Obesity

etiology

E imbalane

genetic

metabolism

behavior

environment

culture

socioeconomic

medical conditions

meds

etiology: genetics

associated chrom mutations --> no leptin gene, mutation in lepton receptor gene, mutation of adipocytes TF gene

etiology: socioeconomic

poor socio = high obesity, low income = high obesity F

etiology: cushing syndrome

high cortisol = high appetitie = high obesity

etiology: hypothyroid

low TH = high appetite = high obesity

etiology: insulinoma

high insulin = high appetitie = high obesity

adipose tissue

composed of metabolic active, endocrine, inflammatory adipocytes that provides insulation, E storage, cushion

adipokines

cytokines in fat tissue

adipokines: adiponectin

enhances insulin insensitivity, anti inflammatory, protective against CVD, low adiposity = high adiponectin

adipokines: leptin

inhibits appetite

adipokines: resistin

increases insulin resistance, increases triglyceride

adipokines: inflammatory mediators

TNF-a and IL-6 reduces insulin activity, promotes lipolysis

adipokines: vascular mediators

AGT increases bp, PAI increases clot info

adipokines levels in obesity

increase leptin, resistin, AGT, PAI, TNF-a, IL-6, lipolysis

decrease adiponectin

diagnosing obesity

hydrostatic weighing

bio electrical impedance

skin fold thickness

girth measurements

MRI

CT

DEXA

Bod pod

complications

cerebral/CAD artherosclerosis

MI

stroke

HTN

L ventricular hypertrophy

pickwickian syndrome

gall stones

DM

hyperlipoproteinemia

treatment: dietary

using caloric restriction 500-1000 less than usual intake, diet composition of limited fats and no processed foods

treatment: physical activity

150 min/wk to reduce abdominal fat, increase cardiorespiratory fitness, prevent decrease of muscle mass

treatment: behavior therapy

self monitor eating habits, establishing self-control, support system, stress management, realistic goal making

treatment: pharmacotherapy

meds to those who have BMI > 30 or BMI > 27 with other risk factors

pharmacotherapy: reduce food intake

CNS - decrease hunger = increase satiety

pharmacotherapy: act out brain

decrease lipid absorb in small intestine = reduces stomach space

lorcaserin

serotonin receptor agonist to increase satiety - peripheral signals --> 5-HT --> ARC --> POMC --> increase satiety

orlistat

fat blocker to decrease amt of fat being absorbed --> increase secretion --> decrease weight

plenity

expands and fills stomach to make less room for food --> increase satiety

bariatric surgery

weight loss surgery for those who have BMI > 40 or BMI > 35 with comorbid conditions where therapies have failed

bariatric surgery: adjustable band procedure

silicone band is placed around upper portion of stomach to decrease food intake but increase satiety tolerance

bariatric surgery: roux en y gastric bypass

small pouch is connected directly to small intestine bypassing most of stomach to reduce caloric absorb and food intake

limit: roux en y gastric bypass

change diet to lifetime vitamin supplement, high protein low fat