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Obesity Mgmt
Clinical Medicine II
Question | Answer |
---|---|
What are the ethnic variations in obesity | NA>AA>Hispanic>caucasion,low SES and education, Rural>urban W>M, Age |
What ↑ prevelance of obesity | sedentary life-styles, eating patterns, abundance of food |
What is obesity comorbities to (5) | HD, cancer, stroke, DM, HTN (now listed 2nd leading COD) |
How has child obesity changed over the years | 3 fold increase! |
Causes of childhood obesity | not eating to guidelines, not enough fruits and vegetables, ↑ sweetened bevereages, ↑tv and game time, too little exercise |
Where does endocrine control of appetite come from | hypothalamus, many of them, |
What are factors of hunger | endocrine, behavioral/environmental, psychological, cultural, psychological, cultural self control |
Where does satiety come from | neural, hormonal and metabolic fb (hypothalamus) |
Hormonal influences from the GI system on appetitie | polypeptide YY, CCK, neuropeptide Y, leptin, ghrelin, insulin |
What produces ghrelin, fxn | stomach & pancreas, stimulates hunger, ↑ before meals and↓ after meals |
Counterpart to ghrelin | leptin |
What ↑ghrelin levels | rise w/ dieting and wt loss, makes it difficult to lose weight |
Why does gastric-bypass ↑ wt loss? | reduced levels of ghrelin, satiety occurs earlier |
What produces leptin | apidose tissue, signals level of energy reserves to hypothalamus, induces satiety when at higher concentrations: ↑ leptin ↓ food intake, |
Functions of leptin | modulates satiety and hunger, modulates energy expenditure |
When does insulin rise and fall | low bw meals, higher during meals |
Fxns of insulin | promoting fat synthesis, insulin promotes weight gain, want to control the trouphs and peaks |
What are incretins | GI hormones, glucagon-like-peptide-1, gastric-inhibitory-peptide, inhibits glucagon release and HGP production |
Fxn in incretins | promotes insulin sensitivity, ↓ gastric emptying, ↓ abosorption,→ ↓ food intake |
Two supplements of incretins | Byetta and Victoza |
Long term affects of incretins | pancreatitis, glucose intolerance |
What is amylin | islet amyloid polypeptide (IAPP), ↓ appearance of nutrients/glucose in plasma, inhibits glucagon, ↓ insulin needs, promotes satiety, ↓ food intake, slows gastric empyting, inhibits digestive secretion |
Where is amylin secreted from | beta bells from the pancreas w/ insulin |
What is #1 cause of obesity | genetics as much of 70% varability of BMI bw individuals |
What is # 1 cause of prevalence in obesity | environment |
What are different genetic factors contributing to obesity | metabolic rate, thermic response to food, spontaneous physical activity, ethnic differences and pattern of weight gain |
What does and ↑ of LBM lead to | ↑ basal metabolic rate (but is NOT proportional!) |
A person w/ a low BMR might need what | 300-500kcals less per day |
What is the < amount of calories needed for BMR | not <1000kcals/day |
What affects thermogenesis | brown adipose tissue (in human infants and other mammals used for heat production and cold adaption) possibly see is some adults? |
What is TEE | total energy expenditure, BMR, is often lower in obese patients |
What happens with hyperthyroidism | hypermetabolic, and ↑ temperature (thermogenesis?) |
What is the set point theory | in prisons, fed some people twice as much (different amounts of wt gain) some returned to their normal wt, some did not |
Many endocrine causes to obesity | Hypothyroidism, menopause, PCOS, ↑ cortisol levels, insulin resistance |
How does menopause cause obesity | ↓ estrogen and GH→rapid ↑ in visceral fat |
Why can both low and high levels of leptin cause hunger | leptin causes ↑food intake, but in obesity, there may be a defect in the receptor, leptin resistance? |
What gene can be linked to obesity | leptin gene, seen hypogonadotropin hypogonadism, |
Leptin levels in most obese individuals | elevated (defective |
What may be linked to insulin resistance | high carbohydrate diets and high glycemic index foods |
↑ carbs causes what | ↑ insulin, down regulation of receptors? Diabetes |
What does hyperinsulinemia cause | fat synthesis, insulin inhibits lipolysis, euglycemia preferred |
What does physical activity have on obesity | greatest impact on prevention and maintenance |
How do we lose weight | input |
What is the greatest impact on wt loss and maintanence | physical activity or exercise |
How does wt gain overlap with psych issues | ↑ wt w/depression and antidepressant medications |
How many kcals is 1 pound | 3500 |
How many kcals/day will show wt gain | 100kcal/day, 10kcal/day will show overweight in 25 years… |
Problem w/ DM tx | start them on insulin, usually show wt gain initially |
What is accounting for the rising INCIDENCE of obesity | eating patterns, lack of activity, and life-style changes |
What is MC etiology of obesity | genetics |
How do we dx a pt w/ obesity | BMI, Waist circumference, comorbid conditions |
BMI classifications | overweights 15-30, obese: >30, mod: 30-35, severe 35-40, very severe >40 aka class I, II, III of obesity |
Obese waist circumference | Men >40 Women >35 |
What disease does upper body waist fat distribution associated w/ | insulin resistance, DM, HTN, Hyperlipidemia, CVD, metabolic syndrome, hyperandrogenism |
Cardiac risks | HTN >140/90, LDL >160, HDL <35, FBG 110-125, FHx M<55, F<65, Physical inactifity, TG >200 (>3: high risk) |
When do we address the obesity issue | if there is a concern for medical necessity or if the pt asks (even tho we want to prevent…) |
Lifestyle modifications | diet, exercise, behavior modifications |
3 ways to lose wt | lifestyle modifications, pharmacotherapy, bariatric surgery |
How do we promote wt loss w/ food intake | ↓ intake 500-1000kcal/day for 1-2lb/wk loss |
How do we maintain wt loss for sedentary adults | ↓ 20-25 kcal/kg |
What are some meal plan patterns | exchange diet, My pyramid, NCEP dietary guidelines/DASH, 2005 diet for Americans |
What will ↑ LBM and BMR | exercise, particularly resistance training |
How can we control rebound hunger | ↓ CHO intake |
Goal fat intake | 30% calories |
Wt loss program should include what | diet, exercise, behavior modifications |