01-03 Obesity Flashcards
1) Be able to define obesity, know how current measurements are made and their limitations. 2) Understand that obesity is a multifactorial problem. 3) Know medical complications of obesity 4) Identify treatment options for obesity
Ann Int Med definition of obesity?
“…increase in body weight of 20% or more above desirable weight constitutes an established health hazard.”
Simple Height-Based Method for Estimating Ideal Weight
60 inches = 100lbs
—In females add 5lbs/in
—In males add 6lbs/in
BMI Equation (metric)
BMI = Weight (kg)/ Height (m)2
BMI cut-offs
—underweight
—overweight
—obese
Underweight: < 18.5 Overweight: 25-29.9 Obesity: > 30 (Obesity II: > 35) (Extreme: > 40)
Link between obesity and education
In men: no relationship
In women: higher ed → less obesity
% adults obese in U.S.
—♀ vs. ♂
—Ethnic groups hardest hit
> 33% adults obese & ~17% youth
♀ = ♂
50% non-hisp blacks > mexican amer > all hisp > non-hisp white 34.3%
Cancers assoc’d w/ obesity
♀: breast, cerv, endometrial, ovarian, biliary tract
♂: colon, rectal
define incr waist circumference by sex
—independent of BMI, incr wait circum incresase risk of?
♀: > 35 in
♂: > 40 in
—incr risk of DM*, HTN, CVD, Hyperlipidemia
*strongest correlation with DM in nurses’ health study
Neuroendocrine causes of obesity
1.– Hypothalalmic Obesity
• damaged ventromedial hypothal → hyperphagia → obesity
• Rare-tumors, surgery, trauma, inflam dzs
2.– Cushing’s syndrome
• Central obesity-h&n, abd, trunk, sparing the extremities
3.– Hypothyroidism
•Wt gain due to slowed metab activity; usu modest, and marked obesity is uncommon.
4.– Polycystic ovarian syndrome
•~50% ♂ w/ PCOS are obese. Cause unknown.
5.– Hypogonadism
•Menopause tends to be assoc’d w/ an ↑ r/o obesity and a shift to an abd fat distrib
6.– GH deficiency in adult
•Assoc’d w/ ↑ abd and visceral fat
Peptides and Neurotransmitters that ↑ appetite (8)
- Neuropeptide Y (NPY)
- Agouti related peptide (AGRP)
- Melanin concentrating hormone (MCH)
- Ghrelin (from GI tract, in PHARM lecture)
- Endocannabinoids
- Orexins
- Galanin
- Opiods
Peptides and Neurotransmitters that ↓ appetite (12)
• Leptin • Melanocortin (aMSH) • CRF • Cocaine-amphet. reg'd transcript (CART) • Glucagon-like peptide (GLP-1)* • Neuromedin U • Urocortin • Cholecystokinin (CCK)* • IL-6 • CNTF •Peptide YY 3-36 (PYY)* • Oxyntomodulin (OXM)* —amylin* —pancreatic polypeptide* —*in Pharm lecture; from GI Tract
Leptin
—made in fat, gut, and placenta
—signals whether fat stores are enough; when low leptin falls triggering hunger (this threshold may be genetically or developmentally set)
—Leptin-def mice (ob mice): hyperphagia, insulin resist, hyperinsulinemia, and infertility.
—high leptin, however, does not cause anorexia
Agouti related peptide (AGRP)
—AGRP stimulates food intake by binding to the melanocortin-4 receptor in the hypothalamus
—MSH inhibits food intake
—also inhibits MSH binding in skin (↓ melanin)
Lorcaserin
– Selective 5-HT2C receptor agonist
– 5-HT2C receptor activation of proopiomelanocortin (POMC) neurons results in
Phentermine-Topiramate
—immed release phentermine + controlled release topiramate —>5% weight loss 67-79% —Wt loss 10.5% —Wt loss 11kg —AE-paresthesias, dry mouth, constipation, dysgeusia* and anxiety,(TPM-teratogenic, oral clefts) —Dose titration —Pregnancy category X *messed up taste
PHENTERMINE
—sympathomimetic amine
—pharm activity similar to amphetamine
—effect of phentermine on chronic wt mgmt likely mediated by release of NE in hypothal → ↓ appetite and ↓ food intake
TOPIRARAMTE
—fructose monosaccharide derivative with sulfamate functionality
effect on chronic weight management is not known. Its effect on obesity may be due to increased energy expenditure, decreased energetic efficiency, and decreased caloric intake.
