Obesity Flashcards
What is the definition and occurance of obestiy
- Excessive accumulation of (white) fat tissue
- Energy intake > utilization
- Overweight ca/fe: ideal body weight +15-30%
- Obese ca/fe: ideal body weight + >30%
- Occurrence of obesity ca/fe: 20-45%
- Endocrine disease: <1% of obese ca/fe
What is the two-component model
A technique of masuring body composition based on two components: 🔺Fat Mass (FM) - Energy reserve (fat) - Homogeneous composition - Water and potassium free 🔺 Fat Free Mass (FFM) - Health state - Constant ratio of components (minerals, ec/ic water, glycogen)
What are different methods/modles we can use to describe body composition and nutritional status?
- Body weight (change)
- Body Condition Score (BCS)
- Cachexia Score (sick animals) = Muscle Condition Score (MCS)
- Morphometric measurements
- Bioelectrical Impedance Analysis (BIA)
- Dual Energy X-ray Absorptiometry (DEXA) (Most specific- density of both soft tissues and bone - osteopor.!)
- (Densitometry, CT/MRI, whole body potassium )
- (Chemical analysis of dead body) most accurate but can only be done in dead…
What does the body weight measure inform us about?
- No information on body composition
- Modified by dehydration or fluid accumulation
- Scale: exact, same (Should be appropriate for the size of patient)
- Monitor changes! (Most imp thing of bwt! Growth, decr: fat accumulation or loss (or other))
What does the body condition scoring (BCS) inform us about?
- 1…3…5 or 1…5…9 - charts
- Most practical (Very important, valuble - should be part of basic values!)
BUT: - Subjective
- Investigator-to-investigator variance
- Body composition is only estimated
What are the basic causes of obesity
- lower Basic Metabolic Rate (BMR)
- lower Physical activity
- higher Energy intake
We rarely have them alone! May influence eachother
Describe the possible backgrounds of decreased BMR
- Breed, genetic factors (retriever, beagle, spaniel, dachshund…)
- Gender:
The female ffm is lower than the male ffm, so the female bmr is lower too as their energy demand is lower.
➡️ in most spp female is more predisp to develope obesity - Neutering decr the BMR
- Aging decrease the energy demand/BMR
➡️ Ca: 7-12 years = esp prone to obesity - Hypothyroidism decr. BMR
Describe the connection between neutering and obesity
🔺Neutered dogs: prevalence of obesity 2x!!!
- BMR ⬇️
- Appetite ⬆️
- Physical activity ⬇️
🔺 Fe: castrated Male can dev most severe obesity!
Indoor neut. (diff in dog - female)
🔺 Energy demand 30% ⬇️ (must red. Intake!)
🔺 2-3 body weight and BCS
monitoring in the year following neutering!
Describe the connection btw hypothyroidism and obesity
- Especially if the breed is predisposed to both (Eg. Beagles)
- FM increase, FFM normal!
- BMR decrease, physical activity decrease (lethargy)
What are causes of decreased physical activity
🔺Indoor lifestyle - Room dog: 31% - Garden dog: 23% 🔺Aging (Painful joint, bone diseases also a factor) 🔺Owner's lifestyle
Describe higher energy intake as cause of obesity
🔺 Polyphagia (pathology, hormones, drugs)
- Cushing’s syndrome!!, stress, (acromegaly)
- Medications: glucocorticoids, progestins, antiepileptics (phenobarbital)
🔺 Calories (fat and carbohydrates) in food ⬆️
- eg. Diet wrong proportion of nutrients, right amount of food.
🔺 Feeding problem/error
- Too big/frequent doses or ad libitum feeding
- Treats, “snacking” at family meals
- Competing for food, more pets in the family
- More family members are feeding
- Feeding ≠ love, voracity ≠ health, snacks ≠ boredom killing
What is the connection bwt Cushing’s syndrome and obesity
- higher fat mass, lower(!) Fat free mass
- Abdominal size increase/pot belly, muscle weakness (decr. Activity contr more to problem aswell!)
Describe the connection betweein higher calorie/fat content of food and obesity
🔺 The energy concentration of fat is highest 🔺 Satiety - Fat ☹️ - Carbohydrate 🙂 - Protein/amino acid 🙂 🔺 Utilization/digestebility of energy content (monogastric) - Fat 98% - Carbohydrate 94% - Protein 77% 🔺 Fat supplement: palatability ⬆️
How might obesity be a health risk?
🔺Physical
🔺 Endocrinologic and metabolic
🔺 Other
How does the physical consequences of obesity influence the health?
🔺 Increased load on joints/bones
- Ca: cruciate ligament rupture, discopathy
🔺 Tracheal collapse (ca)
🔺 Heatstroke (ca) (more “insulation”/fat tissue
How does the Endocrinologic and metabolic consequences of obesity influence the health?
🔺 Hypoxia in cell groups of fat deposits
🔺 Fat stores produce inflammatory mediators (adipokins which are released:)
🔺 TNF-α ⬆️, IL-6 ⬆️, leptin ⬆️, CRP , adiponectin ⬇️!! (Benefitial, reduce inflamm, decr insulin resistance)
- Chronic systemic inflammation (➡️ osteoarthritis)
- Hypertension (ca), atherosclerosis
- Insulin resistanceðtype-2 DM (fe! ca?)
🔺 Hyperlipidemia (TG ⬆️, cholesterol ⬆️)
- Pancreatitis
- Liver lipidosis (fe esp!)
Explain the connection between obesitas and hypertension
🔺 Circulating volume ⬆️, cause:
- adipokine release ➡️ RAA system activation ➡️ renal water retention
🔺 Peripheral resistance of blood vessels ⬆️, cause:
- Endothelial dysfunction
- Adipokins ⬆️ (inflamm mediators)
Mention the other risk factors we might see in connection to obesity
- Ca-oxalateurolithiasis (ca)
- Other urinary tract diseases
- Heart disease (ca)
- Kidney disease (ca)
- Incontinence (ca)?
- Tumors
- Reproductive problems
How does obesity increase the incidence of heart disease?
🔺Most common: myocardial hypertrophy
- Circulating volume incr ➡️ Preload increase
- Hypertension ➡️ Afterload increase
- adipokins ➡️ Myocardial hypertrophy and fibrosis
- ➡️ Coronary calcification
➡️➡️➡️ DECREASED LEFT VENTRICLE FUNCTION
Describe the connection btw obesity and nephropathy
Release of adipokins➡️ RAAS activated ➡️ Hypertension
➡️ increased GFR ➡️ Glomerulus expands, Bowman’s capsule is tight ➡️Glomerulosclerosis
What are the main points in the treatment of obesity
- Diet
- Increase physical activity
- Treatment of hormonal disease
- Medication support? No longer available
How do you approach starting a weight loosing diet?
🔺 Body weight (BW) – ideal body weight (IBW) – target body weight (TBW)
🔺 optimal body weight loss: 1-2% /week, 4-8% /month
🔺 Calorie intake ⬇️
- (40-)60% of target body weight maintenance energy demand
(set if lower if:)
- female: -15%
- Neutered: -15%
Don’t be drastic: rather too little than too muc!
- Hunger ➡️ behavior ➡️ owner gives up
- Excessive FFM ⬇️
- Increased risk of relapse (BMR ⬇️)
- Liver lipidosis (fe) due to fat mobilisation
How do you modify the nutrient proportion correctly while decreasing caloric intake?
🔺 Fat/calorie ratio ⬇️
- Fat: max. 25% of ME content (25-30g fat/Mcal ME)
🔺 Fiber ⬆️ (not too much!)
- Water soluble:
gastric emptying ⬇️, nutrient absorption ⬇️
- Insoluble: passage ⬆️
- Palatability ⬇️ but satiety⬆️ (full stomach)
- (Stool quantity ⬆️, frequency ⬆️)
- (Flatulence, diarrhea)
🔺 (Water ⬆️, air ⬆️) to increase volume!
🔺 Protein-to-calorie ratio ⬆️ (higher protein)
- Target body weight protein requirement
- FFM↔️, FM⬇️
- Protein energy is utilized worse
- Satiety ⬆️
🔺After ideal weight is met, we switch to maintenance diet
Things to add to a weight loss diet?
🔺 Vitamin/mineral supplementation +/-
➡️ Bc diet low in fat, fat soluble vits need to be absorbed in presence of fat!
🔺 Potentially slimming additives
➡️ Chitosan, green tea extract, L-carnitine, ginseng saponins, chromium, conjugated linoleic acid (t10, c12-CLA) … etc.
How does physical activity affect the FFM?
Either it stays the same or it might increase (mm building)
