestra
    2. orlistat
    3. serotonin
    4. phentermine

60. How does orlistat function in the body to promote weight loss?
    1. orlistat reduces taste sensation.
    2. orlistat inhibits lipoprotein lipase.
    3. orlistat inhibits pancreatic lipase.
    4. orlistat alters circulating leptin concentrations.

61. After gastric surgery, which of the following hormones is reduced, thus suppressing hunger?
    1. leptin
    2. adinopectin
    3. ghrelin
    4. PYY

62. Which of the following is a characteristic of the results of weight-loss surgery?
    1. Hunger is only slightly suppressed.
    2. Deficiencies of carbohydrate and fibre are common in the long term.
    3. Dramatic improvements are seen in blood lipids, diabetes, and blood pressure.
    4. Medical supervision in the postsurgery period is required only for the first 6–9 months.

63. Which of the following describes the research results regarding obese women in weight-loss programs?
    1. They were mostly satisfied with a 15 percent reduction in weight.
    2. They initially expected to lose unrealistic amounts of weight.
    3. They typically lost about 30 percent more weight than researchers predicted.
    4. They experienced fewer psychological benefits than expected after losing weight.

64. In a weight reduction regimen, the most realistic time frame for losing 10 percent of initial body weight is which of the following times?

1. 1. 6 weeks
   2. 3 months
   3. 6 months
   4. 1 year

65. Which of these is a safe rate of weight loss on a long-term basis for most overweight people?
    1. 0.5–1 kg/week
    2. 1.4 - 1.8 kg/week
    3. 5 percent body weight/month
    4. 10 percent body weight/month

66. Which one of the following is a sensible guideline for diet plans?
    1. Consume low-fat foods only.
    2. Eat rapidly to avoid prolonged contact with food.
    3. Adjust energy intake downward as weight loss progresses.
    4. Skip breakfast but eat a mid-morning snack.

67. As a general rule, which of the following is the minimum number of kcalories per day necessary to en- sure nutritional adequacy in an eating plan for reducing body weight?
    1. 500 kcal
    2. 800 kcal
    3. 1200 kcal
    4. 1600 kcal

68. Which of the following approaches would be most effective at lowering energy intake in a person on a weight reduction program?
    1. Decrease portion size.
    2. Select less energy-dense foods.
    3. Restrict fibre intake as a means to reduce excess water retention.
    4. Consume a small high-fat snack before each meal to reduce appetite.

69. The feeling of satiety from weight-loss diets is best achieved by diets rich in which food components?
    1. fat
    2. short-chain fats
    3. simple carbohydrates
    4. complex carbohydrates

70. What is the best approach to weight loss?

1. 1. Avoid foods containing carbohydrates.
   2. Eliminate all fats from the diet and decrease water intake.
   3. Greatly increase protein intake to prevent body protein loss.
   4. Reduce daily energy intake and increase energy expenditure.

71. An important aid in any weight-loss diet program is which of the following?
    1. decrease water intake
    2. increase physical activity
    3. speed up thyroid activity with metabolic enhancers
    4. develop ketosis by keeping carbohydrate intake as low as possible

72. Which of the following describes a connection between physical activity and energy expenditure?
    1. Walking a km uses about the same energy as running a km.
    2. Walking a km uses about half as much energy as running a km.
    3. Exercising the leg muscles is effective at burning away fat primarily around the thighs and hips.
    4. Exercising the abdominal muscles is effective at burning away fat primarily around the ab- domen.

73. A typical person who burns 200 kcalories during a 3 km run would, in the post-exercise period, burn an additional
    1. 30 kcal
    2. 75 kcal
    3. 150 kcal
    4. 300 kcal

74. In order for weight loss to be effective, one's caloric expenditure should exceed one's energy intake by approximately how many kcalories?
    1. 500 kcal
    2. 550 kcal
    3. 600 kcal
    4. 650 kcal

75. What is the principal reason that appetite is turned off immediately after a person finishes an intense workout?
    1. The feeling of thirst overpowers the desire for food.
    2. The elevated blood lactate level antagonizes ghrelin.
    3. Glucose and fatty acids are still abundant in the blood.
    4. The senses of smell and taste are suppressed for at least 1 hour.

76. A fact about the adaptive response to regular physical exercise includes which one of the following?
    1. Regular physical exercise increases appetite.
    2. Regular physical exercise stimulates digestive function in the post-exercise period.
    3. Regular physical exercise increases energy expenditure in the post-exercise period.
    4. Regular physical exercise triggers release of glucose from glycogen from the muscles.

77. What is the chief reason that health care professionals advise people to engage only in low-to-moder- ate intensity activities for prolonged duration rather than more intense, shorter routines?
    1. Cost is lower.
    2. Boredom is reduced.
    3. Compliance is better.
    4. Monitoring time is diminishe

78. How does "spot reducing" benefit one's body?
    1. It doesn't, because no exercise can target fat removal from any specific area of the body.
    2. Upper body fat is mostly unaffected by exercising lower body muscles.
    3. Lower body fat in women is depleted at a faster rate than abdominal fat.
    4. Abdominal fat in men is released more readily with anaerobic exercise.

79. Approximately how many kcalories are expended per kilogram body weight when walking 1.6 km at a moderate pace?
    1. 0.1 kcal
    2. 1 kcal
    3. 2.5 kcal
    4. 5 kcal

80. Approximately how many kcalories per week should be expended in physical activity in order to main- tain a weight loss?
    1. 2000 kcal
    2. 4000 kcal
    3. 6000 kcal
    4. 9000 kcal

81. Jeff reads the entire newspaper while consuming his large breakfast by himself in his kitchen. Which one of the following environmental behaviours is influencing his actions?
    1. atmosphere
    2. accessibility

1. 3. socializing
   4. distractions

82. Which one of the following represents a common environmental influence on eating behaviours?
    1. Eating while performing hard physical work.
    2. Socializing with strangers during a meal often leads to reduced food intake.
    3. Having to walk to the grocery store to purchase food before preparing it.
    4. Being in a pleasant atmosphere often lengthens the time of the meal but not the amount of food eaten.

83. To help maximize the long-term success of a person’s weight-loss program, which of the following personal attitudes should be encouraged in the individual?
    1. strongly believing that weight can be lost
    2. viewing the body realistically as being fat rather than thin
    3. refraining from expressing overconfidence in ability to lose weight
    4. accepting that little or no exercise is a part of the lifestyle of most overweight people

84. Which of the following is a positive feature of the effect of food accessibility on food intake?
    1. Keeping healthy food within view is an effective way to eat less.
    2. People underestimate the amount of a snack eaten when it is a short distance away.
    3. People eat more of a snack when it is on their desk than when situated only 6 feet away.
    4. People at home would rather travel to the store to obtain new food than eat the leftovers.

85. Which of the following is an association between the environment and food intake?
    1. Distractions generally appear to reduce food intake.
    2. The fewer the number of foods at a meal, the more likely people will overeat.
    3. The mere sight or smell of food prompts people to commence eating even if they are not hungry.
    4. Small portions of food on small plates lead people to underestimate the amount of food eaten.

86. Which of the following is an example of a behaviour modification technique for weight control?
    1. feeling guilty after you overeat
    2. keeping a record of your eating habits
    3. always cleaning your plate when you eat
    4. having someone watch you to prevent overeating

87. Which of the following percentages is described as successful weight-loss maintenance?

1. 1. 5 percent
   2. 10 percent
   3. 15 percent
   4. 20 percent

88. To qualify for successful weight-loss maintenance, a 200-pound person who intentionally lost 20 lbs must hold the loss for at least which of the following durations?
    1. 3 months
    2. 6 months
    3. 1 year
    4. 2 years

89. Approximately what percentage of overweight people who intentionally lose weight are able to main- tain the weight loss for at least 1 year?
    1. 25 percent
    2. 50 percent
    3. 75 percent
    4. 90 percent

90. Because obesity apparently has many causes, even in an individual, the best approach seems to be which of the following?
    1. fasting
    2. medicines
    3. prevention
    4. genetic counselling

91. Approximately what percentage of Canadian adults are classified as underweight?
    1. 2 percent
    2. 5 percent
    3. 10 percent
    4. 12 percent

92. The classification of underweight is defined when the BMI first drops below which of the following values?
    1. 14

b. 18.5

c.     20

d. 22.5

93. Among the following, which is the most important strategy for an underweight person who wishes to achieve a healthy body weight?
    1. a high-kcalorie diet plus regular exercise
    2. a high-kcalorie diet and minimal exercise
    3. a high-protein diet plus regular exercise
    4. total elimination of alcohol and exercise

94. Of the following, which one is among the recommended strategies for weight gain in an underweight person?
    1. behaviour modification training
    2. increased physical activity, especially endurance training
    3. forced awakening during the night for supplemental meals and snacks
    4. consumption of regular meals and snacks that provide high-kcalorie foods in small volumes

95. Which of the following foods would be an excellent energy-dense food for an individual who is hoping to gain weight?
    1. cucumber instead of avocado
    2. cod instead of salmon
    3. milkshakes instead of skim milk
    4. salad with vinaigrette instead of mayonnaise

96. When exercising to build muscle, how many additional kcalories above one's normal intake are re- quired to support the exercise and the building of the muscle?
    1. 100 - 500 kcals
    2. 250 - 650 kcals

c.     500 - 1000 kcals

d.   750 - 1250 kcals

97. Fad diets often produce weight loss, at least initially, for which of these reasons?
    1. They dictate the correct distribution of energy among the macronutrients.
    2. They prevent rapid spikes and declines in one’s blood glucose level.
    3. They don’t require people to count kcalories, and are thus easier to stick to.
    4. They are designed to limit energy intake to around 1200 kcal/day.

98. Jody is taking a nutrition class, and has been assigned to evaluate a popular diet plan. She finds a de- scription of a plan for her assignment in a magazine at the grocery store. Which of the following state- ments in the magazine would suggest that this plan is an unsound, fad diet?
    1. “Keep fresh fruit or carrot sticks in the fridge at work so you won’t be tempted to raid the vending machine for a snack.”
    2. “Once you complete this 6-month plan, you’ll never have to diet again.”
    3. “Starting an aerobic exercise plan may seem daunting, but you can start out with shorter, easier sessions and then build up to 3 or more hours a week.”
    4. “On this plan, you can lose up to 5 kgs per week!”

MATCHING

1. 1
2. 2
3. 10
4. 40
5. 60
6. 66
7. Leptin
8. Orlistat
1. Ghrelin
10. Cellulite
11. Set point
50. White fat
1000. Adiponectin
14. Brown fat
15. Ephedrine
16. Liposuction
17. Phentermine
18. Lipoprotein lipase
19. Hypertrophic obesity
20. Hyperplastic obesity

1. Percentage of Canadian adults considered overweight
2. An enzyme that promotes fat storage
3. A term that describes an increase in fat cell number in obesity
4. A theory that the body tends to maintain a certain weight by internal controls
5. A term that describes an increase in fat cell size in obesity
6. Hormone that suppresses appetite
7. Hormone that stimulates appetite
8. Adipose tissue substance that inhibits inflammation
9. Type of adipose that primarily stores fat
10. Type of adipose that primarily produces heat
11. Percentage of non-prescription weight-loss product users in Canada who are at a normal weight
12. Substance in some herbs that may cause heart attacks and seizures
13. A fraudulent term to describe lumpy fat
14. Minimum BMI of a clinically severe obese person
15. A drug that releases norepinephrine
16. Inhibitor of pancreatic lipase
17. A cosmetic surgical procedure
18. Safe rate of weight loss, in kgs per week
19. Percentage of Canadian adults classified as underweight
20. Recommended minimum number of minutes per day of moderately intense physical activity to prevent weight gain