Obesity Flashcards

Question

Brown adipose tissue

Answer 1

Common in animals. Metabolic rate: production of ATP. Thermogenesis: production of heat. Human equivalent? β3 stimulation activates PPARγ co-activator which leads to uncoupling protein synthesis. Uncoupling proteins 1-5, 1 and 2, maybe more, in humans. Uncoupling proteins in mitochondria of BAT: Unlink e- transport from ATP production, Energy dissipated as heat. Drugs that do this are CN, CO, and metformin.

Answer 2

Leptin deficiency (very rare), give leptin. Melaonoctin-4-receptor mutation: 4-6% of obese kids; early onset severe obesity, food seeking, hyperinsulinemia. Treatment is behavioral (caloric intake expenditure)

Answer 3

Genetic or chromosomal defects. Two most common obesity syndromes: Prader-Willi Syndrome and Albright’s Hereditary Osteodystrophy. Treatment: behavioral (restrict food).

Answer 4

Not as common. Usually Hypothyroidism (low free T4), Cushing’s Disease (high cortisol), Growth hormone deficiency, Hypopituitarism (CNS injury)

Answer 5

Congenital or acquired, Inability to move: Loss of muscle mass , Decreased energy expenditure, Requires dietary treatment

Answer 6

Glucocorticoids; Newer antipsychotics or antidepressants (Risperidone, Olanzapine, Clozapine, Paroxetine (Paxil®), Amitryptaline (Elavil®)); Antiepileptics: Valproate, Carbemazepine

Answer 7

For each 1 kg loss, life expectancy increases by 3-4 months. Reducing the BMI to \<28 will decrease cardiovascular mortality by 50% (77% if hypertensive). Even people who try but don’t lose weight are at lower risk.

Answer 8

Losing weight (how much) and how we maintain the loss

Answer 9

Dietary intervention, Increased physical activity, Behavioral modification, Psychological and social support, Pharmacotherapy, Surgical intervention

Answer 10

Meal replacement is good for underreporters. But generally most diets etc will reduce weight modestly with some regain after (metabolism can overcompensate).

Answer 11

Exercise doesn’t necessarily burn tons, but dramatically increases metabolic rate and remains elevated for 24-72h afterwards (excess post-exercise O2 consumption). Depends on intensity of exercise. Long-term exercise may elevate resting metabolic rate (RMR). Other benefits: Improved physical fitness, Facilitates greater more intense daily activities, Acts on brain like fat intake, Produces rates of fat oxidation similar to fat intake, Beneficial effects on lipid mobilization and oxidation, Biochemical/morphologic changes in muscle fiber

Answer 12

BMI \>27 and 1 other CV factor, or BMI \>30. Reduce Energy intake (lower hunger, more satiety, less absorption) and increase energy expenditure (increase metabolic rate)

Answer 13

Inhibits intestinal lipases, decreases fat absorption by about 30%, leads to a 5-10% weight loss in obese subjects

Answer 14

serotonin and NE reuptake inhibitor; acts by decreasing appetite and by increasing activity of β3 receptors in BAT (leading to an increase in ‘metabolism’); may directly increase insulin sensitivity

Answer 15

Cannabinoid receptor blocker (rimonabant), Ciliary neurotrophic factor, Lipase inhibition, Adrenergic β3 receptor agonists, Vegetable-based natural appetite suppressants

Answer 16

Stapling or partial gastrectomy - old, less effective (stomach stretches). Gastric bypass (roux-en-Y): stomach still there but food doesn’t enter there. Good effects on people at risk (recover the medical costs within 2 years).

Answer 17

BMI \> 40, or BMI \> 35 and co-morbidities or significant risk factors. 25% adverse events (bloating, abdominal pain)

Answer 18

Significant of decreased all cause mortality, CV disease, cancer, diabetes (huge)

Answer 19

Obesity is a chronic disease, Risk factor for many other diseases, Manageable with lifestyle modifications and pharmacotherapy (in appropriate patients), Modest weight losses (5% to 10%) provide significant health benefits, Realistic expectations must be established