Obesity

Front 1

Calculation of BMI

Back 1

kg/height in m^2

Front 2

Close to ____% of population is overweight and _____% Is obese

Back 2

65; 30

Front 3

T/F MI risk is increased in even mild-to-moderately overweight women

Back 3

T

Front 4

T/F The differences in food intake between obese and normal weight people are not dramatically different

Back 4

T. Obese people eat slightly more.

Front 5

Basal metabolic rate: defn

Back 5

Amount of energy we burn when we are in a truly rested state.

Front 6

BMR average ___% of daily energy expenditure

Back 6

60

Front 7

T/F BMR varies directly with lean body mass

Back 7

T

Front 8

T/F BMR decreases with age

Back 8

T

Front 9

What is the thermal effect of food and what % of our total energy expenditure is this?

Back 9

Energy we expend to digest food. 10%

Front 10

What are the two types of activity?

Back 10

1) Volitional exercise

2) non-exercise activity thermogenesis (NEAT)

Front 11

What is non-exercise activity thermogenesis (NEAT)?

Back 11

type of activity you do for posture (sitting, standing, lying). Also for activities like walking, etc.

Front 12

T/F Individuals who inherit a low basal metabolic rate are more prone to future weight gain

Back 12

T

Front 13

What is the current theory about body weight?

Back 13

We inherit a "weight class" that can deviate about 10% from genetically predetermined weight

Front 14

What is the highest appetite center?

Back 14

Lateral nucleus of hypothalamus

Front 15

Where are the melanocyte concentrating hormones?

Back 15

lateral nuclei of hypothalamus

Front 16

What does the melanocyte concentrating hormone (MCH) do in people?

Back 16

Appetite stimulant.

Front 17

What stimulates or inhibits the lateral nuclei in the hypothalamus?

Back 17

Neurons from the arcuate nuclei of hypothalamus

Front 18

What are the 2 stimulatory neurotransmitters in the arcuate nucleus?

Back 18

1) Neuropeptide Y

2) Agouti-related peptide (AGRP)

Front 19

What are the 2 inhibitory neurotransmitters in the arcuate nucleus?

Back 19

1) Melanocyte stimulating hormone α (MSHα)

2) Cocaine and amphetamine-regulated transcript (CART)

Front 20

How does proopiomelanocortin (POMC) relate to appetite control?

Back 20

MSHα is produced when it is cleaved. (also produced when it's cleaved: ACTH, endorphins)

Front 21

Since marijuana stimulates appetite, it activates ______-releasing neurons and inhibits ______-releasing neurons.

Back 21

Neuropeptide Y/AGRP ; POMC/CART

Front 22

Chronic regulation of appetite centers is based on presence of what?

Back 22

fat

Front 23

What are the 2 hormones that sense body fat and signal hypothalamus to regulat appetite and energy expenditure

Back 23

Insulin and leptin

Front 24

As people gain weight, what happens to sensitivity to actions of insulin?

Back 24

resistance develops

Front 25

Fasting and postprandial serum concentrations of insulin (increase, decrease) in proportion to the amount of body fat

Back 25

Increase

Front 26

Insulin ______ the appetite stimulating NPY/AGRP neurons and ______ the appetite suppressing POMC/CART neurons

Back 26

Inhibits; stimulates

Front 27

protein secreted by fat cells in proportion to the amount of fat

Back 27

Leptin

Front 28

Leptin _______ the appetite stimulating NPY/AGRP neurons and _______ the appetite suppressing POMC/CART neuron

Back 28

inhibits; stimulates

Front 29

Leptin given to obese mouse causes weight _____

Back 29

loss

Front 30

What is ghrelin?

Back 30

Hormone that play a role in stimulating hunger. Serum concentration of ghrelin rise abruptly before a meal and fall immediately after.

Front 31

Ghrelin ________ the activity of the appetite-stimulating neurons NPY/AGRP

Back 31

stimulates

Front 32

What is protein YY (PYY)?

Back 32

Hormone secreted by distal GI tract. Serum concentrations are low before a meal and rise after a meal. Infusion of PYY reduces food intake and weight gain in animals humans.

Front 33

How does PYY inhibit appetite after a meal? (2)

Back 33

1) Inhibits ghrelin release

2) Directly inhibits NPY/AGRP neurons

Front 34

As people get thinner, PYY levels (increase, decrease).

Back 34

Increase. This is counter to the setpoint theory. Unclear why this is the case.

Front 35

MCR4 defects will result in _____

Back 35

obesity

Front 36

Why does MCR4 mutation cause obesity?

Back 36

MSHα, the appetite stimulant, binds to this receptor.

Front 37

Patients with POMC deficiency are deficient in what proteins?

Back 37

POMC is a prohormone for MSHα and ACTH

Front 38

POMC deficiency - phenotype

Back 38

Adrenal insufficiency, early onset obesity, red hair

Front 39

Leptin and Leptin receptor mutations result in phenotype of

Back 39

Early onset obesity

Front 40

Why do Prader-Willi patients become obese?

Back 40

They overexpress ghrelin, which stimulates appetite

Front 41

Leptin therapy is used in what condition? what has it NOT been useful in?

Back 41

leptin deficiency. it causes a decrease in body fat without comcomitant changes in lean muscle mass.

Unfortunately has NOT been effective in reducing weight in routine obese.

Front 42

Why has leptin not been effective in treating obese people who don't have deficient leptin?

Back 42

It's thought that obese become leptin resistant, needing supre-physiological doses of leptin. At large doses, numerous side effects emerge.

Front 43

What effects does metformin have on weight?

Back 43

Causes modest weight loss apparently thru an appetite suppressing effect.

Front 44

What type of drug is Orlistat? What is MOA?

Back 44

It's a pancreatic lipase inhibitor, resulting in fat malabsorption.

Causes modest weight loss. Side effects include steatorrhea, diarrhea, bloating although patients learn to modify fat intake to avoid the side-effects.

Front 45

Complications of weight loss surgery

Back 45

1) Mortality 1 in 200-1000
2) Wound dehiscence and infections in 20%
3) Nausea and vomiting in first 3 months common
4) Anemia
5) Mineral deficiencies

Front 46

Indications for bariatric surgery

Back 46

BMI > 40
BMI > 35 with serious coexisting condition such as sleep apnea, type 2 DM, joint disease, or other cardiopulmonary disease
Failed non-surgical program of diet, exercise, behavioral modification

Front 47

Initial approach to obese patient

Back 47

1) Diet - first goal to lose 10% of body weight

2) Exercise - at least 30 minutes/day

3) Behavior modification in intensive group setting.

Front 48

Step 2 if initial approach to weight loss doesn't work

Back 48

drug therapy if patients begin to regain weight after 6 months.

Front 49

Step 3 if steps 1 and 2 don't work for obesity

Back 49

Bariatric surgery for adults with morbid obesity or obese with complications who have failed non-surgical treatments.

Front 50

T/F Reductions in mortality naturally follow weight loss.

Back 50

UNCLEAR - certainly is suspected but not yet clearly demonstrated.

Long-term studies lacking because of limited success of medical weight loss.