Obesity by xiaoyounan


									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

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


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


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.


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

      Pharcotherapy27-29.9 with comorbidities or above 30.
      Surgery35.5-39.9 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

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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