Obesity

Question 1

[Review] What do anabolic and catabolic mean?

Answer 1

Anabolic: synthesis (think “anabolic” steroids to build muscle)
Catabolic: breakdown (cats break things down)

Question 2

[Review] What is BMR?

Answer 2

Basal metabolic rate: energy required for body maintenance.

Question 3

What is the average BMR?

Answer 3

10kcal/lb.

Question 4

What 2 factors decrease BMR?

Answer 4

1. High adipose tissue.

2. Low muscle tissue.

Question 5

Which 3 populations tend to have high adipose tissues (and subsequently, low BMR)?

Answer 5

Females (d/t estrogen).
Elderly.
Obese pts.

Question 6

When would we see an increase in energy/BMR requirements?

Answer 6

Illness/infection.

Exercise.

Question 7

What is the primary regulator of hunger?

Answer 7

The hypothalamus.

Question 8

What is the primary hormone that stimulates hunger?

Answer 8

Ghrelin.

Question 9

Where is ghrelin synthesized?

Answer 9

The stomach.

Question 10

Besides ghrelin, what other hormone stimulates hunger?

Answer 10

Dopamine.

Question 11

Which 2 chemical mediators stimulate the feeling of satiety?

Answer 11

CCK (cholecystokinin).

PPY (peptide YY).

Question 12

Which hormone is considered the “opposite of ghrelin” because it stimulates satiety?

Answer 12

Leptin.

Question 13

List 3 possible causes of low hunger drive.

Answer 13

1. Sympathetic stimulation.
2. Low iron.
3. Meds.

Question 14

What is the primary purpose of brown adipose tissue?

Answer 14

Thermogenesis for insulation.

Question 15

Who has the highest % of BAT?

Answer 15

Infants.

Question 16

Adults in _________ will have higher BAT.

Answer 16

Cold climates.

Question 17

What are 3 purposes of white adipose tissue?

Answer 17

Energy.
Insulation.
Organ protection.

Question 18

Breakdown of WAT for energy is stimulated by:

Answer 18

Lipase.

Question 19

List the 3 substances synthesized by WAT.

Answer 19

Leptin.
Adiponectin.
Cytokines.

Question 20

What are 4 functions of adiponectin?

Answer 20

1. Suppress fatty acid influx into the liver.
2. Increase fatty acid oxidation (breakdown).
3. Enhances insulin function & glucose uptake.
4. Anti-inflammatory.

Question 21

What are 3 outcomes of high WAT r/t the 3 substances synthesized by it?

Answer 21

1. Decreased leptin BBB distribution & receptor binding d/t resistance.
2. Decreased adiponectin synthesis & secretion.
3. Increased cytokine levels (r/t #2).

Question 22

What is the major risk r/t leptin resistance?

Answer 22

Continuous weight gain: decreased stimulation of satiety = don’t feel full = overating.

Question 23

What are 3 potential outcomes of decreased adiponectin synthesis?

Answer 23

1. Increased fatty acid deposition (VAT, fatty liver, hyperlipidemia).
2. Insulin resistance.
3. Inflammation & risk of pro-inflammatory diseases.

Question 24

Why is high WAT a risk factor for cardiac disease? (2)

Answer 24

1. Dysfunctional angiogenesis.

2. Increased oxidative stress > atherosclerosis.

Question 25

List 3 environmental factors that can lead to excess fat accumulation.

Answer 25

Inactivity. Increased sugar intake. Overeating.

Question 26

What are 3 metabolic causes of excess fat accumulation?

Answer 26

1. High estrogen/estradiol levels. 2. Low testosterone levels. 3. Impaired thyroid function.

Question 27

The bacterial phylum of Firmicutes affects caloric absorption by:

Answer 27

Increasing digestion: more nutrients digested means more can be absorbed & stored.

Question 28

The bacterial phylum of Bacteroides can:

Answer 28

Help decrease possible weight gain by decreasing absorption.

Question 29

Why can obesity cause conditions such as gastric reflux, urinary incontinence and obstructive sleep apnea?

Answer 29

Increased abdominal girth = increased pressure on thoracic, abdominal and pelvic regions & less space for other organs (stomach, bladder, lungs) to expand.

Question 30

Obesity carries a risk of drug-drug interactions with ________ drugs. Explain.

Answer 30

Lipophilic: fat attracts lipophilic drugs and stores them, so we will see increased half-life & decreased elimination = longer drug effects.

Question 31

What are 4 risks of obesity in pregnant women?

Answer 31

1. Gestational diabetes. 2. Gestational HTN. 3. Infertility. 4. Large infant (& complicated delivery).

Question 32

What BMI is considered overweight? What BMI is considered morbidly obese?

Answer 32

``` >25 = overweight. >40 = morbidly obese. ```

Question 33

What waist circumferences in men and women would be indicators of obesity?

Answer 33

> 102 cm in men. | > 88 cm in women.

Question 34

List the 5 risks factors of metabolic syndrome.

Answer 34

1. Large waist circumference. 2. Elevated BP. 3. Low plasma HDL. 4. Elevated plasma triglycerides. 5. Elevated fasting plasma glucose.

Question 35

Which 2 drug classes are helpful in treating obesity?

Answer 35

Lipase inhibitors. | Anorexiants.

Question 36

What is the mechanism of action for lipase inhibitors?

Answer 36

Prevent hydrolysis of fats = decreased absorption & increased excretion.

Question 37

Orlistat (Xenical) is pregnancy category:

Answer 37

X.

Question 38

What is the mechanism of action for anorexiants?

Answer 38

Stimulating the SNS to increase BMR.

Question 39

List 3 side effects of lipase inhibitors.

Answer 39

1. Decreased lipophilic med/vitamin absorption. 2. Fecal fat leakage. 3. GI bloating & flatulence.

Question 40

Lipase inhibitors are effective for up to ____ of ingested fats.

Answer 40

30%.

Question 41

What is the prototype drug for lipase inhibitors?

Answer 41

Orlistat (Xenical).

Question 42

What is the prototype drug for anorexiants? What is it a combo of?

Answer 42

Contrave: combo of Biproprion + Naltrexone.

Question 43

What is bariatric surgery?

Answer 43

Creation of a gastric pouch to decrease stomach size and limit food intake/absorption.

Question 44

What should be monitored in patients who have undergone bariatric surgery? Why?

Answer 44

Vitamin & electrolyte levels: since we cut some of the duodenum out (where vitamins & electrolyes are absorbed), pt may be at a deficit.