Obesity Flashcards
Obesity prevelance
33% 250 billion spent
obesity contributing factors
genetics behavioral metabolic environmental socioeconomic physical inactivity/sedentary lifestyle
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
caloric intake vs caloric use
hunger & satiety r/t appetite
vs
controlled by metabolic rate (thyroid hormones/activity levels)
short-term appetite regulators
oral receptors
GI tract hormones
stomach stretching
intermediate/long-term appetite regulators
increased BG
adipose leptin
increased blood ketoacids
Hypothalamus
regulates appetite/energy homeostasis
input from peripheral organs
ARC (arcuate nucleus)
also cognitive/memory/feeling components
Adipose Tissue
endocrine organ makes adipocytokines white fat (adults & insulation/cushioning/hormones) brown fat (newborns & thermogenic)
Adipocytokines
leptin (increases w/ adipose creation, causes satiety)
Adiponectin (decreases with increased adipose, regulates insulin sensitivity)
Leptin
inhibits appetite @ hypothalamic
reduces peptides that increase intake
cholecystokinin
stimulates digestion of fat/portein
glucagon-like peptide-1
incretin
enhances seretion of insulin
peptide YY
reduces appetite
ghrelin
“hunger hormone”
adiponectin
glucose regulation
fatty acid oxidation
genetic obesity
monogenic or polygenic
disrupts leptin-melanocotrin pathway
prader-willi
inflammation & obesity
adipocyte become lipid laden & hypertrophied
cellular stress occurs
adipose tissues produce chemicals that trigger inflammation
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)
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
