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Discuss how weight affects energy expenditure
Weight gain ↑total energy expenditure (TEE) and weight loss ↓TEE
---Fat free mass is the main determinant of TEE.
What BMI is considered Obese
and what is considered Morbidly Obese?
Magical number for being OVERWEIGHT?
- Obese: BMI>30
- Morbidly Obese: BMI> 40.
- Underweight: <18.5
Magical number of Overweight: 25!
To determine if children are overweight, do we use BMI scores?
- No, we rely on percentiles.
- ---If between 85-95 % percentile, at risk for being overweight.
- ---If >95% percentile, then overweight.
What are the two types of fat, and which one makes you more likely for CV disease
- Subcutaneous fat.
- and Visceral fat (intra-abdominal fat)--likely to cause CV disease.
What is the waist circumference threshold for obesity?
- Men: 40 inches (102 cm)
- Women: 35 inches (88 cm)
what is the trend in obesity by sex recently?
It has Plateau'd, but it is still more than it was in 1970s.
overall, the population is heavier, and the heaviest have gotten heavier.
what is the prevalence of obesity like for african american women?
they tend to get more and more obese as they age.
explain fat but fit
Increased adiposity and increased fitness is better than decreased adiposity and decreased fitness.
Besides type 2 diabetes, what is the next comorbidity associated with obesity?
while we know that obesity increases the risk of cholesterol, what does obesity have a much stronger correlation with?
- Triglycerides and HDL.
- --for every 1 unit BMI change, HDL drops 1.1 mg/dl for men, and 0.7 mg/dl for women.
WHat are some of the co-morbidities of obesity?
- --there is a DIRECT linear relationship between BMI and coronary heart disease.
- --Sleep apnea in men with BMI>30
- -gallbladder disease
- --endometrial, breast, colon, and prostate cancer.
- --polycystic overian syndrome and irregular cycles in women.
- --increased risk of stroke.
What percent of overeating is caused by emotions?
But people do not relentlessly gain weight over their lifetime, so then how they fluctuate?
they gain or lose 2.5 pounds per year.
Which nutrient has the smallest pool size?
Why is it undesirable to convert amino acid to glucose?
because it draws on the essential protein stores and you lose fat free mass.
high intake of which nutrient will alter many of the metabolic pathways!!
When you eat lots of carbohydrates,
- your fat stores increase.
- your glycogen stores increas.
- your Carb oxidation Increases.
- -decreased insulin sensitivity
- Increased HGP.
What is the best predictor of obesity in rats?
- Increased HGP
- and decreased insulin sensitivity
What are anorexigenic or Orexigenic Medications?
Anorexigenic: promote or cause anorexia.
Orexigenic: stimulating effect on appetite, such as anti-psychotics.
Are the number of fat cells we have limited?
What is the half-life?
No, we can generate more adipocytes.
The half-life is about a year, so damaged lipidogenesis may take years to manifest.
why are visceral fat stores worse than subcutaneous?
Because the visceral fat is more lipolytically active and they can go straight into venous drainage to the liver and affect liver metabolism.
What are the two main types of obesity?
- Hypertrophic and Hyperplastic obesity.
- Hypertrophic: enlargement of the existing fat cells, increased CVD risk.
Hyperplastic: increase in nymber of fat cells, such as by the PPAR agonists (thiazolinediones).
Adipose cell size (independent of BMI) is Negatively correlated with insulin sensitivity.
Whats the difference between apple shaped and pear shaped?
people with Apple shape: more lipoprotein production, more TG production. AND greater turnover of fat (synthesis + hydrolysis).
In both groups, as you increase BODY size, you have increased TG synthetic capacity.
In Familial Partial Lipodystrophy Type 2..
You have subcutaneous fat lipotrophy, and Increased abdominal Fat.
what is the most beneficial location for lipids
(if you lose this, you will also lose the leptin and adiponectin levels).
what is the idea behind her "ice cream experiment"
- Fat Free mass ~ Muscle.
- FFM is the main determinant of TEE.
- TEE increases when you gain weight.
- --carrying Extra fat changes energy cost for ALL tissues (not just the added amount). REE does not change much.
- --TEE is mostly due to the cost of activity here. Huge Increase in the Amount of energy you expend with activity.
- But when you lose weight, your body will try to retain tissue.
- --REE goes down by 50%.
- --TEE also decreased.
Difference between simple carbs and complex carbs?
simple carbs lead to return of hunger sooner.
--complex carbs increase micronutrient, satiety, and fiber intake.
--Higher intake of MuFA and PUFA will increase satiety.
--lower protein will improve constipation, but higher protein increases satiety.
COmpare diet and exercise in regards to fat free loss?
DIET: 28% of weight loss is FFM.
Diet and Exercise: 13% of weight loss is FFM.
When is surgery an option?
When BMI is > 35, or 40. with a co-morbidity.
However, a gastric band is approved for people with BMI > 30, as long as one condition linked to obesity.
Is surgery for obesity actually useful?
•Excess weight loss is 61.2%
- •Diabetes, hyperlipidemia, hypertension and obstructive sleep apnea
- can resolve
what do anti-obesity drugs target?
- --Reduce food intake
- --Block nutrient absorption
- --Increase thermogenesis
- --Modulate fat metabolism
- --Modulate central regulation of body weight (alter signals for fat stores)
which people are approved for us to give them FDA_approved weight loss drugs?
- --BMI >30
- --of BMI > 27, as long as they have obesity-related condition.
- --cannibinoid receptor blockers increasing psychiatric side disorders.
- --Anorexigenic agent Fen-Phen (resulted in heart valve thickening).
- Lipase inhibitor. blocks the absorption of up to one-third of the ingested fat.
- -take it three times with meals.
- side effects: flatuelence, diarrhea, loss of fat soluble vitamins.
- Other effects of Orlistat:
- –Lower plasma low-density lipoprotein cholesterol (LDL) cholesterol levels.
–The decline in LDL cholesterol is greater than that expected due to weight loss alone.
–Lower HgbA1C in diabetic patients
what are unapproved obesity therapies?
- •Thyroid hormone – short-term energy
- restriction reduces T3; restoring T3 does not reduce fat but increases FFM loss
- •Cigarettes (nicotine) – activates the SNS
- reducing appetite, raising REE and reducing weight despite the same or higher
- energy intake
- –activates the sympathetic nervous system (SNS) and increases REE; does not
- promote weight loss except when achieving extreme blood levels; helpful in some
- •Androgens – increase FFM reduce FM; hard to
- prove they increase strength
- •Growth hormone – reduces fat, increases
- insulin resistance early; high cost; cancer risk?
low fat carb diets tend to
Increase TGs and Lower HDLs.