Obesity Flashcards by Iseoluwa Ojo

Excess energy is stored in _____ cells residing within widely distributed _________. This energy stored as ____ are broken down to ______ for use at other sites.

Fat

adipose tissue depots

TGs; free fatty acids

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This physiologic event orchestrated through neuro - endocrine system permits humans to survive starvation for as long as _________

several months.

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Obesity is a state of _______________.

excess adipose tissue mass

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Obesity

A medical condition in which excess ______ has accumulated to the extent that it may cause adverse effect on health.

body fat

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Obesity is directly equivalent to increased body weight.

T/F

Not necessarily equivalent to increased body weight.

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Body Mass Index ( ______ index) metric

Quetelet

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Body Mass Index metric

_________________

Weight(Kg)/Height(m)2 Kg/m2

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Weight is taken (with or without ?) ______, height (with or without?) ______.

Without ; Clothes

Without; shoes

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BMI Classification
Underweight
Normal weight
Overweight(pre-obesity) Class I obesity
Class II obesity
Class III obesity

Less than 18.5
18.5-24.9
25-29.9
30-34.9
35-39.9
Greater than or equal to 40

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BMI

U.S Customary(imperial)

BMI= ______

Ib*703/In2

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The Surgical literature breaks down class III obesity.
Any
BMI _______ is ____ obesity
BMI _______ is ____ obesity
BMI _______ is _____ obese.

35-39.9; severe

40-44.9; morbid

45-50; super

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Asian population develop negative health consequences at a (higher or lower?) BMI than Caucasians.

Lower

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BMI Prime

It is the ratio of the ___________ (currently defined as ___)
Individuals with BMI prime <____are underweight, btw ____ and ____ have optimal weight. Those at ____ or greater are overweight
With BMI prime, at a glance individuals can quantify what percentage they deviate from their upper mass(weight) limit
A person with BMI 34 has BMI prime of 34/25=1.36 and is _____ over his _____

actual BMI to upper limit BMI

0.74

0.74; 0.99

1.00

36%; upper mass limit

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BMI

(Easy or difficult ?) to measure
Useful in _______classification
____ adjustments necessary for racial variation
Useful in surveys

Easy

simple anthropometric

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BMI

Inaccurate in assessment of people with _____________

Does not take _________ into account

Inappropriate in patients with ____ and ____

Underestimation of adiposity in those with ______________

heavy muscular mass e.g athletes, weight lifters etc

regional fat distribution

oedema and dehydration

less lean body mass (elderly)

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Body fat percentage

An estimate of the fraction of the total body mass that is _____(AKA ___ mass) as opposed to ___ body mass(muscle, bone, organ tissue, blood etc)

adipose tissue; fat

lean

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Which is more accurate

Body fat percentage or BMI

With reason

Body fat percentage is more accurate as a measure of excess body weight than BMI.

BMI lumps up all masses into one figure

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Body fat percentage is Used to monitor progress during ______ programme and to assess progress during ______

weight loss

body building

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The body fat percentage can be estimated by using the ______ equation

Deurenberg

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Other measures of assessing obesity

Waist circumference is Of great medical importance, indicative of _______

_____ and _____

____ to ___ ratio(___)

central obesity

CT scan and MRI

Waist to hip ;WHR

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Waist circumference

Male >_____cm
Female >____cm

102

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WHR is A good measure of central adiposity

T/F

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WHR

Measure the;
Waist at its (narrowest or widest?) point width- wise usually just _______________

Hips around the (narrowest or widest?) part of the hip bone

Narrowest; above the belly button

Widest

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A WHR of ____ for women and ____ for men have been shown to correlate strongly with general heath and fertility.

ABNORMAL; Women >____ Men >____

0.7; 0.9

0.9; 1.0

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Classification of obesity as per fat distribution ______ (or _____________, males) ________(________, females)

Android; abdominal or central Gynoid; below the waist

Classification of obesity as per fat distribution Android -Collection of fat mostly in the ______ - -______-shaped -Associated with ———— and _______ disease

abdomen apple Insulin resistance Heart disease

Classification of obesity as per fat distribution Gynoid • Collection of fat on _____ and ______ •_____-shaped -Associated with mechanical problems

hips and buttocks pear

Historical trends Etymology obesity is from a latin word ‘______’ meaning ___,____,____ In ____ ’Esus’ is the past participle of ‘____’(to eat),with ‘ ___’(over). ’_____’ First added to the Oxford English dictionary in _____ by ______.

obesitas fat’ ‘stout’ ‘plump’ Greek; edere; ob; Obesus 1611; Randle Cotgrave

Obesity was First recognised as a medical condition by the ______.

Greeks

Described by Hippocrates “Corpulence is __________________________________”

not only a disease itself, but the harbinger of others

____ surgeon Sushruta (6th century BCE) relates obesity to ____, recommends _____ as a cure

Indian; DM physical work

During the middle ages and the renaissance, the obesity was a sign of ______. Was common among officials.

wealth

Industrial revolution- 19th century height and weight ____eased In the 20th century population reached their genetic potential for height, body weight began to ____ease. In the 1950’s obesity was linked to _____ and insurance companies _____eased premium on the obese.

incr incr morbidities; incr

From 1922 to 1999 the requirement for winning the miss America pageant __% increase in height __% decrease in weight

2 12

Being lean, slim is the ideal presently T/F

Who is more predisposed to obesity Men or women Children or adults

Women Adults

Obesity is endemic in USA T/F

The African Americans are less predisposed to obesity compared to the Caucasians T/F

Lowest incidence of obesity is in _________

sub-saharan Africa

The pathogenesis of obesity is classically and rightfully seen in terms of the simple paradigm of an imbalance between: Energy intake Energy output T/F

F The mechanism of obesity is far more complex than that

LEPTIN Discovered in 1994, from Greek word ‘leptos’(___)

thin

LEPTIN A 16kDa protein expressed in _____ Sends afferent signal that relays the ________ to the CNS (_______) i.e ‘______’

adipocytes magnitude of fat stores hypothalamus; Adipostat

Plasma levels of leptin correlates with adipose tissue mass T/F

LEPTIN Mediates (short or long?) -term appetite control i.e eat (more or less?) when fat storages are low and eat (more or less?) when fat storages are high.

Long More Less

An anorexic hormone-signals satiety to the Hypothalamus (ventro-medial)also modulates energy expenditure T/F.

In the ob/ob mouse there is defective ———— resulting in obesity and _______

leptin production insulin resistance.

Leptin administration in the ob/ob mouse causes ______ by ______

weight loss reducing appetite

Obese humans have low levels of LEPTIN T/F

F paradoxically, we have high levels presumably because of tissue resistance to it

(Minority or Majority?) of obesity may be due to mutation in leptin receptor.

Minority

Ghrelin Produced by the _______ Modulates (short or long?) term appetite control i.e eat when the stomach is ——- and stop when the stomach is ____.

stomach Short empty; full

Ghrelin and leptin are antagonistic in their influence on appetite. T/F

T complementary

Bad news for dieters! Leptins Dieting _____eases leptin levels Reducing metabolism (stimulates or suppresses?) appetite

decr; stimulates

Bad news for dieters Ghrelin Levels in dieters are (lower or higher?) after weight loss The body steps (up or down?) ghrelin production in response to weight loss.

Higher Up

The higher the weight loss, the (lower or higher?) the ghrelin levels.

Higher

Neuropeptide Y Produced in the ______ of the ____ Is a potent (stimulator or suppressor?) of appetite Its production is (enhanced or inhibited?) by leptin.

Arcuate nucleus; Hypothalamus stimulator Inhibited

Proopiomelanocortin Synthesised by ____ (_____ cells of the _____) A large polypeptide

corticotrophs; Basophil; anterior pituitary

Proopiomelanocortin Precursor of both ______ hormone and __________________

adrenocorticotrophic α-Melanocyte Stimulating hormone(MSH)

MSH acts on the _______ receptor (____) in the _____ which ___eases energy expenditure and ____eases food intake

melanocortin-4 ; MC-4 hypothalamus incr decr

Agouti protein(Agouti related peptide AgRP) Expressed in ______ _______ the actions of ____ by ________

hair follicle Antagonises; MSH blocking MC-4 receptor

_________ relationship has been shown btw increasing BMI and BNP conc. No conclusive data yet for NT-ProBNP. However it is thought that the same relationship will hold.

An inverse

POMC and _____ stimulate ____ and inhibit _____

CART satiety feeding

NPY and AgRP stimulate _____ and inhibit ____

feeding satiety

Leptin ______ NPY/AgRP group while _______ the POMC/CART group.

inhibits stimulating

Total calorie consumption is related to obesity T/F

Most extra calories are from _____ rather than ____

CHO fat

Resting or Basal Metabolic Rate(BMR) Is the Energy cost of _______ and ———

metabolising and storing food

Adaptive thermogenesis in Brown Adipose tissue(BAT) –through the action of ________________

UCP-1 uncouple mitochondria resp.

BMR accounts for about ____% of daily energy expenditure whereas active physical activity contributes _____%. Thermic effect contributes ____%.

60-65 25-30 10

Obesity results from an imbalance btw _______ and ———-

energy intake and expenditure.

____ % of the world’s population get insufficient exercise

Genetics _______ in various genes controlling appetite and metabolism predispose to obesity when sufficient calorie is present

Polymorphism

Genetics, obesity Inheritance is Mendelian T/F

F not

Genes Vs Environment genes influence susceptibility to obesity T/F

The OB gene is absent in humans T/F

F Present and is expressed in fat

Early onset morbid obesity in humans have association with mutation in either _______ or ______ eg hypogonadotropic hypogonadism which is reversed by __________

leptin or leptin receptor leptin replacement

Mutation in the gene encoding POMC-through failure to synthesise ______, a key neuropeptide that _____ appetite in the hypothalamus.

α-MSH inhibits

————— mutation by preventing synthesis of α-MSH from its precursor POMC

Proenzyme convertase 1(PC-1)

α-MSH binds to _______ receptor, a key ______ receptor that ______ eating.

type 4 melanocortin hypothalamic inhibits

Heterozygous mutation in this gene encoding POMC causes obesity in as much as ___% of all cases.

Which obesity related gene isn’t found in rodents but found in humans

PC-1

Which obesity related gene isn’t found in humans but found in rodents

Tub Fat AgRP

Medical and psychiatric illnesses that can cause obesity ______ syndrome, ______,____ hormone Eating disorders; _____ disorder, _______ syndrome, ______ Drugs; ______, _____, certain anti- convulsants (_____), _______ and some forms of ________

Cushings; hypothyroidism; growth Binge eating ; Night eating ; Bulimia nervosa antidepressants; steroids phenytoin and valproate pizitifen; hormonal contraceptions

Medical conditions that predispose a person to obesity Insulinoma Patients gain weight as a result of ____ to avoid ______ symptoms Craniopharyngiomas and other disorders involving the _______ Tumours, trauma or inflammation cause ________ affecting centres that control hunger, satiety and energy expenditure.

overeating; hypoglycemia Hypothalamus hypothalamic dysfunction

Social determinants Social class and income inequalities Societal perceptions; ‘ ________ three square meals a day’ Number of children; women ___% risk per child. Men ___% risk per child Malnutrition in early life In a 2006 study ;insufficient sleep and ____easing rate of smoking.

Big man big Belly’ 7; 4 decr

Clinical features of obesity Adverse effect on health Morbidly obese individuals(200% ideal body weight have as much as ___ fold increase in mortality Mortality rises as obesity increases especially with increasing _____ and ____ Increases the risk of many __ and _______ conditions. These co-morbidities are commonly shown in the metabolic syndrome a combination of; ____,_____ , dyslipidemia (high cholesterol and TGs)

12 abdominal and intra-abdominal fat physical and mental Type II DM, high BP

Metabolic syndrome Involves picking 1 from : ____,____,____ And picking 2 from : ___,___,____,_____

Type 2 diabetes Insulin resistance Hypertension Obesity Dyspilidaemia Microalbunuria

Hyper-insulinaemia and type II DM ____eases with weight gain and _____ with weight loss Insulin resistance is more strongly linked to ________ obesity May be due to insulin itself by _____________

Incr diminishes intra- abdominal inducing receptor down regulation.

Hyper-insulinaemia and type II DM are pervasive features of obesity T/F

Obesity and DM cont... Various circulating peptides produced by adipocytes eg the cytokines(____) and ‘adipokines’ _____ and _____have altered expression in obese adipocytes. These are capable of modifying ____ action.

IL-6 adiponectin and resistin insulin

In obesity, Free fatty acids are known to be increased and capable of impairing ____ action

insulin

Most obese individuals develop DM. T/F

F They do not

As many as 80% of patients with type II DM are obese. T/F

Even modest weight loss improves insulin sensitivity. T/F

CV mortality may be seen in BMI as low as _______

The ______ study revealed that obesity was an independent risk factor for 26 year incidence of CV disease.

Framingham

Abdominal obesity is associated with _____ lipid profile ;with ____eased LDL cholesterol, VLDL and TG and ____eased HDL cholesterol. This causes coronary Heart dx and IHD

artherogenic incr decr

Obesity and Pulmonary Reduced ________ Increase ________ ____eased total Lung capacity and functional residual capacity Obstructive ______ ______________ syndrome Increased complication during general anaesthesia Weight loss improves condition.

chest wall compliance work of breathing Decr sleep apnoea Obesity hypoventilation

GIT _______ billiary secretion of cholesterol, ____saturation of bile causing ______ NAFLD(Steatosis, Steatohepatitis and Cirrhosis) GERD Pancreatitis Abdominal ___

Enhanced super- cholesterol gallstones hernias

fasting causes super-saturation of bile, resulting in gallstone formation T/F

I Higher in obesity in males; Ca oesophagus, Colon, Rectum, Pancreas, Liver and Prostate Higher in obesity in females; _____ , Breasts, Endometrium, Cervix and Ovaries Non-Hodgkins lymphomas and multiple myeloma

Gall bladder

Obesity accounts for ____% of cancer deaths in men and ___% in women.

14 25

Reproductive Disorders-men Male _______ is associated with increased adipose tissue Decrease plasma ______ and _________ Increase _____ level derived from conversion of _______ in adipose tissue

hypogonadism testosterone Sex Hormone Binding Globulin(SHBG) oestrogen; adrenal androgens

Obesity and reproductive disorders in men _________ _________ may be decreased in morbidly obese men

Gynecomastia Free testosterone

masculinisation, libido, potency and spermatogenesis are preserved in most obese men T/F

Reproductive disorder-women _______ abnormalities (oligomenorrhea) particularly in women with _____ obesity Increased _____ production Decreased ______ ____eased peripheral conversion of androgen to oestrogen PCOS (anovulation and ovarian hyperandrogenism)

Menstrual upper; androgen Sex hormone binding globulin ; Incr

____% of women with PCOS are obese

In obese women with PCOS, weight loss or treatment with insulin sensitizing drugs often restores normal menses Infertility T/F

Obesity, Psychiatric Depression(especially in ____) Social ——— /weight based ______ _______ impact

women stigmatisation discrimination Economic

Additional facts and figures On the average, obesity reduces life expectancy by ______ years BMI of 30 to 35 reduces life expectancy by _______ years BMI >40 reduces life expectancy by _____ years

6 to 7 2 to 4 10

Pharmacologic Therapy Centrally acting drugs: they are _______ Peripherally acting drugs: they - _______________

appetite suppressants reduce fat absorption

Class 3 obesity is also known as _____ obesity

Morbid obesity

______ cells of the ________ and ______ produce ghrelin

Epsilon Pancreas Stomach

Obesity Flashcards

(112 cards)