obesity Flashcards
obesity rates in children and adults
35% of adults are obese
17% of children are obease
How many women are obease?
How many men are obease?
69% of adults are overweight or obese
- 5% of men are obease
- 8% of **women **are obease
Are minorities more obease or less obease then non-minorties?
For men obesity does not vary significantly among racial/ethnic groups.
36% white, 38.8% black, 35.3% hispanic
For **women **obesity varies siginificantly among racial/ethnic groups.
32% white, 58.5% black, 40.7 % Hispanic
black women are almost 2x as likely to be obease then white
*23% of middle age black women (age 40-59) have stage 3
Underweight BMI
BMI < 18.5
Overweight BMI
BMI=25-29.9
Normal BMI
BMI=18.5-24.9
Obese BMI
BMI=30
Stage 1 Obeasity BMI
BMI=30-34.9
Stage 2 Obeasity
BMI=35-39.9
Stage 3 obesity
BMI>40
Super obease BMI>50
Childhood obesity
Determined by age percentile
- Overweight defined as body mass index 85th to 95th percentile for age and gender
- Obesity is defined as body mass index 95th percentile or greater for age and gender
BMI formula
BMI=mass(kg)/height(m)^2
Factors contributing to obesity
- Dietary habits (cheap, energy dense, highly palatable)
- Activity level (sedentary)
- Genetics- (FTO, MC4R mutation)
- Gut Bacteria
- Maternal Environment
- Socioeconomic status
- Friends
- Environment
- Medications (steroids, SSRIs, anti-psychotics)
Orexigenic
appetite stimulant
NPY-neurotransmitter in the autonomic nervous system
- elevating NPY-ergic activity increases food intakeAgRP- signaling neuropeptide produced in the brain
- appetite-stimulating effects of AgRP are inhibited by the hormone leptin and activated by the hormone Ghreli
Ghrelin-released by the pituitary gland, activates AgRP
cortisol - secreted by the adrenyl gland
Anorexigenic
appetite supressent
POMC, CART, alpha-MSH, CCK, Pancreatic Peptide (PP), Peptide tyrosine-tyrosine (PYY), GLP-1
- Leptin - produced by fat cells
- Insulin - secreted when blood glucose levels are high
How many years does being overweight and obease retract from one’s life expectancy?
diminished life expectancy in the obese
overweight
o decreases life by 3yrs
obese
o decreases life by 6-7yrs
- Life expectancy decreases as obeasity becomes more extreme (stage 1 better then superobease)
What are the pyschosocial effects of being obease?
- Less education
- Less likely to be married
- Lower household income
- Higher rates of poverty
- Depression, impaired self-esteem
- Prejudices- “sloppy, lazy, lack self-discipline”
- 1.4-2.4 x number of sick days (Swedish Obesity Study 2002)
- 1.5-2.8 x more likely to be on disability
- *SOCIAL STIGMATIZATION is the root cause *of the psychosocial effects of obeasity
What types of cancerare associated with obeasity?
Cancer
- breast, uterus, cervix
- colon, esophagus, pancreas
- kidney, prostate
What are some common medical problems associated with obesity?
- Adipose tissue is an endocrine organ
- many problems assicated with obesity are endocrin
- hypoventilation syndrome
- stroke
- diabetes
- osteoarthritus
- cirrhosis
- Coronary heart disease
- gout
- osteoporosis is not assicated with obesity
What are the 3 treatment options for obesity?
- Behavior/Lifestyle modification
- Pharmacotherapy
- Bariatric surgery
- risk for obesity relapse is high, must be managed over the long term
- obesity counciling by Drs increases chance pts will achieve weightloss
How much weight loss of needed to improve health outcomes?
pts who loose 5-10% of body mass reduce their risk of morbidity associated with overweight/obesity.
What are some common pharmacotherapy drugs used in treating obesity?
o ADHD drug derivatives
- Belviqàlocaserinà selective 5HT2c agonist
- Phentermin (stimulant)
- Xenicalà Orlistat (Alli)
Contraveà Naltrexone SR/Bupropion SR modulate dopamine association with food (still in clinical trials)
- Dopamine blocking drugs
Drugs used to achieve clinically signicant weightloss ( 5-10% of weight) to improve health outcomes
What percentage of eligibe pts use pharmacotherapy and surgery?
Pharmacotherapy
- 2-3% of pts eliglbe use drug therapy
Surgery
- 1% of eligible obease pts opt for surgery
Why such low utilizaiton of resources?
- Time (obesity counciling takes allot of time)
- Utility (most physicans are apathetic towards obesity tx)
- Reimbursement is low for medical obesity counciling
- Surgery is generally covered
- Cultural barriers (overweight is not a problem in som cultures)
- Comfort level (pts dont like talking about their weight)
What are some behaviors associated with weightloss?
- Record food intake daily
- Weight: check at least once per week
- Low-calorie, low-fat diet
- Total energy intake1300-1400 kcal/d
- Eat breakfast daily
- Regular physical activity (60 minutes per day)
- meal replacement (weight wachers, slimfast) used 1x per day assocated with 3kg-5kg weightloss
What are the criteria for weightloss surgery?
- BMI >40 or BMI >35 with comorbidities (i.e diabetes)
- Failed medical weight loss for 6 months
- Absence of uncontrolled psychiatric disorder or substance abuse
What are the 3 types of weightloss surgery?
**Gastric banding **
- least effective surgery
- reversible
- indicated for pts with BMI 30-35
**Gastric bypass **
- Alterations in ghrelin/leptin
- results in 50-60% weight loss
- .1% mortality risk (similar to galbladder, appendectomy)
- risk of nutritional defficencies
**Gastric sleeve **
- results in 30-50% of excess body weight loss
- indicated for pts with superobesity (BMI>50)
- reduced nutrient deficency side effects
