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Flashcards in obesity Deck (26)
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1

obesity rates in children and adults

35% of adults are obese

17% of children are obease

2

How many women are obease?

How many men are obease? 

69% of adults are overweight or obese

35.5% of men are obease 

35.8% of women are obease 

 

3

Are minorities more obease or less obease then non-minorties?

For men obesity does not vary significantly among racial/ethnic groups.

36% white, 38.8% black, 35.3% hispanic

For women obesity varies siginificantly among racial/ethnic groups. 


32% white, 58.5% black, 40.7 % Hispanic 


black women are almost 2x as likely to be obease then white 




*23% of middle age black women (age 40-59) have stage 3 

4

Underweight BMI

BMI < 18.5

5

Overweight BMI

BMI=25-29.9

6

Normal BMI

BMI=18.5-24.9

7

Obese BMI

BMI=30

8

Stage 1 Obeasity BMI

 BMI=30-34.9

9

Stage 2 Obeasity

BMI=35-39.9

10

Stage 3 obesity 

BMI>40 

Super obease BMI>50 

11

Childhood obesity

Determined by age percentile 

  • Overweight defined as body mass index 85th to 95th percentile for age and gender 
  • Obesity is defined as body mass index 95th percentile or greater for age and gender

12

BMI formula

BMI=mass(kg)/height(m)^2

13

Factors contributing to obesity

  • Dietary habits (cheap, energy dense, highly palatable)
  • Activity level (sedentary)
  • Genetics- (FTO, MC4R mutation)
  • Gut Bacteria
  • Maternal Environment
  • Socioeconomic status
  • Friends
  • Environment
  • Medications (steroids, SSRIs, anti-psychotics)

14

Orexigenic

appetite stimulant 

  NPY-neurotransmitter in the autonomic nervous system

  • elevating NPY-ergic activity increases food intake

  AgRP- signaling neuropeptide produced in the brain

  • appetite-stimulating effects of AgRP are inhibited by the hormone leptin and activated by the hormone Ghreli

Ghrelin-released by the pituitary gland, activates AgRP

cortisol - secreted by the adrenyl gland

15

Anorexigenic 

appetite supressent

  POMC, CART, alpha-MSH, CCK, Pancreatic Peptide (PP), Peptide tyrosine-tyrosine (PYY), GLP-1

  •   Leptin - produced by fat cells 
  •   Insulin - secreted when blood glucose levels are high

  

16

How many years does being overweight and obease retract from one's life expectancy? 

diminished life expectancy in the obese

overweight

o   decreases life by 3yrs

obese

o   decreases life by 6-7yrs

  • Life expectancy decreases as obeasity becomes more extreme (stage 1 better then superobease)

17

What are the pyschosocial effects of being obease?

  • Less education
  •  Less likely to be married
  • Lower household income
  • Higher rates of poverty
  • Depression, impaired self-esteem
  • Prejudices- “sloppy, lazy, lack self-discipline”
  • 1.4-2.4 x number of sick days (Swedish Obesity Study 2002)
  • 1.5-2.8 x  more likely to be on disability
    • SOCIAL STIGMATIZATION is the root cause of the psychosocial effects of obeasity

18

What types of cancerare associated with obeasity?

Cancer

  • breast, uterus, cervix
  • colon, esophagus, pancreas
  • kidney, prostate

19

What are some common medical problems associated with obesity?

  • Adipose tissue is an endocrine organ
    • many problems assicated with obesity are endocrin
  • hypoventilation syndrome
  • stroke 
  • diabetes 
  • osteoarthritus
  • cirrhosis
  • Coronary heart disease
  • gout
    • osteoporosis is not assicated with obesity

20

What are the 3 treatment options for obesity?

  1. Behavior/Lifestyle modification
  2. Pharmacotherapy
  3. Bariatric surgery
    • risk for obesity relapse is high, must be managed over the long term 
    • obesity counciling by Drs increases chance pts will achieve weightloss 

21

How much weight loss of needed to improve health outcomes?

pts who loose 5-10% of body mass reduce their risk of morbidity associated with overweight/obesity. 

22

What are some common pharmacotherapy drugs used in treating obesity? 

 

o   ADHD drug derivatives

  • Belviqàlocaserinà selective 5HT2c agonist
  •  Phentermin (stimulant) 
  • Xenicalà Orlistat (Alli)

Contraveà Naltrexone SR/Bupropion SR modulate dopamine association with food (still in clinical trials)

  • Dopamine blocking drugs

Drugs used to achieve clinically signicant weightloss ( 5-10% of weight) to improve health outcomes 

23

What percentage of eligibe pts use pharmacotherapy and surgery?

Pharmacotherapy

  •  2-3% of pts eliglbe use drug therapy

Surgery

  • 1% of eligible obease pts opt for surgery

Why such low utilizaiton of resources? 

  • Time (obesity counciling takes allot of time) 
  • Utility (most physicans are apathetic towards obesity tx)
  • Reimbursement is low for medical obesity counciling
  • Surgery is generally covered
  • Cultural barriers (overweight is not a problem in som cultures)
  • Comfort level (pts dont like talking about their weight)

24

What are some behaviors associated with weightloss?

 

  • Record food intake daily
  • Weight: check at least once per week
  • Low-calorie, low-fat diet
  • Total energy intake1300-1400 kcal/d
  • Eat breakfast daily
  • Regular physical activity (60 minutes per day)
  • meal replacement (weight wachers, slimfast) used 1x per day assocated with 3kg-5kg weightloss 

25

What are the criteria for weightloss surgery?

  • BMI >40 or BMI >35 with comorbidities (i.e diabetes)
  • Failed medical weight loss for 6 months
  • Absence of uncontrolled psychiatric disorder or substance abuse

26

What are the 3 types of weightloss surgery?

Gastric banding 

  • least effective surgery
  • reversible 
  • indicated for pts with BMI 30-35

Gastric bypass 

  • Alterations in ghrelin/leptin
  • results in 50-60% weight loss 
  • .1% mortality risk (similar to galbladder, appendectomy)
  • risk of nutritional defficencies

Gastric sleeve 

  • results in 30-50% of excess body weight loss

  • indicated for pts with superobesity (BMI>50)

  • reduced nutrient deficency side effects