GROUP

C2
[OBESITY]
Physiology Laboratory
Small Group Discussion
Output
By: ASUBARIO, Olufunmilola Omonike; BALADAD, Alvin Bryan; DE JESUS, Chrislou; GURUNG,
Man Bahadur; KALANGEG, Kristie; MAHALEE, Naphitcharak; MONTHATHONG, Thanapol;
March 22, 2016Rikkimae Maria; SAMSON, Chino Paolo; SOLONIO, Natalie Keith; VALDEZ, Gregorio
PANLASIGUI,

Physiology Laboratory Small Group Discussion Output | Obesity 0

 OBESITY

Obesity is a complex disorder involving an excessive amount of body fat.

Obesity isn't just a cosmetic concern. It increases your risk of diseases and
health problems, such as heart disease, diabetes and high blood pressure. Being
extremely obese means you are especially likely to have health problems related
to your weight.

Symptoms

Obesity is diagnosed when your body mass index (BMI) is 30 or higher. Your body
mass index is calculated by dividing your weight in kilograms (kg) by your height in
meters (m) squared.

BMI Weight status

Below 18.5 Underweight

18.5-24.9 Normal

25.0-29.9 Overweight

30.0-34.9 Obese (Class I)

35.0-39.9 Obese (Class II)

40.0 and higher Extreme obesity (Class III)

For most people, BMI provides a reasonable estimate of body fat.

However, BMI doesn't directly measure body fat, so some people, such as
muscular athletes, may have a BMI in the obese category even though they don't
have excess body fat.

Physiology Laboratory Small Group Discussion Output | Obesity 1

Causes

Although there are genetic, behavioral and hormonal influences on body

weight, obesity occurs when you take in more calories than you burn through
exercise and normal daily activities. Your body stores these excess calories as
fat.

Obesity can sometimes be traced to a medical cause, such as Prader-Willi

syndrome, Cushing's syndrome, and other diseases and conditions. However,
these disorders are rare and, in general, the principal causes of obesity are:

 Inactivity. If you're not very active, you don't burn as many calories. With
a sedentary lifestyle, you can easily take in more calories every day than
you use through exercise and normal daily activities.

 Unhealthy diet and eating habits. Weight gain is inevitable if you

regularly eat more calories than you burn. And most Americans' diets are
too high in calories and are full of fast food and high-calorie beverages.

Recent research shows that in some cases, certain genetic factors may
cause the changes in appetite and fat metabolism that lead to obesity. For a
person who is genetically prone to weight gain (e.g., has a lower metabolism)
and who leads an inactive and unhealthy lifestyle, the risk of becoming obese is
high.

Although a person's genetic makeup may contribute to obesity, it's not the
primary cause. Environmental and behavioural factors have a greater influence –
consuming excess calories from high-fat foods and doing little or no daily
physical activity over the long run will lead to weight gain. Psychological factors
may also foster obesity. Low self-esteem, guilt, emotional stress, or trauma can
lead to overeating as a means to cope with the problem.

Certain medical conditions such as binge eating disorder (BED), Cushing’s

disease, and polycystic ovary syndrome can also lead to weight gain and obesity.
BED is an eating disorder where a person has recurrent episodes of binge
eating. During these episodes, the individual eats a large amount of food quickly
and feels a lack of control over this eating.

Risk factors

Obesity usually results from a combination of causes and contributing factors,

including:

Physiology Laboratory Small Group Discussion Output | Obesity 2

 Genetics. Your genes may affect the amount of body fat you store, and
where that fat is distributed. Genetics may also play a role in how
efficiently your body converts food into energy and how your body burns
calories during exercise.

 Family lifestyle. Obesity tends to run in families. If one or both of your

parents are obese, your risk of being obese is increased. That's not just
because of genetics. Family members tend to share similar eating and
activity habits.

 Inactivity. If you're not very active, you don't burn as many calories. With
a sedentary lifestyle, you can easily take in more calories every day than
you burn through exercise and routine daily activities. Having medical
problems, such as arthritis, can lead to decreased activity, which
contributes to weight gain.

 Unhealthy diet. A diet that's high in calories, lacking in fruits and

vegetables, full of fast food, and laden with high-calorie beverages and
oversized portions contributes to weight gain.

 Medical problems. In some people, obesity can be traced to a medical

cause, such as Prader-Willi syndrome, Cushing's syndrome and other
conditions. Medical problems, such as arthritis, also can lead to decreased
activity, which may result in weight gain.

 Certain medications. Some medications can lead to weight gain if you

don't compensate through diet or activity. These medications include some
antidepressants, anti-seizure medications, diabetes medications,
antipsychotic medications, steroids and beta blockers.

 Social and economic issues. Research has linked social and economic
factors to obesity. Avoiding obesity is difficult if you don't have safe areas
to exercise. Similarly, you may not have been taught healthy ways of
cooking, or you may not have money to buy healthier foods. In addition,
the people you spend time with may influence your weight — you're more
likely to become obese if you have obese friends or relatives.

 Age. Obesity can occur at any age, even in young children. But as you
age, hormonal changes and a less active lifestyle increase your risk of
obesity. In addition, the amount of muscle in your body tends to decrease
with age. This lower muscle mass leads to a decrease in metabolism.
These changes also reduce calorie needs, and can make it harder to keep
off excess weight. If you don't consciously control what you eat and

Physiology Laboratory Small Group Discussion Output | Obesity 3

 become more physically active as you age, you'll likely gain weight.

 Pregnancy. During pregnancy, a woman's weight necessarily increases.

Some women find this weight difficult to lose after the baby is born. This
weight gain may contribute to the development of obesity in women.

 Quitting smoking. Quitting smoking is often associated with weight gain.

And for some, it can lead to enough weight gain that the person becomes
obese. In the long run, however, quitting smoking is still a greater benefit
to your health than continuing to smoke.

 Lack of sleep. Not getting enough sleep or getting too much sleep can
cause changes in hormones that increase your appetite. You may also
crave foods high in calories and carbohydrates, which can contribute to
weight gain.

Complications

If you're obese, you're more likely to develop a number of potentially serious

health problems, including:

 High triglycerides and low high-density lipoprotein (HDL) cholesterol

 Type 2 diabetes
 High blood pressure
 Metabolic syndrome — a combination of high blood sugar, high blood
pressure, high triglycerides and low HDL cholesterol
 Heart disease
 Stroke
 Cancer, including cancer of the uterus, cervix, endometrium, ovaries,
breast, colon, rectum, esophagus, liver, gallbladder, pancreas, kidney and
prostate
 Breathing disorders, including sleep apnea, a potentially serious sleep
disorder in which breathing repeatedly stops and starts
 Gallbladder disease
 Gynecological problems, such as infertility and irregular periods
 Erectile dysfunction and sexual health issues
 Nonalcoholic fatty liver disease, a condition in which fat builds up in the
liver and can cause inflammation or scarring
 Osteoarthritis

Physiology Laboratory Small Group Discussion Output | Obesity 4

Quality of life

When you're obese, your overall quality of life may be diminished. You may
not be able to do things you used to do, such as participating in enjoyable
activities. You may avoid public places. Obese people may even encounter
discrimination.

Other weight-related issues that may affect your quality of life include:

 Depression
 Disability
 Sexual problems
 Shame and guilt
 Social isolation
 Lower work achievement

Pathophysiology

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Energy balance and etiology of obesity. Energy balance is determined by the
interplay between food intake, energy expenditure and energy storage. Obesity is
a multifactorial disorder resulting from combination of several environmental and
genetic factors. Reduction in physical activity, metabolic rate and thermogenesis
eventually decrease energy expenditure leading to increased energy storage and
obesity. Availability of palatable food as well as hypothalamic injury and different
drugs stimulate food intake. A growing list of genetic factors including dysmorphic
syndromes, leptin/receptor mutation, -3 AR mutation and overexpression of NPY
contribute to development of obesity

Leptin is a peptide hormone that provides signals to the brain about the
amount of fa t stores and is secreted mainly by t he adipose tissue. Leptin is
found in the blood of normal mice but not of genetically obese ob/ob mice. If
recombinant leptin is injected in to the third or the lateral ventricle of the ob/ob
mouse, it r educes food intake and weight gain, acting on neural networks of the
brain involved in the control of food intake and energy expenditure. In addition,
leptin increases the level of activity in the recipient mice, normalizes body
temperature and restores reproductive

Physiologic regulation and metabolic effects of leptin and adiponectin.

Physiology Laboratory Small Group Discussion Output | Obesity 6

 Physiologic regulation and metabolic effects of leptin and adiponectin.
Adipose tissue secretes leptin in states of food deprivation, SNS stimulation,
exercise and cold exposure. Leptin secretion from adipose tissue is inhibited by
obesity states, glucocorticoids, glucose and insulin. Leptin reaches
hypothalamus, where in turn i t inhibits secretion of NPY that normally reduces
energy expenditure, enhances appetite and stimulates synthesis and storage of
fat. Adiponectin normally sensitizes tissues for insulin effects. Obesity and insulin
resistance negatively regulate adiponectin secretion from adipose tissue,
whereas weight reduction enhances its secretion.

Among other targets, in the brain, leptinacts on neurons within arcuate

nucleus of hypothalamus and signals them to reduce neuropeptide Y (NP Y)
production

Food deprivation enhances production of NP Y by the hypothalamus. NPY

stimulates food intake and decreases sympathetic outflow, and through these
ways lowers energy expenditure. It also promotes storage and synthesis of fat by
a n action on lipoprotein lipase in adipose tissue. Although NPY is an important
component of the response, its absence can be compensated by other

Physiology Laboratory Small Group Discussion Output | Obesity 7

mechanisms. Leptin acts on ot her important targets: it increases gene
expression of corticotropin-releasing factor (CRF) in the hypothalamus, which
reduces food intake. The action of melanocyte-stimulating hormone (MSH) may
also be necessary for the response to leptin .Orexins and other mediators
produced in the hypothalamus act i n central feedback mechanisms that regulate
feeding behavior. Food intake and energy expenditure will finally determine the
weight of an individual

Diagnosing

The diagnosis of obesity is usually based on a physical examination and a

patient history (i.e., eating and exercise habits).

A measurement called the body mass index (BMI) does not directly measure
body fat, but it is a useful tool to assess the health risk associated with being
overweight or obese. A BMI of 18.5 to 24.9 is considered within the healthy
range. The BMI is calculated using kilograms (kg) and metres (m) instead of
pounds (lb) and inches/feet. Keep in mind that 1 lb equals 0.45 kg and 1 inch
equals 0.0254 m.

BMI is calculated as follows:

BMI = body weight (kg) ÷ height² (m)

Health Canada classifies BMI according to the associated risk of developing

health problems:

BMI value Classification* and Health risk

BMI Classification Health risk

Less than 18.5 Less than 18.5 Increased

18.5 to 24.9 Normal weight Least

Increased
25.0 to 29.9 Overweight
High
30.0 to 34.9 Obese class I
Very high
35.0 to 39.9 Obese class II

Physiology Laboratory Small Group Discussion Output | Obesity 8

40 and above Obese class III Extremely high

*The above classification does not apply to people younger than 18 years of age,
pregnant women, or breast-feeding women. For people 65 years and older, the
"normal" range is higher, beginning slightly above 18.5 and extending into the
"overweight" range.

Doctors may also use other measurements, such as waist size, to evaluate
health risks associated with excess abdominal fat. When BMI and waist size
indicate a high risk for health problems, additional tests may also be performed.

Treatment & Prevention

Changing your lifestyle- Obesity is managed and treated to decrease the health
risks caused by obesity and to improve quality of life. An appropriate weight
management program usually combines physical activity, healthy diet, and
change in daily habits. Other programs may also involve psychological
counselling and, in some cases, drug therapy. Losing weight and keeping it off is
very challenging because lifestyle and behavioural changes are required. What's
important is to eat a healthy, balanced diet. Fad and crash diets don't work and
can be dangerous. The body needs a minimum amount of energy from food to
function normally. No daily diet with less than 1000 to 1200 calories should be
used without medical supervision. "Crash diets" are never successful in the long
term because once the diet is stopped, the weight usually comes back.
Commercial weight-loss plans and clinics are successful businesses because
they have so many return customers.

To lose weight successfully, and to maintain a healthy weight, requires

lifelong changes in eating and exercise habits as well as an understanding of
emotional factors that lead to overeating. It also involves setting and achieving
specific and realistic goals. People who are medically obese should consult a
doctor or dietitian for a safe and personalized weight-loss program. Behavioural
therapy or modification can also help. Seeing a therapist or counsellor can help
you understand the emotional and psychological reasons for overeating and can
teach you ways to manage your eating triggers.

Regular physical activity is an important part of weight management. In

addition to managing weight, exercise also improves overall health and can help
reduce the risk of diseases such as certain cancers, heart disease, and
osteoporosis. Regular physical activity doesn't mean you have to join the nearest

Physiology Laboratory Small Group Discussion Output | Obesity 9

gym. It can be as simple as climbing the stairs instead of taking the elevator,
walking or cycling to work and leaving the car at home (if at all possible), or going
for a walk at lunchtime with coworkers. What's important is to add exercise to
your daily routine, and to work towards a higher activity level. Choose activities
and exercises you enjoy.

Medical intervention- Medications may be part of a weight management

program. Medications aren't "magic cures" leading to permanent weight loss.
They're generally used in combination with a proper diet and exercise program.
They are only for people who are classified as obese (i.e., those with a BMI over
30), or people with a BMI of 27 and extra heart disease risk factors such as high
cholesterol or diabetes.

Some medications are approved for short-term use only. One example of a
weight-loss medication available in Canada is orlistat which blocks the absorption
of fat from the bowel. Talk to your doctor about whether medications are an
option for you.

 Surgery is only considered when other weight management options have

not been successful. There are many forms of obesity surgery, but often
surgery reduces the size of the stomach so that only a small amount of
food can be eaten comfortably. Some of the terms used to describe the
surgeries used to treat obesity include:

* gastric surgery

* gastric bypass surgery

* laparoscopic band surgery

* Roux-en-Y gastric bypass

* stomach "stapling"

. References:

1. Guyton, AC; Hall, JE: Textbook of Medical Physiology, 11 th edition. Elsevier Inc.
2006.

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2. Koeppen, BM; Stanton, BA: Berne and Levy Physiology, 6 th edition. Elsevier
Inc. 2010.

3. en.wikipedia.org

4. http://www.nhlbi.nih.gov/health/health-topics/topics/af

5. www.emedicinehealth.com

6. http://www.hc-sc.gc.ca/fn-an/nutrition/weights-poids/guide-ld-adult/qa-qr-pub-
eng.php

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