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Obesity Mgmt

Clinical Medicine II

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
Created by: becker15
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