Obesity

Epidemiology

• over 40% of adults are obese

• presence of signification geographic, racial and ethnic, and income disparities

• 1 in 10 children become obese as easy as ages 2-5

• Obesity rates are highest: in south, black and hispanics, lower income and less educated

Energy Expenditure

• too much calories in and not enough energy expended

• Recommended: 150-300 min/week moderate intensity and strength training 2x/week

Environmental Factors

• increase access to food with poor nutritional qualities

• common to underestimate food and caloric intake

• lack of physical exercise — sedentary habits

• low socioeconomic status

Obesity : Patho

• body weight beyond physical requirements

• abnormal increase and accumulation of fat cells (increase in fat mass)

• adipocytes: increase in number (hyperplasia) and increase size (hypertrophy)

• large increase in lipid storage

• preadipocytes are triggered to become adipocytes once storage of existing fat cells is exceeded

Production of adikopines

• contribute to insulin resistance, dyslipidemia and hypertension

• may disrupt immune factors and predispose to certain cancers

Obesity: Hormonal Component

• Leptin: satiety (released by adipocytes, tells body we have had enough to eat and to stop eating

• Ghrelin: Hunger (released by stomach, tells brain we are hungry)

• Insulin: glucose regulation (released by pancreas)

Psychosocial Factors: Obesity

people use foods for many reasons

• comfort and reward

• associations begin in childhood

• sense of satiety can be altered

• mindless eating

• eating is social and often associated with please and fun

Obesity: cardiovascular problems

• increase risk of heart attack and stroke

  • android obesity (abdominal obesity) patients are at greatest risk: increased LDLs (bad), high triglycerides, decreased HDLs (good)

• Hypertension

Endocrine Problems: Diabetes

• greater risk of type 2

• excess weight makes endogenous insulin less effective, too much glucose stays in blood stream and more insulin is made

• pancreatic beta cells get overworks and worn out and can no longer keep Blood Glucose in normal range

• excess weight makes drug treatment less effective

  • hyperinsulinemia

  • insulin resistance

  • glucose intolerance

Obesity: GI and Liver Problems

• GERD

• Gall stones

• Nonalcoholic Steatohepatitis (NASH)— lipids are deposited in the liver, resulting in fatty liver

  • can eventually lead to cirrhosis

  • weight loss can improve NASH

Obesity: Respiratory and Sleep Problems

• sleep apnea

• obesity hypoventilation syndrome

• weight loss can improve lung function

• poor sleep and sleep deprivation may increase appetite

Obesity: Musculoskeletal problems

• osteoarthritis

  • stress on weight bearing joints: knees and hips

  • obesity triggers inflammatory mediators

  • cartilage deterioration

  • higher incidence of hyperuricemia and gout

Obesity: Cancer

• obesity it one of the most important preventable causes of cancer

• increase rates of these cancers:

  • thyroid

  • liver, kidney, colorectal, gallbladder

  • breast and endometrial— may be associated with excess estrogen

Obesity: Psychosocial Problems

• stigmatization: low self esteem, social isolation, depression

• discrimination in employment, education and health care

Obesity: Drug Therapy

used only in conjunction with calorie reduction diet, exercise and behavior modification

• mechanisms: 

  • increase satiety: fullness (liraglutide and semaglutide)

  • decrease fat absorption (orlistat)

• NOT recommended: amphetamines

• Short Term ONLY: nonamphetamine—- phentermine and naloxone

Metabolic Syndrome

• increase risk of CV disease, stroke and diabetes

• 5 Criteria: any 3 out of 5 to be diagnosed

  • increased waist circumference, triglycerides, BP, fasting glucose

  • decreased HDL cholesterol