``` endocrine organ makes adipocytokines white fat (adults & insulation/cushioning/hormones) brown fat (newborns & thermogenic) ```

Obesity Flashcards by Marissa Robertson

Obesity prevelance

33% 250 billion spent

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obesity contributing factors

genetics
behavioral
metabolic
environmental
socioeconomic
physical inactivity/sedentary lifestyle

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healthy people 2030

^ office visits by adults who have obesity
^ consumption of fruits/veggies, dark/green/red/orange veggies/grains/calcium/potassium/vitamin D age 2+
Screen time below 2H/day

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caloric intake vs caloric use

hunger & satiety r/t appetite
vs
controlled by metabolic rate (thyroid hormones/activity levels)

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short-term appetite regulators

oral receptors
GI tract hormones
stomach stretching

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intermediate/long-term appetite regulators

increased BG
adipose leptin
increased blood ketoacids

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Hypothalamus

regulates appetite/energy homeostasis
input from peripheral organs
ARC (arcuate nucleus)
also cognitive/memory/feeling components

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Adipose Tissue

endocrine organ 
makes adipocytokines
white fat (adults &amp; insulation/cushioning/hormones)
brown fat (newborns &amp; thermogenic)

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Adipocytokines

leptin (increases w/ adipose creation, causes satiety)

Adiponectin (decreases with increased adipose, regulates insulin sensitivity)

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Leptin

inhibits appetite @ hypothalamic

reduces peptides that increase intake

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cholecystokinin

stimulates digestion of fat/portein

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glucagon-like peptide-1

incretin

enhances seretion of insulin

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peptide YY

reduces appetite

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ghrelin

“hunger hormone”

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adiponectin

glucose regulation

fatty acid oxidation

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genetic obesity

monogenic or polygenic
disrupts leptin-melanocotrin pathway
prader-willi

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inflammation & obesity

adipocyte become lipid laden & hypertrophied
cellular stress occurs
adipose tissues produce chemicals that trigger inflammation

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Insulin resistance

impaired glucose transport into insulin sensitive cells
more insulin needed to maintain normal blood glucose
hyperinsulinemia (r/t obesity, impaired glucose tolerance, ^ weight/BMI)

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Visceral Adiposity

central fat distribution
increases LDL (increased risk for heart disease)
increased body weight (increased cardiac workload, risk for cardiomyopathy and heart failure)

Reactive oxygen species

highly reactive/unstable molecules
damage other molecules (proteins/lipid/cho/DNA)
impair cell membrane receptors
signaling pathways

oxidative stress

due to increased ROS and decreased antioxidant
defenses
can begin in childhood and lead to progressive damage

antioxidant defenses

vitamin E/C
plant flavonoids (bright fruits/veggies)
enzymes (superoxide dismutase & glutathione peroxidase)

Oxidative stress r/t obesity

hyperglycemia
increased ROS production
decreased antioxidants
chronic inflammation 
increased lipids
hyperleptinemia

metabolic syndrome

insulin resistance
increased visceral fat
increased release of free fatty acids (impairs hepatic insulin clearance)
alterations in peripheral metabolism

metabolic syndrome criteria

``` need 3/5 increased waist circumference (M 40+ F 35+) elevated triglycerides (150+) elevated BP (130/85 +) elevated fasting glucose (100+) reduced HDL (M <40 F <50) ```

obesity health risks

``` reduced quality of life shortened lifespan diabetes orthopedic problems liver disease endocrine changes htn heart disease osa gallbladder disease musculoskeletal/skin disorders cancer ```

maternal obesity considerations

``` pregnancy induced HTN gestational diabetes thromboembolism respiratory complications cardiovascular complications preterm delivery cesarean delivery ```

Phentermine

``` amphetamine-like short-term use BMI 30+ or 27 w/ RF requires behavioral modifications BBW: increased risk of pulmonary HTN ```

obesity tx

surgery gastric banding/gastric bypass (clipping/cutting stomach but can grow back) lifestyle some meds

obesity med history

``` bad addictive heart valve defects stroke cardiac events ```

Orlistat (alli, xenical)

lipase inhibitors blocks absorption of fats in small intestine also blocks fat-soluble vitamins/warfarin small decrease in weight must take 1H before meal w/ fats SE: flatus, oily stool, fecal incontinence, ab pain, headache

Anorexiants

appetite suppressants

diethylpropion

similar to amphetamine limited to 12 weeks (tolerance) CNS effects

phentermine/topiramate

effects hypothalamus decreases appetite CNS side effects seizures if discontinued quickly

locaserin

effects hypothlamus | causes feeling of fullness

bupropion and naltrexone

increases dopamine = decreased appetite | can cause suicidal behavior

malnutrition

acute/chronic illnesses unable to use nutrients

under-nutrition

``` can't intake nutrients old age HIV-AIDS alcoholism burns cancer IBD eating disorders GI disorders surgery trauma ```

malnutrition/under nutrition s/s

generalized weakness muscle wasting loss of subcutaneous fat dry/flaky skin

enteral nutrition

admin via GI tract oral or feeding tube (NJ/NG/gastostomy) may still be eating

polymeric

undernourished w/ functioning GI tract

elemental (monomeric)

malabsorption disorder

semi-elemental (oligomeric)

easily obsorbed

modular

disease specific w/ single nutrient

TPN

requires CVC | check BS and triglyceride levels

Maramus

too few calories and too little protein affects somatic more s/s: progressive loss of muscle/fat stores, wasted appearance, wrinkles, sparse hair, low HR/BP/temp, diarrhea, impaired immune system like COPD CHF cancer and HIV

Kwashiorkor

``` adequate calories too little protein more severe affects visceral more hypoalbuminemia (=edema) desquamating skin (peeling) reddish hair muscle wasting SQ fat normal hepatomegaly distended abdomen tachycardia r/t trauma, burns, spesis ```