OBESITY 물리작업치료전공 강권영

definition A state of excess adipose tissue mass BMI(body mass index) Weight/height2(kg/m2) Overweight>25 Obesity>30                                                                                                                                           

measurements BMI Waist-to-hip ratio -Abnormal>0.9(women) Arthropometry(skin fold thickness) Densitometry(underwater weighing) CT, MRI Electrical impedence

Nomogram for BMI

prevalence Obesity(BMI>30) -14.5%(1976~1980)->22.5%(1988~1994) Overweight(25<BMI<30) -50% of adults(>20 of age) between 1988~1991 Female>male Poor economic state

Physiologic regulation of energy balance Appetite -vagal input- gut distention -hormonal signals- leptin, insulin, cortisol -metabolites- ketone, glucose Control of appetite-hypothalamus -lateral nucleus-enhance appetite -ventromedial nucleus- inhibit appetite

Energy balance Energy expenditure -resting and basal metabolic rate (70%) -the energy cost of metabolizing and storing food -the thermic effect of exercise (5~10%) -adaptive thermogenesis in response chronic calorie intake- rising with increased intake (20%)

Etiology of obesity A chronic excess of nutrient intake relative to the level of energy expenditure Ob(obese) gene -> leptin(thin) Secreted by adipose cell. Acts through the hypothalamus. High level of leptin decrease food intake and increase energy expenditure Mutation in ob gene cause hyperphagia and diminished energy expenditure Obese people have increased level of leptin and don`t have mutation therefore they appear to have a leptin resistance

Other causes Cushing`s syndrome Hypothyroidism insulinoma

                                                        

Complication of obesity(1) Mortality increases Insulin resistance and type 2DM -hyperinsulinemia and insulin resistance -insulin resistance is linked to intra-abdominal fat -80% of patients with type 2DM are obese

Complication of obesity(2) Reproductive disorder -men: testosterone↓, estrogen↑, hypogonadism(생식선기능감퇴증), gynecomastia(여성형 유방) -women: menstrual abnormality Cardiovascular disease -hypertension, coronary disease, congestive heart failure, stroke -waist-hip ratio is the best predictor -HDL↓, LDL and triglyceride↑

Complication of obesity(3) Pulmonary disease -total lung capacity -obstructive sleep apnea Gallstone Higher mortality from cancer Osteoarthritis Venous stasis Friability of skin

treatment Diet Exercise Drugs Surgery others

Diet(1) A deficit of 7500kcal is a weight loss of 1kg Deficit of 1000kcal/day – 1kg weight loss a week Eating 100kcal/day less for a year – 5kg weight loss Weight loss rate is greater in obese, and in men because of higher metabolic rate

Diet(2) Low caloric diets -800~1200kcal/day -diet rich in fruits, vegetable, and whole grain is preferable Very low energy diets -400~600kcal/day -unsafe -45~70g of protein, 30~50g of carbohydrate, 2g of fat -contraindication: pregnancy, cancer, recent MI, cerebrovascular disease, hepatic disease, psychiatric disease

exercise Increase energy expenditure Valuable means to sustain diet therapy Have effect on cardiovascular tone and blood pressure

drugs Subutramine(Reductil) -antidepressant -reuptake inhibitor of norepinephrine and serotonin -suppress appetite -7% weight loss/24weeks Oristat(Xenical) -intestinal lipase inhibitor -fat malabsorption -8.7kg weight loss/year

Subutramine(Reductil) 금기 부작용

Oristat(Xenical) 효능·효과 부작용 용량·용법

Surgery(1) After failure of diet, exercise and drug Criteria 45kg or 100% above ideal body weight or medical condition related to refractory obesity Repeated failure of other therapeutic approaches At eligible weight for 3~5year Capability of tolerating surgery Absence of alcoholism other addiction or major psychopathology Prior clearance by a psychiatrist

Surgery(2) Complication -electrolyte imbalance -gallstone -nephrolithiasis -Gastric ulcer -Hepatic dysfunction -arthritis

reference en.wikipedia.org/wiki/Cushing's_syndrome en.wikipedia.org/wiki/Hypothyroidism http://www.healthkorea.net/HealthInfo/?kspid... Rimonabant: a novel selective cannabinoid-1 receptor antagonist for treatment of obesity. (includes abstract); Patel PN; Pathak R American Journal of Health-System Pharmacy, 3/1/2007; 64 (5): 481-9