Professional Documents
Culture Documents
She lives with an overweight consort and they have been trying
unsuccessfully for 5 yrs to have a child. Her fertility evaluation is said to
be normal although she has irregular menses. She is convinced that
she needs to lose weight at all costs to improve her health and her
chances of becoming a mother. She works as a telephone operator,
has a long commute to work from Portmore, rarely exercises because
of her arthritis and she "does not like gyms." She buys her lunch at
work and there is no evening meal-planning by her consort who does
the majority of cooking.
Harmensz
Rembrandt van
Rijn
1606-1669
Bathsheba
1654 Antonio Allegri, known
as Correggio
1489?-1534
Venus, Satyr and Cupid
Classification of obesity:
Body mass index
Grade Degree of BMI
Obesity
3 Morbid obesity > 40
2 Obesity 30-40
1 Overweight 25-29.9
0 Normal weight 18.5-24.9
Source: FAO for prevalence of undernourishment. Population Health Metrics 10 (22): 1-16 (2012).
Global Burden of Obesity in 2005
and Projections to 2030
50
Prevalence (%)
40
30
20
10
0
USA
UK
Nigeria
Barbados
St. Lucia
Jamaica
Cameroon
+ 7 kg increase in men
Luke 2001 + 14 kg in women
Weight change in the African Diaspora
2.4
2.5
2
1.5 1.16 1.2 1.19
1
0.43
0.5 0.25 0.19
0
-0.05
-0.5 <25 25-29 30+
-1 -0.77
35
Maywood
% Hypertension
30
25 Barbados
St. Lucia
Jamaica
20
15 Cameroon urban
Cameroon rural
10 Nigeria
22 24 26 28 30 32
Body mass index
Gout Phlebitis
venous stasis
Y-Y Paradox:
Limitations of BMI across populations
Brown/beige fat
Visceral Fat Distribution:
Normal vs Type 2 Diabetes
Small Insulin-Sensitive
Adipocytes
Biochem. J. 2010;430:e1-e4
Quality of Life for Obese*
Children and Adolescents
Obesity Predicts Depression:
Prospective Data
How did her Obesity develop?
Pathogenesis of Obesity
X
Sloth
Gluttony
Riotous living
Are Genetic Factors the Cause of Obesity?
Intake vs Expenditure
Feedback Control of Energy Intake
Whopper
660 kcal
Large Fries 400 kcal
Soda 150 kcal
Total 1210 kcal
Adipokines
Control of Meals
Liporex
Lipotrim
Cortislim
Relacore
Cortaway
Cortigen
Cortislender
Cortiblock, etc.
Germs That Are Good For You
Role of energy expenditure
Energy expenditure declines with ageing
Intense
Discretionary Occupational
exercise
Sitting, coffee, Dietary induced Basal metabolic
smoking thermogenesis rate
4000
3000
2000
1000
0
70 kg, Aged 25 years 70 kg, Aged 70 years
James, Ralph and Ferro-Luzzi, 1989
Is Angies metabolic rate low?
Physical activity has changed:
NEAT has declined precipitously
Markers of inactivity related to
obesity incidence
% Obese Cars/household TV viewing (hours/week)
200
% of Mean of All Time Points
100
0
1950 1960 1970 1980 1990
146 km = 25 h of walking
Tracking Tracking
CHILDREN
overweight
Women
Poor nutrition
Adapted from Challenge of obesity in WHO European Region
and strategies for response: Summary; WHO 2007
Could any of her medications be
increasing her weight?
Drugs that cause weight gain
glucocorticoids
progestins
tricyclic antidepressants
phenothiazines
2nd generation anti-psychotics
lithium
insulin
sulphonylureas
HAART
anti-epileptic agents
Not low-dose oestrogens!
Predictors of weight gain
1. parental overweight 9. stress (inc. high
2. lower SES cal/carb foods)
3. smoking cessation 10. multiple births
4. low level of physical 11. endocrine disruptors
activity (phthalates)
5. infancy and childhood 12. gut microbiota
overweight 13. perception of body
6. lack of parental image
knowledge of childs 14. overweight/obese
sweet eating habits social network
7. recent marriage 15. Food policy and
8. lack of sleep security
Principle components of body weight
regulation in an obesogenic environment
Americans enjoy one of the most luxurious lifestyles on Earth:
Our food is plentiful. Our work is automated. Our leisure is
effortless. And it's killing us.
NHLBI recommendations for weight
treatment
BMI category
Pharmacotherapy - If chronic + + +
illnesses
JAMA. 2014;312:923-933.
Drug Therapy
chronic treatment sibutramine
1st generation dexfenfluramine
modest efficacy
no long-term f/u Initial responders
individuals with co- continue to respond;
morbidities initial non-responders
complements but are less likely
doesnt replace life
style modifications
Drug Therapy: Systematic Review
and Meta-analysis
Phentermine Liraglutide Naltrexone- Lorcaserin Orlistat
- topiramate (Victoza) bupropion (Belviq) (Xenical,
(Qsymia) Alli)