Lecture 10: Feast or Famine

Question 1

How is obesity characterized?

Answer 1

1. insulin resistance
2. increased rate of lipolysis
3. non-esterified fatty acid levels
4. excessive accumulation of lipids in the liver

Question 2

What does ghrelin do?

Answer 2

Stimulates feeding and weight increase
Acts on brainstem and hypothalamus
Enhances gastric motility
Elevated ghrelin is seen during FASTING and will be suppressed in meals

Question 3

What is the most practical way to lose weight?

Answer 3

Change your diet so you intake less calories

Exercise not practical because it is good for MAINTAINing and not losing weight

Question 4

In a normal adult, where are energy stored?

Answer 4

1. adipose tissue
2. muscle (most)
3. liver (least)

Question 5

What does sarcopenic mean?

Answer 5

Loss of muscle mass

Question 6

How is glucose taken up in the brain?

Answer 6

GLUT1 and GLUT3 transporters

GLUT4 = insulin depedndent so brain doesn’t need that to take in glucose

Question 7

What is the significance of the loss of melanocortin-4 receptor (MCR4)?

Answer 7

Someone who is MCR4-/- is OBESE because leptin cant bind

Question 8

What hormones does adipose secrete that may lead to inflammation (T2D)?

Answer 8

1. TNFalpha

2. IL-6

Question 9

What does central adiposity predispose you to?

Answer 9

1. diabetes
2. sleep apnea
3. CV disease
4. cancer
   Leg adiposity is not as bad

Question 10

What is the BMI and T2D association?

Answer 10

Higher BMI the higher the risk of T2D

Also coronary heart disease

Question 11

How many deaths are due to obesity a year?

Answer 11

300,000 deaths

75 billion in health care costs

Question 12

What are the drugs approved by FDA for treating obesity?

Answer 12

1. orlistat
2. Phentermine + Topiramate
3. Diethylpropion
4. Phentermine
5. Phendimetrazine
6. Benzphetamine

Question 13

What is Orlistat?

Answer 13

A drug that is approved by FDA to treat obsesity

Pancreatic lipase inhibitor so you don’t absorb as much fat

Question 14

What are the benefits of bariatric surgery?

Answer 14

1. decreases weight and fat
2. decreases diabetes incidence
3. reverses sleep apnea
4. decreases cancer incidence
5. improves psychosocial health

Question 15

What are the adverse effects of bariatric surgery?

Answer 15

1. postoperative complications: bleeding, anastomosis leakage, hernia
2. viatamin, iron, calcium deficiencies
3. dumping syndrome; flatulence
4. recurrent severe hypoglycemia

Question 16

What is cachexia?

Answer 16

Weakness or wasting of body due to chronic illness

Example: cancer

Question 17

What are the cytokines implicated in cachexia?

Answer 17

TNF-alpha
IL-1
IL-6

Question 18

What is involved in the management of cachexia?

Answer 18

1. controlled refeeding
2. diagnose and treat underlying diseases
3. anabolic treatment = megesterol
   Cannabinoids? GHRH? Myostatin inhibitors?

Question 19

What is difference between fast, anorexia and cancer cachexia?

Answer 19

Normal fast = increased appetite
Anorexia/cachexia = reduced appetite
Reduced GH and IGF1 and severely reduced gonadotropes