1. OBESITY
물리작업치료전공
강권영

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

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

5. Nomogram for BMI

6. 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

7. 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

8. 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%)

9. 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

10. Other causes
Cushing`s syndrome
Hypothyroidism
insulinoma

14. 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

15. 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↑

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

17. treatment
Diet
Exercise
Drugs
Surgery
others

18. 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

19. 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

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

21. 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

22. Subutramine(Reductil) 금기 부작용

23. Oristat(Xenical) 효능·효과 부작용 용량·용법

24. 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

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

28. reference en.wikipedia.org/wiki/Cushing's_syndrome
en.wikipedia.org/wiki/Hypothyroidism
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