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Obesity - Pathophysiology Risk Assessment and Prevalence PowerPoint Presentation

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Description : This medical presentation titled ""Obesity - Pathophysiology, Risk Assessment, and Prevalence"" explains how balancing energy intake and energy expenditure is the basis of weight management throughout life.

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Published on : Apr 22, 2021 | Views : 2924 | Downloads : 20

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Slide 1-

Obesity: Pathophysiology, Risk Assessment, and Prevalence
Slide 2-

Obesity Excessive amount of body fat Women with > 35% body fat Men with > 25% body fat Increased risk for health problems Are usually overweight, but can have healthy BMI and high % fat Measurements using calipers
Slide 3-

Desirable % Body Fat Men: 8-25% Women 20-35%
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Regional Distribution The regional distribution of body fat affects risk factors for the heart disease and type 2 diabetes
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Body Fat Distribution: Gynecoid Lower-body obesity--Pear shape Encouraged by estrogen and progesterone Less health risk than upper-body obesity After menopause, upper-body obesity appears
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Body Fat Distribution: Android Upper-body obesity--apple shape Associated with more heart disease, HTN, Type II Diabetes Abdominal fat is released right into the liver Encouraged by testosterone and excessive alcohol intake Defined as waist measurement of > 40” for men and >35” for women
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Body Fat Distribution
Slide 8-

Weight Management Balancing energy intake and energy expenditure is the basis of weight management throughout life
Slide 9-

Set Point Theory Body tends to preserve a given weight Energy expenditure increases and decreases with weight loss and gain Effect may be temporary, e.g. energy needs drop during calorie restriction and normalize when energy balance is achieved
Slide 10-

Components of Energy Expenditure Resting energy expenditure: expressed as RMR Energy expended in voluntary activity Thermic effect of food (TEF) or diet-induced thermogenesis (DIT) Related to energy value of food consumed and adaptive response to overeating TEF may decline as day progresses (Romon, AJCN, 1993)
Slide 11-

Resting Metabolic Rate Increases with increased muscle mass Declines with age Declines during restriction of energy intake (up to 15%) Explains 60-70% of total energy expenditure
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Voluntary Energy Expenditure (activity thermogenesis) The most variable component of energy expenditure Accounts for 15-30% of total Most of us will require increasing voluntary energy expenditure as we age to offset declining fat free mass and RMR in order to maintain weight
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Role of Brain Neurotransmitters Neurotransmitters govern the body’s response to starvation and dietary intake Decreases in serotonin and increases in neuropeptide Y are associated with an increase in carbohydrate appetite Neuropeptide Y increases during deprivation; may account for increase in appetite after dieting Cravings for sweet high-fat foods among obese and bulimic patients may involve the endorphin system
Slide 14-

Hormonal Regulation of Body Weight Norepinephrine and dopamine—released by sympathetic nervous system in response to dietary intake Fasting and semistarvation lead to decreased levels of these neurotransmitters—more epinephrine is made and substrate is mobilized.
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Hormones and Weight Hypothyroidism may diminish adaptive thermogenesis Insulin resistance may impair adaptive thermogenesis Leptin is secreted in proportion to percent adipose tissue and may regulate (decrease) appetite
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Hunger vs. Satiety Satiety—postprandial state when excess food is being stored Hunger—postabsorptive state when stores are being mobilized Short-term regulation affected
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Hunger vs. Satiety—cont’d Feedback mechanism with signal from adipose mass when weight loss occurs—eating is the natural result Not always identified in the elderly This occurs mostly in young people Long-term regulation affected
Slide 18-

Nature vs Nurture Identical twins raised apart have similar weights Genetics account for ~40%-70% of weight differences Genes affect metabolic rate, fuel use, brain chemistry, body shape Thrifty metabolism gene allows for more fat storage to protect against famine
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Nature vs Nurture Obesity tends to run in families If both parents are normal weight – 10% chance of obesity in offspring If one parent is obese – 40% chance If both parents obese – 80% chance Is it genetics or learned eating behavior?
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Nurture vs Nature Environmental factors influence weight Learned eating habits Activity factor (or lack of) Poverty and obesity Female obesity is rooted in childhood obesity Male obesity appears after age 30
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Nurture vs Nature Overeating learned early in childhood Bottle vs breast Urging children to eat more, clean their plates Use of food as a reward
Slide 22-

Food = Love Shelly Thorene Photography
Slide 23-

Nature and Nurture Obesity is nurture allowing nature to express itself Location of fat is influenced by genetics A child of obese parents must always be concerned about his weight
Slide 24-

Nature and Nurture The influence of environment is apparent in the fact that the prevalence of obesity has increased dramatically in the US in the past 40 years
Slide 25-

Causes of Obesity
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Causes of Excessive Energy Intake Active: large portion sizes, frequent meals and snacks Passive: excessive intake of energy-dense foods containing hidden calories Variety of options: the greater the variety of foods offered, the greater the intake Sensory-specific satiety: as foods are consumed they become less appealing
Slide 27-

Low Energy Expenditure There is a mismatch between our thrifty metabolic genetic heritage and the sedentary American lifestyle
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Obesity is a Growing Problem 127 million adults in the U.S. are overweight, 60 million obese, and 9 million severely obese. 66 percent of U.S. adults are overweight (BMI≥25) 32 percent are obese (BMI≥30) 17% of children and adolescents ages 2-19 are overweight
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Obesity Trends* Among U.S. Adults BRFSS
Slide 30-

Prevalence of Obesity in Ohio
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Obesity: A Major Health Issue Obesity is the No. 2 preventable cause of death and disability (smoking is #1) Obesity is associated with increased risk of heart disease, stroke, gallbladder disease, cancer, osteoarthritis, sleep apnea Obesity-related health problems cost $75 billion annually (2003 data) The public pays about $39 billion a year -- or about $175 per person -- for obesity through Medicare and Medicaid programs
Slide 32-

Health Problems Associated with Excess Body Fat Surgical risk Lung (pulmonary) disease Sleep apnea HTN CVD Bone and joint disorders (gout, osteoarthritis) Type 2 diabetes Gallstones Cancers (breast, colon, pancreas, gallbladder) Infertility Pregnancy- difficult delivery Reduced agility Early death
Slide 33-

NHANES III Prevalence of Hypertension* According to BMI *Defined as mean systolic blood pressure 140 mm Hg, mean diastolic 90 mm Hg, or currently taking antihypertensive medication. Brown C et al. Body Mass Index and the Prevalence of Hypertension and Dyslipidemia. Obes Res. 2000;8:605-619. Percent
Slide 34-

Obesity and Diabetes Risk BMI Levels Incidence of New Cases per 1,000 Person-Years Knowler WC et al. Am J Epidemiol 1981;113:144-156.
Slide 35-

Weight Gain and Diabetes Risk Body Mass Index at Age 21 Relative Risk Weight Change Since Age 21 Adapted from Chan JM et al. Diabetes Care 1994;17:960-969.
Slide 36-

Metabolic Syndrome Criteria* Three or more of the following abnormalities: Waist circumference >102 cm (40 inches) in men and > 88 cm (35 inches) in women Serum triglycerides of at least 150 mg/dL High density lipoprotein level <40 mg/dL in men and <50 mg/dL in women Blood pressure >=135/85 mm/hg Serum glucose >=110 mg/dl Includes 47 million US residents (27.7% of the population *ATP III Guidelines. National Cholesterol Education Program, 2001
Slide 37-

Polycystic Ovary Syndrome (PCOS) Endocrine disorder characterized by hyperandrogenism and insulin resistance Associated with android obesity Affects 5-10% of reproductive age women Erratic menstrual periods, chronic anovulations resulting in multiple ovarian cysts; infertility, acne, hirsutism and alopecia Increased risk of heart disease, type 2 diabetes, reproductive cancers
Slide 38-

Management of PCOS Symptom oriented, as etiology is unclear Individualized diet and exercise plan to promote weight loss and normalize insulin levels Medications to alleviate symptoms
Slide 39-

26 -Year Incidence of Coronary Heart Disease in Men Incidence/1,000 BMI Levels Adapted from Hubert HB et al. Circulation 1983;67:968-977. Metropolitan Relative Weight of 110 is a BMI of approximately 25.
Slide 40-

26 -Year Incidence of Coronary Heart Disease in Women Incidence/1,000 BMI Levels Adapted from Hubert HB et al. Circulation 1983;67:968-977. Metropolitan Relative Weight of 110 is a BMI of approximately 25.
Slide 41-

Hypertension BMI Percentage 20 25 30 35 40 20 10 30 50 40 60 Relationship between BMI and crude percentage of women reporting medical problems, surgical procedures, symptoms, and health care utilization. Brown WJ et al. Int J Obes 1998;22:520-528.
Slide 42-

BMI Percentage 20 25 30 35 40 0 10 5 15 Diabetes Brown WJ et al. Int J Obes 1998;22:520-528. Relationship between BMI and crude percentage of women reporting medical problems, surgical procedures, symptoms, and health care utilization.
Slide 43-

BMI Percentage 20 25 30 35 40 5 10 15 25 20 Cholescystectomy Relationship between BMI and crude percentage of women reporting medical problems, surgical procedures, symptoms, and health care utilization. Brown WJ et al. Int J Obes 1998;22:520-528.
Slide 44-

BMI Percentage 20 25 30 35 40 20 15 30 25 35 Back Pain Brown WJ et al. Int J Obes 1998;22:520-528. Relationship between BMI and crude percentage of women reporting medical problems, surgical procedures, symptoms, and health care utilization.
Slide 45-

Body Mass Index and Mortality Risk (Adapted from Bray GA. Gray DS, Obesity, part 1: Pathogenesis. West J Med 149:429, 1988; and Lew EA, Garfinkle L; Variations in mortality by weight among 750,000 men and women. J Clin Epidemiol 32:563, 1979.)
Slide 46-

BMI and Health