Obesity

Question 1

Low physical activity levels and high BMI are associated with:

Answer 1

Increased Morbidity:

• Increased risk of acquiring a chronic or diabling disease

Increased Mortality:

• Increased risk of premature death

Question 2

BMI Classification

Answer 2

< 18.5 = Underweight

18.5 - 24.9 = Normal Weight

25-29.9 = Overweight

30-34.9 = Obesity I

35-39.9 = Obesity II

>40 = Extreme Obesity

Don’t forget to consider waist circumference…

Question 3

Trend in macronutrient intake

Answer 3

Total energy intake increased by ~200-300 kcals

Fat as a percentrage of total kcals decreased, but absolute fat intake increased

Question 4

Labor Saved, Calories Lost

Answer 4

“If a person was to decrease their energy expenditure by 111 kcals/day (and not change food intake), annual body weight might increase by 10lbs”

Question 5

Risk of Obesity

Answer 5

Genetic:

• Ethnic background
• Single gene defects
• Gene polymorphisms

Behavioral:

• Sedentary lifestyles
• Unhealthy eating habits

Environmental:

• Energy-saving devices
• Food more available
• Aggressive marketing
• Poor social trends

Question 6

Genetic Defects

Answer 6

Negatively Affect

• Energy expenditure
• Regulation of energy intake

Physical activity levels

Question 7

Important Note:

Answer 7

Genetics is a strong risk factor for Type II diabetes and obesity

Question 8

Putative Contributors

Answer 8

Microbial infections

Fetal programming

Increasing maternal age

Increased sleep debt

Antidepressants

Less variable ambient temperature

Question 9

Sleep and obesity

Answer 9

Prospective and cross-sectional studies have linked short sleep duration with increased weight gain

• Lowest risk at 7-8 hrs
• Short sleep alters hormonal regulation of appetite, increased intake of calories from snacks (EE increases ~5% while food intake increases ~40%)

Question 10

Medical Complications Associated with Obesity

Answer 10

Pulmonary Disease

Nonalcoholic fatty liver disease

Gall bladder disease

Gynecologic Abnormalities

Osteoarthritis

Skin

Gout

Phlebitis

Cancer

Severe Panreatitis

Coronary heart disease

Cataracts

Stroke

Idiopathic intracranial hypertension

Question 11

Osteopathic Considerations

Answer 11

OA of the knee

Plantar fasciitis and heel pain

Carpal tunnel syndrome

Rotator cuff tendinitis

Low back pain

Question 12

Knee OA and Obesity

Answer 12

Higher GRFs

Abnormal gait (bilateral abducted forefeet)

More rearfoot motion (heel pain)

Shortened stride … decreases load on knee extensors … increases load on hamstrings

Question 13

Summary

Answer 13

Prevalence is not likely due to changes in gene pool, but rather, changes in the environment have increased susceptibility in individuals with certain genetic traits

Monogentic mutation are sometimes associated with massice obesity, but this account for relatively few cases worldwide

Polygenic mutation may be assoicated with “garden variety” obesity, but evidence is not strong

Body fay distribution is more important than overall body fatness when considering metabolic health risk

Excess body fatness negatively impacts nearly every organ/system in the body

Metabolic and non-metabolic complications of obesity are improvved with even modest decreases in adiposity and increased physical activity