Obesity Flashcards
Obesity Assc w
classified as
poorly defined correlation
better correlation uses ___ and comorbids
Men waist circum and waist to hip ratio
Women waist circum and waist to hip ratio
comorbidities, shortened life expectancy
inc BMI
to comorbidities
centripetal obesity
102 cm (40in) or .9
88cm (35 in) or .85
indicates high values
Obesity Linked to
Main cerebral center controlling food intake
Lateral hypothalamic area fxns as
Ventromedal hypothalamic area serves as
inc calorie intake beyond need for metabolism/
activity
arcuate nucleus in hypothalamus
feeding center- food intake
satiety center- inhibiting food intake
Stimuli for food intake
released to stimulate
Stimuli for satiety
stimulate satiety through
Insulin/Leptin trigger satiety via
Ghrelin stimulates food intake via
nueropeptide Y, AgRP
food intake or antagonise MC4R (satiety)
POMC and CART
MC4R
antagonizing NPY nad AgRP, stimulating POMC/CART
stimulating NPY/AgRP release
Genetic alterations
MC4R mutation
Agouti gene expression
AgRP overexpression
prevents bind of alpha MSH, a derivative of POMC
altered via epigenetic mechanisms- methylation dec gene expression, environmental factors lead to hypomethylation/inc gene expression
inhibits satiety signal from AMSH binding at MC4R
Fasting state, stomach releases
W consumption
With food in SI
GLP1 inhibits food intake via
consumption of fat leads to
Ghrelin- stimulates lateral hypothalamus
Ghrelin inhibited, digestive hormones released
GLP1 released from intestinal enteroenddocrine cells
inc insulin/glucagon sec, inibits gastric emptying
CCK, inhibits gastric emptying
Carb intake stimulates
Incompletely digested nutrients enter ileum and colon
Adipocytes release
Leptin binds to cells in
Excessive intake or insulin
panc release of insulin- inhibits food intake
EE cells release peptide YY, inhibiting food intake/gastric emptying/intestinal motility
leptin proportional to fat mass
Lateral/VM hypothalamus to inhibit food intake
inc release of leptin
Mutation in leptin inc propensity to
Usually results in dec
these individuals will
develop obesity
leptin protein/receptor
consume excess calories/have low BMR
Brown adipose tissue found
abundance of
After infancy, ___ dominates
White fat fxn
Beige fat fxn
during infancy
mito in cells responsible for thermogenesis
white/beige fat
energy storage, few mito
moderate amount of mito, undergo thermogenesis in response to stress
MC genetic cause for obesity
FTO gene produces
plays a key role in
inc activity results in
Risk alleles have been identified
inc white fat prodxn
enzyme removing methyl groups from DNA
direct fat cell differentiation
higher body weight
inc risk for obesity
Wl accompanied by
After months, a rebound in
Research indicates this doesnt happen as often, so there is a need to
NT and hormones in person w obesity
excessive cals stored as, wl less likely to be followed with
dec BMR- natural survival response to conserve energy
Met rate back to baseline
dec cal intake over time
differ
fat mass, dec met rate
Environmental influences are
play role in
Consumption of ____ inc development of obesity
most significant in
essential
epigenetic alterations, impact cal intake and expenditure
sugar sweetened bevs/sat fat
children, FTO gene
Sedentary lifestyle
another consideration
this leads to an inc
inc risk for obesity
sleep deprivation- dec serum leptin, inc ghrelin
consumption of high carb foods
Many drugs result in
most w
Atypical antipsy C/O/R
TCA A/C/I
antiepileptics V/C
DM I/S/T
Exogenous
weight gain
clozapine/olanzapine/risperadone
amitryptiline, clomipramine, imipramine
valproic acid/carbamezipine
insulin, sulfonylureas, thiazolidinediones
CS
Medical conditions
Childhood
Leads to central obesity in
CS induce
Hypothyroidism
Hypothalamic obesity assc w
result of
GH deficinecy
Cushing’s syndrome/inc CS
face, neck, trunk, ab
11BHydroxysteroid dehydrogenase, inc lipogenesis
slows metabolism- modest wg (wl w meds)
damage to VM hypothalamus (hyperphagia)
massive trauma or hypothalamic dz/surgery
inc central adipose
Childhood obesity common pops
In adulthood
obesity more prev in
American Indian, Black, Mexican
all ethnicities except Asian Americans
Low income pops
Physiologic effects mediated via
Ab adipose tissue has inc propensity to
FFA in liver leading
Inc VLDL inc circ
FFA stimulates pancreas to release
serum glucose in
central adipose tissue
release FFA- induce change in liver, muscle and panc
steatosis (NAFLD), inc gluose/TG/VLDL release
dec HDL and inc LDL
insulin, muscle becomes insulin resistant- fat in muscles
insulin resistance
Obesity inc risk of
indiv w ____ obesity at greatest risk
inc body weight also effects
OSA/obesity hypoventilation result from
Adolescent obesity assc w
Adult obesity assc w
CV dz, hyperlipidemia, DM< HTN, biliary stones, Ca
ab (metabolic syndrome)
breathing/MS function
obstructed upper airway (adipose tissue)
SCFE- bc strain on physis
OA/gout
Screening for, obtain
BMI >25 obtain
waist circumference important bc of
BMI can be, look for
all patients, accurate w/h
w/h circumference
metabolic syndromes
misleading (lots of muscle mass), waist or w-h ratio
Central obesity pt, clinician looks for
such as
obesity in childhood/adolescne at risk for
Test for
DM, LD, hyperlipidemia
contributing factors/comorbids
sedentary, inc calorie intake, meds
DM/CV dz
Fasting glucose and HbA1c (DM), liver enzymes (NAFLD), lipid profiles (hyperlipid)
Primary goal of mx
mainstay of mx
Meds/surgery debated in, limited to
prevent/reverse comps
lifestyle modification
children, obese and fully mature who have failed lifestyle modfication
Complication and Recommended intervention
BMI 25-30
27-30
30-40
35-40
40+
None- diet, exercise
HTN, DM, HL, OSA- diet, ex, meds
None- diet/ex/meds
2+: HTN/OSA/NAFLD/OA/HD/GI/HL- add surgery
None/any- same
Goal of treatment
wl of 3-5% assc w
dec in BP w
lower weight
reduced TG/blood glucose/DM
wl of 7-10%
successful diet/exercise leads to
for children, focus on
red met rate, must
even if met resistant, cal intake less than 1000
5-7% wl
health diet/exercise
reevaluate cal goals
leads to wl
Best diet
key is to
Exercise effect is _____ calorie burn
Goal for patients w exercise
balanced
modify/monitor cal intake
overestimated
mod exercise 150+ min wk, maintaining wl and cv benefit
