obesity

obesity

1. definition: increase in body fat

2. epidemiology

   • The prevalence of overweight among children and adolescents aged 5-19 has risen dramatically from just 4% in 1975 to just over 18% in 2016.
     • Once considered a high-income country problem, overweight and obesity are now on the rise in low- and middle-income countries. In Africa, the number of overweight children under 5 has increased by nearly 50 per cent since 2000.

3. clarifying terms:

   • Hunger
     • Craving for food (need to eat) Associated with other physiological factors e.g release of ghrelin, rhythmical contractions of stomach. Seeking an adequate food supply.
   • appetite
     • desire for food *not associated with hunger* and associated with sensory control like smell, sight...
   • satiety
     • feeling full after a meal
   • starvation
     • depletion of food and energy in our body

4. physiology

   • vagal nerve ascending tract receives inputs from GI and adipose tissue then goes to NTS in brain stem then to dorsomotor nucleus in medulla where they become integrated into arcuate nucleus in hypothalmus
     • then arcuate nucleus have 2 set of neurons: anorexigenic neuron ex: POMC THAT Releases CART AND ALPHA-MSH that will bind to MC receptor located in Paraventricular nucleus.
       • then impulses will travel into feeding center in hypothalmus which is Lateral nucleus of hypothalamus
         • then to efferent tract of vagus nerve and then to adipose tissue or GIT
           • but for satiety it follows the same path but they have orexogenic neuron that will release neuropeptide Y and AGRP that will stimulate satiety center in hypothalamus.
             • this pathway is also regulated by hormones

5. Risk Factors:

   • modifiable
     • lifestylle
       • Social and economic issues.
         • Unhealthy diet.
           • Pregnancy.
             • medications
               • cortisol
               • anti-seziures
               • anti-depressants
             • oral contraceptive drugs
   • non-modifiable
     • genetics
       • age

6. causes

7. Complications of obesity

   • NASH/NAFLD=cirrhosis=liver failure…
     • Investigations of NAFLD/NASH
       • Blood tests: aspartate aminotransferase [AST] and alanine aminotransferase [ALT] are elevated
       • Imaging procedures: ultrasound, CT scan, [MRI]) may reveal fat accumulation in the liver
       • Liver biopsy:  determine the severity of inflammation, detect liver scarring , provide clues about the future course of the condition
   • Pulmonary diseases (restrictive lung disease)
   • dyslipidemia
   • hypertension
   • Insulin resistence=diabetes type 2=diabetic fatigue
   • Heart diseases
   • Cancer (Hepatocellularcarcinoma…)

8. management

   • pharmacology
     • Orlistat
       • Orlistat blocks the action of pancreatic lipase, reducing triglyceride digestion and, thus, absorption.
         • Adverse effects include flatulence, fatty/oily stool, increased defecation, and fecal incontinence.
     • Lorcaserin
   • surgery
     • Bariatric surgery
       • Complications
         • Indigestion and malabsorption
           • gallstones
             • Hair loss and dental problems
     • Gastric Banding

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