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Obesity Weight Management

Body Composition
the proportions of muscle, bone, fat, and other tissue that make up a persons total body weight
How do most researches asses body composition
body weight-fat and lean tissue (including water)
defining a healthy body weight
-a weight within the suggested range for height
-a fat distribution pattern that is associated with a low risk of illness and premature death
-a medical history free from risk factors associted with obesity
Health risks of overweight and obesity
diabetes- 3 times greater
hypertension
High blood lipids (HDL and LDL )
cardiovascular disease- links with high blood pressure and high cholesterol
sleep apnea
flat feet
complications in pregnancy and surgery
liver malfunctions
osteoarthritis- pressure on joints
HDL
high density lipoprotein- good gets rid of excess cholesterol
*cant eat produced by liver
LDL
low density liproprotein – bad because stores or positions around the body
*cant eat produced by liver
Bioelectrical impedence
way to mesaure body fat. fat has more water and can conduct electricity
visceral fat
fat protection from organs bad if too much cause effects function of organ
how many people are considered over weight in the us?
over 2 thirds of adults
who is the prevalance of over weight higher in?
women, the poor, african americans, and latin americans
what does the amount of fat in the body reflect?
the number and size of the fat cells
when does the number of fat cells increase most rapidly?
in obease children than in lean children
-obease children entering there teens may have as many fat cells as an adult
what happens to fat cells?
they expand as they fill with fat and then they may divide.. they can increse there size by 20 fold and their numbers by several thousand fold
what happens to fat cells with fat loss?
the size of the fat cell shrinks but not the number.. obesity is critical during the growing years when fat cells increase in number
LPL (lipoprotein lipase)
promotes fat storage in adipose and in muscle cells
high LPL- store fat more effectively
Is lipoprotein lipase gender specific?
yes more in women and in areas where fat calls are most abundant
What is different about fat in lower parts of the body?
there are differences in activity of enzymes controlling fat breakdown in different parts of the body.fat it lower parts of the body are less resistant to fat breakdown
what happens after weight loss?
lipoprotein lipase activity increases and most dramatically in those who lose more weight
What happens if both parents are obease?
80% risk children are obease
what happends if neither parent is obease?
10% chance
Twin studies on obesity
identical twins are more likely to weigh the same as faternal twins even when spread apart
What are all influenced by genetics?
food intake, tastes, BMR, number of fat cells, enzymes
causes of obesity
-lipoprotein lipase- enzyme which promotes fat storage in fat cells and muscle celss
leptin- hormone which influences appetite and energy balance
-uncoupling protein
-environmental stimuli
-learned behavior
-physical inactivity
leptin
obesity gene (ob)
-acts as a hormone in hypothalamus
what does leptin signal?
sufficent energy stores and promotes negative energy balance by suppressing appetite and increasing energy expenditure
Leptins action on the body
leptin suppresses food intake and increases energy expenditure
What are the two kinds of fat?
white fat and brown fat
white fat
stores fat for other cells to use for energy
brown fat
releases stored energy as heat
what happens when fat is oxidized?
some energy is released as heat, and some is captured in ATP
What happens when brown fat is oxidized?
only heat is released
Who has high amounts of brown fat? small amounts?
-newborns, people living in cold climates, and hibernating animals
-most adults have small amounts
What is in brown and white fat?
a gene that codes for a protein that uncouples reactions and appers to influence BMR and resist in weight gain
Non- drug ways of losing weight
goals-lose weight for health not for looks
dangers of weight loss
-weight cycling- yo-yo dieting
-psychological problems- told to lose weight just based on will power and hard work
Aggressive Treatments of obesity
drugs- over the counter: diuretics, appetite supressor, herbal supplements

-prescriptions- sibutramine inhibits uptake of serotonin, most effective in combination with reduction of calories and exercise
-low kilocalore diets
-surgery
–stomach stapling, gastric bypass, lap band

What is the one drug FDA has approved?
Benzocaine (anesthetizes the tounge)
What does your BMI need to be inorder to get weight loss surgery?
BMI of greater then 40 or 35
-for patients where medical therapy has failed
The surgeon constructs a small gasteric pouch and restricts the outlet from the stomach to the intestine
vertical band gastroplasty
The sergeon constructs a small gasteric pouch and creates an outlet directly to the jejunum
gastric bypass
How is vitamin B12 absorbed?
-in stomach, HCL and pepsin release B12 from the proteins to which it is bound
-in top of small intesine- B12 binds to Intrinsic factor and travels to end of intestine
-at the end of small intestine intrinsic factor is degraded and vitamin B12 is gradually absorbed in to the blood stream
Reasonable strategies for weight loss
1. realistic energy intake
2. nutritional adequacy
3. small portions
4. carbs, not fats
5. limit sugar and alcohol
6. adequate water
6. physical activity
What can physical activity help
increase energy expenditure
protects and builds lean body mass
improves psychological factors
reduces risk of morbidity and mortality
what is physical activitys impact on comorbidities
enhances cardiorespiratory fitness
improves lipid profile
reduces blood pressure
increases insulin sensitivity
improves blood glucose control
Behavior Therapy
b t
self monitoring
keep records of the amount and types of food eaten
physical activity
stress management
get out of situations that lead to overeating:
-coping strategies
-meditation
-relaxation techniques
problem-solving
relize you need to lose weight and figure out how
stimuls conrol
change techniques
-learn to shop for heathy foods
keep high-calorie foods out of the home
-limit the times and places of eating
contingency management
use of rewards for specific actions
cognitive restructuring
good thoughts instead of negative ones
socail support
positive reinforcement from family friends and collegues

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