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25 Cards in this Set
- Front
- Back
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How do we define obesity?
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Excess body fat (not excess weight)
BMI -Greater than 25 kg/m2 = overweight -Greater than 30 kg/m2 = obesity 66% of US is overweight 32% of those 66% are obese |
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What 3 states in the US have highest rates of obesity (over 30%)?
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Missippi, alabama, and louisiana - higher prevalence of obesity.
-large portion of food is saturated fat. |
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What are some medical complications of obesity?
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Pulmonary disease: abnormal fnc, sleep apnea, hypo vent syndrome.
Nonalcoholic fatty liver disease - stateosis, steatohepatitis, cirrhosis Gynecologic abnormalities- menses, infertitliy, POS Osteoarthritis Idiopathic intracranial HTN Stroke Cataracts CHD, DM, dyslipidemia, pancreatitis cancer |
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What is the 2nd most common modifiable behavioral risk factors in preventing CVD death?
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Physical activity - not doing reader. we're getting better at smoking though.
Energy expenditure << energy intake (high energy dense foods) Also, genetic susceptibility exists to store body fat. |
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How much weight does the avg. American gain since 25 years of age to 50?
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Age 25 to 50 - average American gains one pound per year from between these ages. The small daily imbalances of energy intake lead to this increase in body fat mass over time.
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What percentage of Americans have no physical activity? What percentage are considered sedentary?
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40% = no phyiscal actvitiy
70% - considered sedentary |
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Compare the risk of developing obesity related DM between men and women
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Women have higher risk of developing obesity related DM. Men and women risk is 3- 23 times that of ideal weight.
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What is the relationship between obesity, DM, MI, and mortality?
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Based on Haffner study.
Prior MI and type 2 DM both lead to the same mortality rates. For both DM and MI the mortality rate is greater. |
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How is visceral fat studied? How do you find the WHR?
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take samples of visceral fat and look for inflammatory markers that lead to obesity or other disease. Must take samples and look at MRI to distinguish between visceral fat and central adiposity.
To find ratio, for waist: measure at narrowest pt which stomach is relaxed. For hips - measure at fullest point. |
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What is leptin?
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Leptin is secreted by fat tissue and signals satiety signals to the brain. This prevents you from starving to death.
Its a long term protector of fat stores. Other signals from the gut signal short term hunger signal. Angiotensinogen, CRP, FFAs, PAI-1, ASP, IL-6, TNF-alpha = all of these contribute to inflammatory signals and obesity + cross talk to arteries. |
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Not all fat cells are created equal. Difference between large and small adipocytes?
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Large: insulin resistant, more adreneric receptors, insulin mediated antilypolysis catecholamine mediated lipolysis.
Small: insulin sensitivite, adrenergic receptors decrease. |
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How much weight loss is significant?
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7% wegith loss reduced progression to type 2 DM. Others showed 5-10% weight reduction over 6 months and subsequent weight maintenance contributes significantly to decreased morbidity.
This will reduce all the components that contribute to metabolic syndrome. Don't even need to get down to an ideal body weight. |
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What was the outcome of the DM prevention program research group - regarding metformin and lifestyle changes?
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Metformin given to a pre DM patient works well, but not as well as lifestyle arm.
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What did weight loss vs. control do for vascular endothelial function?
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Weight loss imporives vascular endothelial fcn more than the control group.
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What dietary modifications must we go to manage metabolic syndrome?
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-Reduce saturated fat + simple sugar intake.
-Weight loss 5-10% per year -Excersive 30 min per day, mod intensity -Pharmacological managemet - only effective after lifestyle changes. DM meds make you increase weight. Metformin was first drug that helps DM lose weight. |
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Does liposuction work to improve risk of DM and heart disease?
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Even after 20 lb reduction, there was no change in BP, glucose, insulin, TGs, etc.
-Induction of neg energy balance is critical for achieving. However, need to distinguish between visceral body fat. Visceral body fat removal also did not show any improvement. |
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4 viewpoints of diet
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Low-fat/High-carb: Ornish, Pritikin, Life Choice Diet, Turn Off the Fat Genes, Volumetrics
Low-carb/High-protein: Atkins, Zone, South Beach, Sugar Busters Moderate-fat/Calorie-reduced: AHA Step I/II; DASH diet - only one in RCT to improve risk factors; USDA food guide pyramid; IOM guidelines Mediterranean: good vs. bad fats |
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Conventional vs. Atkins diet in weight loss
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Over end of 1 yr, weight loss between Atkins and conventional is the same.
-Atkins dieters may not have stayed on the diet between 6 months to a year. Low fat vs. low carb = no difference. Caloric restriction is more important in weight loss. |
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How well do these very different popular diets work under realistic clinical conditions over 1 year period?
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All dieats had similar effect: 20-25% of subjects sustained modest weight loss beyond 1 year. What an individual will adhere to is the key, than the specific diet.
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Which is better at reducing visceral fat - exercise or diet?
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Exercise - keeping the weight off and maintaining your health. 30 min per day of moderate excerise to maintain it.
60-90 min to lose weight. |
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Criteria for use and rationales for using medications for obesity
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Rationale:
Patients can lose an average of 3-8% more with medication than diet and exercise alone Criteria for use: BMI > 30 kg/m2 or BMI > 27 kg/m2 with co-morbidities - and - If lifestyle interventions have been ineffective for weight loss and/or improvement of health |
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Medical therapy
1. Phentermine 2. Sibutramine 3. Orlistat |
Phentermine (Ionamin, Fastin, Adipex)- Amphetamine derivative. Not approved in pediatrics. Avoid in hypertension and coronary heart disease. Approved for short term (12 weeks)
Sibutramine (Meridia)- Blocks norepinephrine and seratonin uptake. Avoid in hypertension. Not on the market any more. Orlistat (Xenical)- lipase inhibitor. Also as OTC as ally. |
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What's the only cure we have for mass obesity reduction?
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Indications
-BMI > 40, 35-40 and life threateng cardiopulmonary disease, severe DM, or lifestyle impairment. -failure to achieve adequate weight loss w/ non surgical treatment Contra 1. history of non compliance w/ med care 2. certain psych illness 3. unlikely to survive surgery |
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What are the 3 current surgical procedures?
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1. Gold standard: Roux en Y gastric bypass: 48-74% of initial weight
2. Vertical banded gastroplasty 50- 60% initial weight 3. Adjustable gastric banding - 36% excess weight. Max weith loss is 10-24 months post op |
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Describe the outcomes for those who have had bariatric surgery
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-Percent excess weight loss 61.2%
-Operative mortality - 0.1- 1.1% Diabetes resolved - 76.8% HTN resolved - 61.7% -Sleep apnea resolved 85.7% |
