obesity Flashcards
energy cause of weight gain
E in exceeds E out
increase intake - decrease expenditure
describe components of energy expenditure
intake = metabolism and storage
energy is expended by - adaptive thermogenesis (regulated by the brain, temp and diet, occur in brown adipose tissue, skeletal muscle), physical activity, obligatory energy expenditure (basal, for performance)
env/genetic
there is a genetic impavct but the main factor is environment #
disease of aging
once you have crossed the weight percentile - chance of getting off is tiny
higher in lower social classes
describe the genetic contribution to obesity
200 genes associated with weight gain
genes are there to protect against malnutrition
they are orexigenic/anabolic molecules
or anorectic/catabolic molecules
orexigenic/anabolic molecules that regulate body weight
Neuropeptide Y (NPY) Agouti gene related peptide (AGRP) Agouti-related transcript (ART) Melanin-concentrating hormone (MCH) Dopamine
anorectic/catabolic molecules that regulate body weight
Leptin receptor (LEPR) Pro-opiomelanocortin (POMC) Melanocortin receptor 4 (MCR4) Corticotropin releasing hormone (CRH) Serotonin receptor subtype 2C (5-HT2C) Glucagon-like peptide 1 receptor (GLP-1R)
how many extra calories would be needed for weight gain
0.02% increase a year = 3500Kcal/yr = 1lb weight gain a year
financial complications of obesity
£49m
because it causes so many other conditions
effects of obesity
depression IHD gallstones cancers infertility strole sleep apnoea hyopertension diabetes - inmsulin resistance osteoarthritis gout
effect of bariatric surgery
absorb less from food
depression lifts as you lose the weight
sustainable weight loss
how do you measure waist circumference
midrib between the lowest rib and iliac crest
1cm above naval
accuracy difficult inf BMI >35
what are the interpretations of waist circumference
action level 1 women >=80cm, men >= 94cm - health risk increasing - take personal action to avoid weight gain
action level 2 women 88cm, men 102cm multiple health problems, professional health needed
what is the effect of 10% weight loss
improves all aspects of the metabolic syndrome 50% fall in 10% decrease in cholesterol 15% LDL 30% triglycerides 8% rise in HDL improvement of BP of 10/120mmHg
20-25% reduced mortality
30-40% reduction in diabetes related mortality
40-50% reduction in cancers
difficulty with such good results at 10% weight loss
difference in perception of management - feel like its failure and bounce back
recommendations from NICE
diet Exercise Behavioural therapy Drug treatment Surgery (if BMI >40)
what are the weight loss outcomes after interventions
weight is lost for 6months and then regained after
this is because the support is stopped after 6months so people find it difficult to carry on
what diseases are associated with an increase in BMI
T2DM - tightest relationship
cholelithiasis
hypertension
CHD
how is T2DM related to obesity
genetic fault in pancreas anyway
being obese dribes you over the edge - insulin resistant - more fat stored in the liver and pancreas = toxic
2 body shapes casued by obesity
android - apple
gynoid - pear
how can people with same BMI have different risk
fat that is stored around organs = higher chance for CHD and T2DM
affects liver and metabolism
immune cells present - become inflamed because there is a lot of fat
dictate metabolism
blood goes through adipose and to the liver
effect of increase of visceral fat
deteriation in metabolic disease
many systems go wrong
how does the body respond as you try to lose weight
nutritional hormones that regulate diet are increased -
peptide YY and ? increases
people feel more hundry - their physiology works against them
what happens to the diabetes level when people are given continuous support
there is a reduction in T2DM
antiobesity drugs
most withdrawn - they have effects on other functions
antiobesity drug nad its side effects
serotonin
depression and hypertension - taken off market
best way to tackle obesity
need to treat it as a pathway
so that people cant drop off
tier 1 of the anti obesity pathway
overweight - can exit here
delivery to everyone
behavioural changes
tier 2 of obesity path
overweight/obese
lifestyle weight management
delivery - community/GP
tier 3 of obesity path
very obese/morbidly obese individual
MDT
tier 4 obesity path
very obese/morbidly obese individual
bariatric surgery
supported by MDT pre and post operatively
delivery - MDT
