Unhealthy eating habits

Unhealthy eating habits

1. Physiology of Appetite

   • Neuronal control
     • Satiety center
       • Ventromedial nucleus (MAIN)
         • Activation --> Complete satiety
         • Destruction --> Continued eating
       • Paraventricular nucleus
         • Lesion --> excessive eating
     • Feeding center
       • Lateral Hypothalamic nucleus (MAIN)
         • Activation --> Increase intake
         • Destruction --> Decrease intake
       • Dorsomedial nucleus
         • Lesion --> Depress eating behavior.
     • Arcuate nucleus mediates the communication between the brain & the GIT & Adipose tissue
       • Satiety
         • 1. Afferent fibers from the GIT/adipose will relay in POMC
         • 2. The hormones within the POMC neurons (a-MSH and CART) will stimulate the satiety centers in the hypothalamus
         • 3. The hypothalamus will stimulate the NTS
         • 4. The NTS will stimulate the DMN
         • 5. Vagal efferent nerves will be sent to the GIT--> release of insulin, decrease GI motility, etc
       • Feeding
         • 1. Afferent fibers from the GIT/adipose will relay AGRP and NPY
         • 2.They will stimulate the feeding nuclei in the hypothalamus
         • 3. The hypothalamus will inhibit the NTS
     • Neurohormonal control of food intake
   • Hormonal control
     • Short term
       • Involved during every meal from start to finish
       • Neurohormonally regulated
         • Makes sure the right amount of food is eaten
         • Regulates digestion and absorption
         • Initiates satiety
       • Involes hormones: Ghrelin, CCK, PYY, and Incretins (GIP; GLP-1)
     • Long term
       • Involved with nutrient stores, making sure they are maintained
       • Neurally regulated
         • If nutrient stores are low --> hunger increases (same vice versa)
         • If temperature is low--> hunger increases

2. Obesity

   • Epidemiology
   • Definition
     • The state of being grossly fat or overweight.
   • Causes
     • Unhealthy eating habits
     • Lack of physical activity
     • Genetics
     • Medical reasons
   • Lab investigations
     • HCO3 : Increased respiratory rate, CO2 in blood is LOW, HYPERVENTILATION , acidosis and to compensate _ the kidneys will make metablic compensatory alkalosis
     • Glu, fasting : insulin resistance- decreased glucose uptake which leads to increased glucose production = HYPERGLYCEMIA
     • TG: increased VLDL production, decreased peripheral TG clearance = HYPER TG
     • Impaired insulin inhibition of VLDL and glucose production
   • Complications
     • Poorly controlled hypertension
     • Type 2 diabetes
     • MI
     • Hypertensive retinopathy
     • osteoarthritis
     • metabolic syndrome
       • What it it?
         • A cluster of conditions occurring together, increasing the risk of cardiovascular diseases, stroke and diabetes.
       • Symptoms
         • Visceral obesity
         • Low HDL-Cholesterol
         • High triglycerides
         • Insulin resistance
         • Hypertension
       • Risk factors
         • Age.
         • Race. In the United States, Mexican-Americans appear to be at the greatest risk of developing metabolic syndrome.
         • Obesity.
         • Diabetes.
         • Other diseases. cardiovascular disease, nonalcoholic fatty liver disease or polycystic ovary syndrome.
       • IDF Criteria for metabolic syndrome:
       • Treatment
         • Healthy lifestyle adoption
         • Medications to control blood pressure, high blood sugar, and cholesterol levels
     • non-alcoholic fatty liver disease (NAFLD)
     • Acute cholecystitis due to gallstones
   • Management
     • Pharmacological
       • Orlistat
         • Mechanism of action
           • Inhibits lipase (Gastric & pancreatic) --> Peripherally acting.
           • Therefore, decrease in fat breakdown & absorption.
         • Adverse effect:
           • Flatulence.
           • Diarrhea (Specifically steatorrhea) Fatty/oily stool.
           • Fecal incontinence.
     • Surgical
       • Bariatric surgery
         • Achieved by reducing the size of the stomach with a gastric band or through removal of a portion of the stomach or by resecting and re-routing the small intestine to a small stomach pouch.
         • How you prepare
           • Deed to have various lab tests and exams
           • Have restrictions on eating and drinking and which medications you can take.
           • May be required to start a physical activity program and to stop any tobacco use.
         • Types
         • Eating after bariatric surgery
         • Long-term risks for patients
           • Dumping syndrome.
           • Low blood sugar.
           • Malnutrition.
           • Vomiting.
           • Bowel obstruction.
           • Hernias
           • Ulcers.
     • European Guidelines For Obesity Management in Adults

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