nursing 344 - obesity

obesity

chronic complex disease defined by excessive fat deposits that can impair health

weight bmi

• underweight: <18.5

• normal: 18.5-24.9

• overweight: 25-29.9

obesity bmi

• obesity class I: 30-34.9

• obesity class II: 35-39.9

• obesity class III: >40

bmi obesity treatment of care

• >25 - lifestyle modifications (diet, exercise, behavior)

• >27 with comorbidities + >30 without comorbidities - pharmacotherapy

• >35 with comorbidities + >40 without comorbidities - surgery

lifestyle modification treatment

• high-intensity, in-person diabetes prevention programs

  • 12 visit in 6 months

  • personalized feedback

women and men circumference

• women waist circumference: <35

• men waist circumference: <40

best predictor for metabolic disorders

• diabetes

• hypertension

• dyslipidemia

visceral obesity

• apple shape

• fat around abdomen and upper body

• associated with more obesity complications than peripheral

visceral fat factors

• high risk of insulin resistance and disease

• more visceral fat = shorter lifespan

subcutaneous fat vs visceral fat

• as people get older:

  • visceral fat>subcutaneous fat

  • leads to worse metabolic health compared to younger people

peripheral obesity

• pear shaped

• distribution of body fat is extraperitoneal

• distributed around thighs and buttocks

types of adipose tissue

• white adipose tissue (wat)

• brown adipose tissue

white adipose tissue

• store energy

• most of surface fats

brown adipose tissue

• burns energy

• located mostly on shoulder and necks

adipose tissue functions

• insulation

• immune cell function

• energy reserve

hypertrophy

• too much fat in wat

  • hypoxia in wat

  • induces inflammation

  • metabolic issues

what happens in body for mild chronic inflammation of adipose tissue?

• insulin resistance

• atherosclerosis

• coronary heart disease

leptin

• expressed by adipocytes

• acts on hypothalamus

• involved in satiety and appetite

• high leptin does not = weight loss

adiponectin

• regulates insulin sensitivity

• high adipose leads to low adiponectin

risk factors for obesity

• genetics

• neurohormones: brain + hormones controlling hunger

• sleep: low sleep = high hunger

medical conditions risk factors

• hypothyroidism: slow metabolism

• pcos: hormone imbalance = weight gain

• hypogonadism: low sex hormone = high fat

• cushing’s syndrome: too much cortisol = fat buildup

medication risk factors

• steroids: high appetite

• antidepressants: can alter appetite/metabolism

• antidiabetics (like insulin): promote fat storage

endocannabinoids

effects regular appetite and digestion

ghrelin

hunger hormone

resistin

• pro-inflammatory that makes insulin resistance higher

• increase when fat storage increases

• when high: type 2 diabetes, dyslipidemia, metabolic syndrome

neurologic - obesity complications

cerebrovascular accident (cva)

cardiovascular - obesity complications

• hypertension, myocardial infarction

• pvd, venous thrombosis

• hyperlipidemia

respiratory - obesity complications

• sleep apnea

• low ventilation

• pneumonia

• asthma

orthopedic - obesity complications

• immobility

• osteoarthritis

• chronic pain

gastrointestinal - obesity complications

• non-alcoholic fatty liver disease

• gallstones, gerd, abdominal hernia

• diabetes

genitourinary - obesity complications

• infertility + low testosterone

• kidney stones + urinary incontinence

• bph + erectile dysfunction

cancers - obesity complications

• breast cancer

• endometrial cancer

• liver cancer

• prostate cancer

childhood obesity

• bmi >95th percentile = obese

• obese children = obese adults