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Obesity: Etiology and Treatment Obesity is considered to be an epidemic in the US. A whole lot of people are going to be obese at some point in their life. The prevalence of extreme obesity is higher in women than in men, but men are more likely to be overweight. Increase in obesity accounts for much of the increase in the total overweight/obese count. Causes of Obesity Genetics—more than 250 genes, markers and chromosomal patterns have been linked to obesity. you cannot control everything about your weight Environmental: Types of Food and lack of exercise Genetics are setting us up to be obese in the enviroment we are in. There is a strong correlation (NOT CAUSATION) between parent size and obesity. Gene-Environment Interaction is best described by the Pima Indians. In Mexico, they eat a nice Mexican diet (low fat) and in Arizona, they eat a normal America diet. In Arizona, there is a much higher rate of Obesity. BMI Assoxiated Disease Risk Underweight is less than 18.5 and is at increased risk Normal is 18.5-24.9 is at normal risk Overweight is 25.0-29.9 is at elevated risk Obese is over 30 and is at high risk Being overweight makes people die faster. Having metabolic Syndrome (which is highly correlated with obesity) greatly increases risk of cardiac mortality and mortality in general BMI in relation to Relative Risk of Death Best place to be in between 23 and 24 After you are 25, weight change has an effect on risk of DMII. Weight Gain greatly increases risk of DMII, note that normal weight increase is 10-15 pounds (which is huge risk 4-5X) Obesity costs America a lot. Multiple sectors affected 36% increase in medical costs Costs increased to employers by lost days Cost to tax payers by Medicaid/Medicare DOES LOSING WEIGHT HAVE BENEFITS? Losing weight helps with insulin resistance. You DON’T need them to get down to an ideal weight to see affects. Significant effects seen at 2.5% weight loss. Persons had increased insulin sensitivity. Weight Change and CHD risk factor sum loss of greater than 2.25 kg decreased sum by 48%. Gain of similar amount increased by 20% Plasma Lipids drop when people are actively losing. When weight is stable after weight loss, HDL will pop up. 10% weight loss will affect all lipids in panel, 5% will affect TG levels Weight loss decreased blood pressure and weight gain increased blood pressure X axis is in quintiles (boxes) Weight gain increases increases apnea and hypopnea and weight loss decreases it. 5-10% Weight loss will decrease HbA1c, BP, Total Cholesterol, and Triglycerides and will increase HDL cholesterol. This shows us that its not necessary to get to ideal weight. Work with the patient to lose 5-10% of weight to get positive benefits. WEIGHT REGULATION Most of Energy is stored in adipose tissue, even in lean persons. Our body has three major uses for energy Thermic effect of Feeding ~8% Energy Expenditure of Physical Activity (voluntary muscle activity, posture, fidget energy) This is under our control ~17% in sedentary, ~32% in active Resting Energy Expenditure~75% in sedentary, ~60% in active. Active persons also use ~400kcal/day more than Sedentary persons In General, Obese persons have higher resting energy expenditures, but they also have more tissue. Obese persons also report that they eat less and do more Regulation of Food Intake-Really important ones Leptin—made by adipose tissue. It inhibits Food intake Ghrelin—made by stomach and intestinal tract—Makes you hungry Just know that food intake is complicated To Control hunger, establish healthy meal habits Not eating changes the amount of ghrelin, which is a powerful stimulant. Many people will not eat, then eat way too much after. Small dietary imbalances cause weight gain. 12 calories more than needed per day cause a gain of 1 lb per year. RECOMMENDING WEIGHT LOSS Rapid weight loss can induce gall stones Short Term therapy does not cause long term weight loss. Within 5 years after stopping therapy, there is full weight regain, some times more. Follow up twice a month is necessary. You cant just give them a diet sheet and say, “Have fun!” Tx Pyramid Focus on diet and activity. There are a few drugs, but emphasize the diet and activity Surgery should be used seldom Treatments Pharcotherapy27-29.9 with comorbidities or above 30. Surgery35.5-39.9 with comorbidities or above 40 Decreasing Fat DOES NOT mean eat pretzals instead of chips. The goal of reducing cut the fat, you are reducing the calories not the quatinity. A teaspoon of carbs is 16 Cal and a teaspoon of fat has 45 Cal. Reduce the CALORIC INTAKE! Lowering fat usually decreases energy density of food. Foods that are more watery have less calories. The water will descrease the energy density. Exposure to more food will cause us to eat more. If you are presented with more food, you will eat more.
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