Obesity Flashcards
Excess energy is stored in _____ cells residing within widely distributed _________. This energy stored as ____ are broken down to ______ for use at other sites.
Fat
adipose tissue depots
TGs; free fatty acids
This physiologic event orchestrated through neuro - endocrine system permits humans to survive starvation for as long as _________
several months.
Obesity is a state of _______________.
excess adipose tissue mass
Obesity
A medical condition in which excess ______ has accumulated to the extent that it may cause adverse effect on health.
body fat
Obesity is directly equivalent to increased body weight.
T/F
F
Not necessarily equivalent to increased body weight.
Body Mass Index ( ______ index) metric
Quetelet
Body Mass Index metric
_________________
Weight(Kg)/Height(m)2 Kg/m2
Weight is taken (with or without ?) ______, height (with or without?) ______.
Without ; Clothes
Without; shoes
BMI Classification
Underweight
Normal weight
Overweight(pre-obesity) Class I obesity
Class II obesity
Class III obesity
Less than 18.5
18.5-24.9
25-29.9
30-34.9
35-39.9
Greater than or equal to 40
BMI
U.S Customary(imperial)
BMI= ______
Ib*703/In2
The Surgical literature breaks down class III obesity.
Any
BMI _______ is ____ obesity
BMI _______ is ____ obesity
BMI _______ is _____ obese.
35-39.9; severe
40-44.9; morbid
45-50; super
Asian population develop negative health consequences at a (higher or lower?) BMI than Caucasians.
Lower
BMI Prime
It is the ratio of the ___________ (currently defined as ___)
Individuals with BMI prime <____are underweight, btw ____ and ____ have optimal weight. Those at ____ or greater are overweight
With BMI prime, at a glance individuals can quantify what percentage they deviate from their upper mass(weight) limit
A person with BMI 34 has BMI prime of 34/25=1.36 and is _____ over his _____
actual BMI to upper limit BMI
25
0.74
0.74; 0.99
1.00
36%; upper mass limit
BMI
(Easy or difficult ?) to measure
Useful in _______classification
____ adjustments necessary for racial variation
Useful in surveys
Easy
simple anthropometric
No
BMI
Inaccurate in assessment of people with _____________
Does not take _________ into account
Inappropriate in patients with ____ and ____
Underestimation of adiposity in those with ______________
heavy muscular mass e.g athletes, weight lifters etc
regional fat distribution
oedema and dehydration
less lean body mass (elderly)
Body fat percentage
An estimate of the fraction of the total body mass that is _____(AKA ___ mass) as opposed to ___ body mass(muscle, bone, organ tissue, blood etc)
adipose tissue; fat
lean
Which is more accurate
Body fat percentage or BMI
With reason
Body fat percentage is more accurate as a measure of excess body weight than BMI.
BMI lumps up all masses into one figure
Body fat percentage is Used to monitor progress during ______ programme and to assess progress during ______
weight loss
body building
The body fat percentage can be estimated by using the ______ equation
Deurenberg
Other measures of assessing obesity
Waist circumference is Of great medical importance, indicative of _______
_____ and _____
____ to ___ ratio(___)
central obesity
CT scan and MRI
Waist to hip ;WHR
Waist circumference
Male >_____cm
Female >____cm
102
88
WHR is A good measure of central adiposity
T/F
T
WHR
Measure the;
Waist at its (narrowest or widest?) point width- wise usually just _______________
Hips around the (narrowest or widest?) part of the hip bone
Narrowest; above the belly button
Widest
A WHR of ____ for women and ____ for men have been shown to correlate strongly with general heath and fertility.
ABNORMAL; Women >____ Men >____
0.7; 0.9
0.9; 1.0
Classification of obesity as per fat distribution
______ (or _____________, males)
________(________, females)
Android; abdominal or central
Gynoid; below the waist
Classification of obesity as per fat distribution
Android
-Collection of fat mostly in the ______ -
-______-shaped
-Associated with ———— and _______ disease
abdomen
apple
Classification of obesity as per fat distribution
Gynoid
• Collection of fat on _____ and ______
•_____-shaped
-Associated with mechanical problems
hips and buttocks
pear
Historical trends
Etymology
obesity is from a latin word ‘______’ meaning ___,____,____
In ____ ’Esus’ is the past participle of ‘____’(to eat),with ‘ ___’(over). ’_____’
First added to the Oxford English dictionary in _____ by ______.
obesitas
fat’ ‘stout’ ‘plump’
Greek; edere; ob; Obesus
1611; Randle Cotgrave
Obesity was First recognised as a medical condition by the ______.
Greeks
Described by Hippocrates “Corpulence is __________________________________”
not only a disease itself, but the harbinger of others
____ surgeon Sushruta (6th century BCE) relates obesity to ____, recommends _____ as a cure
Indian; DM
physical work
During the middle ages and the renaissance, the obesity was a sign of ______. Was common among officials.
wealth
Industrial revolution-
19th century height and weight ____eased
In the 20th century population reached their genetic potential for height, body weight began to ____ease.
In the 1950’s obesity was linked to _____ and insurance companies _____eased premium on the obese.
incr
incr
morbidities; incr
From 1922 to 1999 the requirement for winning the miss America pageant
__% increase in height
__% decrease in weight
2
12
Being lean, slim is the ideal presently
T/F
T
Who is more predisposed to obesity
Men or women
Children or adults
Women
Adults
Obesity is endemic in USA
T/F
T
The African Americans are less predisposed to obesity compared to the Caucasians
T/F
F
Lowest incidence of obesity is in _________
sub-saharan Africa
The pathogenesis of obesity is classically and rightfully seen in terms of the simple paradigm of an imbalance between:
Energy intake
Energy output
T/F
F
The mechanism of obesity is far more complex than that
LEPTIN
Discovered in 1994, from Greek word ‘leptos’(___)
thin
LEPTIN
A 16kDa protein expressed in _____
Sends afferent signal that relays the ________ to the CNS (_______) i.e ‘______’
adipocytes
magnitude of fat stores
hypothalamus; Adipostat
Plasma levels of leptin correlates with adipose tissue mass
T/F
T
LEPTIN
Mediates (short or long?) -term appetite control i.e eat (more or less?) when fat storages are low and eat (more or less?) when fat storages are high.
Long
More
Less
An anorexic hormone-signals satiety to the Hypothalamus (ventro-medial)also modulates energy expenditure
T/F.
T
In the ob/ob mouse there is defective ———— resulting in obesity and _______
leptin production
insulin resistance.
Leptin administration in the ob/ob mouse causes ______ by ______
weight loss
reducing appetite
Obese humans have low levels of LEPTIN
T/F
F
paradoxically, we have high levels presumably because of tissue resistance to it
(Minority or Majority?) of obesity may be due to mutation in leptin receptor.
Minority
Ghrelin
Produced by the _______
Modulates (short or long?) term appetite control i.e eat when the stomach is ——- and stop when the stomach is ____.
stomach
Short
empty; full
Ghrelin and leptin are antagonistic in their influence on appetite.
T/F
T
complementary
Bad news for dieters!
Leptins
Dieting _____eases leptin levels
Reducing metabolism (stimulates or suppresses?) appetite
decr; stimulates
Bad news for dieters
Ghrelin
Levels in dieters are (lower or higher?) after weight loss
The body steps (up or down?) ghrelin production in response to
weight loss.
Higher
Up
The higher the weight loss, the (lower or higher?) the ghrelin levels.
Higher
Neuropeptide Y
Produced in the ______ of the ____
Is a potent (stimulator or suppressor?) of appetite Its production is (enhanced or inhibited?) by leptin.
Arcuate nucleus; Hypothalamus
stimulator
Inhibited
Proopiomelanocortin
Synthesised by ____ (_____ cells of the _____)
A large polypeptide
corticotrophs; Basophil; anterior pituitary
Proopiomelanocortin
Precursor of both ______ hormone and __________________
adrenocorticotrophic
α-Melanocyte Stimulating hormone(MSH)
MSH acts on the _______ receptor (____) in the _____ which ___eases energy expenditure and ____eases food intake
melanocortin-4 ; MC-4
hypothalamus
incr
decr
Agouti protein(Agouti related peptide AgRP)
Expressed in ______
_______ the actions of ____ by ________
hair follicle
Antagonises; MSH
blocking MC-4 receptor
_________ relationship has been shown btw increasing BMI and BNP conc.
No conclusive data yet for NT-ProBNP. However it is thought that the same relationship will hold.
An inverse
POMC and _____ stimulate ____ and inhibit _____
CART
satiety
feeding
NPY and AgRP stimulate _____ and inhibit ____
feeding
satiety
Leptin ______ NPY/AgRP group while _______ the POMC/CART group.
inhibits
stimulating
Total calorie consumption is related to obesity
T/F
T
Most extra calories are from _____ rather than ____
CHO
fat
Resting or Basal Metabolic Rate(BMR)
Is the Energy cost of _______ and ———
metabolising and storing food
Adaptive thermogenesis in Brown Adipose tissue(BAT) –through the action of ________________
UCP-1 uncouple mitochondria resp.
BMR accounts for about ____% of daily energy expenditure whereas active physical activity contributes _____%.
Thermic effect contributes ____%.
60-65
25-30
10
Obesity results from an imbalance btw _______ and ———-
energy intake and expenditure.
____ % of the world’s population get insufficient exercise
60
Genetics
_______ in various genes controlling appetite and metabolism predispose to obesity when sufficient calorie is present
Polymorphism
Genetics, obesity
Inheritance is Mendelian
T/F
F
not
Genes Vs Environment
genes influence susceptibility to obesity
T/F
T
The OB gene is absent in humans
T/F
F
Present and is expressed in fat
Early onset morbid obesity in humans have association with mutation in either _______ or ______ eg hypogonadotropic hypogonadism which is reversed by __________
leptin or leptin receptor
leptin replacement
Mutation in the gene encoding POMC-through failure to synthesise ______, a key neuropeptide that _____ appetite in the hypothalamus.
α-MSH
inhibits
————— mutation by preventing synthesis of α-MSH from its precursor POMC
Proenzyme convertase 1(PC-1)
α-MSH binds to _______ receptor, a key ______ receptor that ______ eating.
type 4 melanocortin
hypothalamic
inhibits
Heterozygous mutation in this gene encoding POMC causes obesity in as much as ___% of all cases.
50
Which obesity related gene isn’t found in rodents but found in humans
PC-1
Which obesity related gene isn’t found in humans but found in rodents
Tub
Fat
AgRP
Medical and psychiatric illnesses that can cause obesity
______ syndrome, ______,____ hormone
Eating disorders; _____ disorder, _______ syndrome, ______
Drugs; ______, _____, certain anti- convulsants (_____), _______ and some forms of ________
Cushings; hypothyroidism; growth
Binge eating ; Night eating ; Bulimia nervosa
antidepressants; steroids
phenytoin and valproate
pizitifen; hormonal contraceptions
Medical conditions that predispose a person to obesity
Insulinoma
Patients gain weight as a result of ____ to avoid ______ symptoms
Craniopharyngiomas and other disorders involving the _______
Tumours, trauma or inflammation cause ________ affecting centres that control hunger, satiety and energy expenditure.
overeating; hypoglycemia
Hypothalamus
hypothalamic dysfunction
Social determinants
Social class and income inequalities
Societal perceptions; ‘ ________ three square meals a day’
Number of children; women ___% risk per child. Men ___% risk per child
Malnutrition in early life
In a 2006 study ;insufficient sleep and ____easing rate of smoking.
Big man big Belly’
7; 4
decr
Clinical features of obesity
Adverse effect on health
Morbidly obese individuals(200% ideal body weight have as much as ___ fold increase in mortality
Mortality rises as obesity increases especially with increasing _____ and ____
Increases the risk of many __ and _______ conditions.
These co-morbidities are commonly shown in the metabolic syndrome a combination of; ____,_____ , dyslipidemia (high cholesterol and TGs)
12
abdominal and intra-abdominal fat
physical and mental
Type II DM, high BP
Metabolic syndrome
Involves picking 1 from : ____,____,____
And picking 2 from : ___,___,____,_____
Type 2 diabetes
Insulin resistance
Hypertension
Obesity
Dyspilidaemia
Microalbunuria
Hyper-insulinaemia and type II DM
____eases with weight gain and _____ with weight loss
Insulin resistance is more strongly linked to ________ obesity
May be due to insulin itself by _____________
Incr
diminishes
intra- abdominal
inducing receptor down regulation.
Hyper-insulinaemia and type II DM are pervasive features of obesity
T/F
T
Obesity and DM cont…
Various circulating peptides produced by adipocytes eg the cytokines(____) and ‘adipokines’ _____ and _____have altered expression in obese adipocytes.
These are capable of modifying ____ action.
IL-6
adiponectin and resistin
insulin
In obesity, Free fatty acids are known to be increased and capable of impairing ____ action
insulin
Most obese individuals develop DM.
T/F
F
They do not
As many as 80% of patients with type II DM are obese.
T/F
T
Even modest weight loss improves insulin sensitivity.
T/F
T
CV mortality may be seen in BMI as low as _______
25
The ______ study revealed that obesity was an independent risk factor for 26 year incidence of CV disease.
Framingham
Abdominal obesity is associated with _____ lipid profile ;with ____eased LDL cholesterol, VLDL and TG and ____eased HDL cholesterol. This causes coronary Heart dx and IHD
artherogenic
incr
decr
Obesity and Pulmonary
Reduced ________
Increase ________
____eased total Lung capacity and functional residual capacity
Obstructive ______
______________ syndrome
Increased complication during general anaesthesia
Weight loss improves condition.
chest wall compliance
work of breathing
Decr
sleep apnoea
Obesity hypoventilation
GIT
_______ billiary secretion of cholesterol,
____saturation of bile causing ______
NAFLD(Steatosis, Steatohepatitis and Cirrhosis) GERD
Pancreatitis
Abdominal ___
Enhanced
super-
cholesterol gallstones
hernias
fasting causes super-saturation of bile, resulting in gallstone formation
T/F
T
I
Higher in obesity in males; Ca oesophagus, Colon, Rectum, Pancreas, Liver and Prostate
Higher in obesity in females; _____ , Breasts, Endometrium, Cervix and Ovaries
Non-Hodgkins lymphomas and multiple myeloma
Gall bladder
Obesity accounts for ____% of cancer deaths in men and ___% in women.
14
25
Reproductive Disorders-men
Male _______ is associated with increased adipose tissue
Decrease plasma ______ and _________
Increase _____ level derived from conversion of _______ in adipose tissue
hypogonadism
testosterone
Sex Hormone Binding Globulin(SHBG)
oestrogen; adrenal androgens
Obesity and reproductive disorders in men
_________
_________ may be decreased in morbidly obese men
Gynecomastia
Free testosterone
masculinisation, libido, potency and spermatogenesis are preserved in most obese men
T/F
T
Reproductive disorder-women
_______ abnormalities (oligomenorrhea) particularly in women with _____ obesity
Increased _____ production
Decreased ______
____eased peripheral conversion of androgen to oestrogen
PCOS (anovulation and ovarian hyperandrogenism)
Menstrual
upper; androgen
Sex hormone binding globulin ; Incr
____% of women with PCOS are obese
40
In obese women with PCOS, weight loss or treatment with insulin sensitizing drugs often restores normal menses
Infertility
T/F
T
Obesity, Psychiatric
Depression(especially in ____)
Social ——— /weight based ______
_______ impact
women
stigmatisation
discrimination
Economic
Additional facts and figures
On the average, obesity reduces life expectancy by ______ years
BMI of 30 to 35 reduces life expectancy by _______ years
BMI >40 reduces life expectancy by _____ years
6 to 7
2 to 4
10
Pharmacologic Therapy
Centrally acting drugs: they are _______
Peripherally acting drugs: they -
_______________
appetite suppressants
reduce fat absorption
Class 3 obesity is also known as _____ obesity
Morbid obesity
______ cells of the ________ and ______ produce ghrelin
Epsilon
Pancreas
Stomach
