Weight & Obesity Flashcards
Chemical produced by fat cells; binds to Hypothalamus to simulate SATIETY via activation of POMC neurons inhibiting MCH neurons
Leptin
Leptin works to (stimulate/suppress) appetite via (NPY/POMC) neurons
neurons in the lateral Hypothalamus)
Chemical produced by GI system; binds to Hypothalamus to stimulate HUNGER via activation of NPY neurons
Ghrelin
Ghrelin works to (stimulate/suppress) appetite via (NPY/POMC) neurons
Stimulate; NPY
Leptin is produced by (fat/GI tract)
Fat
Ghrelin is produced by (fat/GI tract)
GI tract
Leptin deficiency is responsible for most cases of obesity (True or False)
False; thought to be Leptin resistance
Which cells in the Hypothalamus respond to Letin (inhibited) and Ghrelin (activated)
NPY cells
Chemical synthesized in the BRAIN from polyunsaturated fats to stimulate food intake; may be cause of “munchie” with marijuana use
Endocannabinoids
How to calculate BMI
weight (kg) / height (m^2)
Normal BMI range
18.5-25
Shortcomings of BMI
Very muscular person (falsely high)
Older (more fat and shorter)
Female (more body fat)
People with a (apple/pear) fat distribution are at an inc. risk for Type 2 Diabetes
Apple (fat deposition is above waist)
What are the two largest energy stores in the body?
Adipose
Tissue protein
About ____% of energy breakdown is lost in the form of heat
80
We get ___ kcal of energy per gram of carbohydrate
4
We get _____ kcal of energy per gram of fat
9
We get _____ kcal of energy per gram of alcohol
7
What is Metabolic Adaptation?
With increased activity, there is a slowing of RESTING metabolic rate as a sort of “compensatory” mechanism; thought to contribute to weight regain
Structure in the Hypothalamus responsible for monitoring energy signals, such as nutrients, food intake, fat stores, etc.; composed of Orexigenic (appetite stimulating) and Anorexigenic (appetite suppressing) neurons
Arcuate Nucleus
Orexigenic neurons are (NPY/POMC) neurons in the Hypothalamus that function to (stimulate/suppress) appetite
NPY; stimulate
Anorexigenic neurons are (NPY/POMC) neurons in the Hypothalamus that function to (stimulate/suppress) appetite
POMC; suppress
Part of the Hypothalamus that receives inputs from the Arcuate Nucleus; activated by NPY cells and inhibited by POMC cells
Lateral Hypothalamus
“Classic” satiety signal from duodenal I-cells; secreted in response to lipids and proteins; reduces hunger and promotes a feeling of fullness
Cholecystokinin (CCK)
Cholecystokinin is secreted from _____-cells
I
Satiety signal from intestinal L-cells; inhibits GI motility and secretions, causing “ileal brake”; stimulates Insulin secretion and inhibits glucagon release
Glucagon-like Peptide-1 (GLP-1)
GLP-1 is secreted from ______-cells
L
Neurotransmitters that help control food intake (3 total)
Dopamine
NorEpi
Serotonin
*all work to suppress appetite
Most common cause of MONOgenic obesity
MC4-R deficiency (can’t receive inhibitory signals from POMC)
Best predictors for long-term weight loss maintenance
Motivational tools Regular exercise Eat breakfast every day Reduce calorie intake Regular weight monitoring
The Mortality of obesity increases rapidly after what BMI
> 30
A 20 pound weight loss is associated with what reductions morbidity/mortality?
20% lower death
~30-40% lower death from CVD, DM or Cancer
Medications account for ___% of obesity in the U.S. due to side effect profiles
10
*so be sure to ask your overweight patients about medications
Categories of drugs that are notorious for weight gain
Anti-psychotics (Risperidone, Clozapine, etc.)
Anti-depressants (Mirtazapine, Paroxetine, etc.)
Anti-diabetics (Insulin, Sulfonylureas, etc.)
Glucocorticoids
At what BMI range do we tend to start treating with medications in addition to diet and exercise?
> 30
*>35 we also consider surgery
What is a realistic weight loss goal for obese patients?
5-10% loss (by next visit)
Patients should exercise for _________ minutes per week, especially if they wish to lose weight
> 150
Behavioral changes that can help a patient lose weight
Eat only at table (no TV)
Small plates
No seconds
Only 3 meals per day
Drugs that are APPROVED for weight loss
Phentermine (short term) Orlistat Topiramate Lorcaserin Bupropion/Naltrexone
MOA for Phentermine (weight loss drug) (short term)
Stimulant related to amphetamine; dec. appetite and inc. satiety
MOA for Orlistat (weight loss drug) (long term)
Inhibits pancreatic lipase, dec. fat absorption
*also helps lipid profiles
Side Effects of Orlistat (weight loss drug) (long term)
assy
Steatorrhea
Vitamin deficiencies (A, D, E and K)
MOA of Lorcaserin (weight loss drug) (long term)
5HT2-C serotonin receptor agonist; dec. appetite and inc. satiety
What BMI range would you begin to consider surgery?
> 35
Examples of gastric surgeries used for weight loss
Lap Band (around cardiac sphincter) Gastrectomy Gastric Bypass Biliopancreatic Diversion (empty into ileum, delaying chemical digestion)
Supplements that patients will need after any Gastric surgery
Vitamin B1 (thiamine) Vitamin B12 Vitamin D Folate Iron Calcium Citrate
