Positive Energy Balance, Obesity

Question 0

Internal control of energy intake

Answer 0

NPY from hypothalamus promotes eating 
Ghrelin release from empty stomach promotes hunger
Food causes:
Pancreas->insulin on adipose->leptin->satiety
GI tract-> 
CCK-> decrease stomach motility
PYY-> decreases ghrelin 
CCK, PYY, GLPI-> satiety

Question 1

Define obesity

Answer 1

Too much body fat to a extent it poses a risk to health
BMI greater than 30
Waste circumference men >102cm women >88
Waist to hip ratio m >0.9 w >0.85
Children above 95th percentile weight for height
1kg of adipose=7000kcal

Question 2

External factors effecting energy intake

Answer 2

Psychological
Palatability, variety 
Cost
Convenience 
Snack
Social pressure

Question 3

Genetic factors that are a risk factor for obesity

Answer 3

Monogenic syndromes-> parade willi, leptin deficiency

Genetic susceptibility-> Pima Indians

Question 4

Environmental risk factors for obesity

Answer 4

Lower exercise level 
Dietary components
Excess intake 
Over nutrition 
Not balanced

Question 5

Weight loss and maintenance

Answer 5

Requires lifestyle changes
Set realistic goals
Diet
Exercise

Question 6

Dietary advice

Answer 6

500kcal/day weight loss is manageable

1kg of adipose=700 kcal

Question 7

Orlistat

Answer 7

Oralistat:
Inhibits fat digestion and absorption
Sterrohea
For BMI>30 
Should've already lost weight 
Maintenance of loss rarely achieved

Question 8

Rimanabant

Answer 8

Blocks canabmoid receptors in brain
Mild side effects
Not for depressed people
5-10% loss in 60-70% of patients 
Regaine weight after

Question 9

Sibutramine

Answer 9

Inhibits serotonin reuptake-> satiety 
Adverse side effects in hypertension 
BMI >30
Not used for more than 12 months
Used in people with difficulty loosing weight 
Maintenance rarely achieved

Question 10

Lorcaserin

Answer 10

5-HT2cR agonist-> activates POM neurone-> inhibits NPY release
BMI >30
Mild side effects
5% loss in 40% of patients

Question 11

Bariatiric surgery

Answer 11

Decrease amount of small bowel
BMI >40
1200-1500kcal day
Deficiencies