1. Endocrine System 2

2. Part 2: Metabolism

4. Overweight or obesity Adiposity Central obesity B.M.I. above normal Body fat greater than normal Abnormal distribution of body fat risk of disease and death

5. Are overweight and obesity risky? Women NEJM 1999 321:427-33 1 Relative risk BMI (Kg/m 2 ) <2122232524 2930262728 4 3 5 6 7 8 2 = DM2 = Colelitiasis = HT = CVD

6. Cancer Anovulation Menstrual irregularities Infertility Osteoarthritis Sleep apnea Are overweight and obesity risky?

7. Cancer types associated with obesity: 1. Esophageal 2. Stomach 3. Colorectal 4. Liver 5. Gallbladder 6. Pancreas 7. Prostate 8. Kidney 9. Non-Hodgkin lymphoma 10. Multiple myeloma 11. Leukemia 12. Breast 13. Uterus 15. Ovary

8. What is the cause of obesity? 3 BIG FACTORS Genetic susceptibility Energy imbalance Economic, social and cultural aspects

9. The body’ s bank account In Out Food intake BASAL METABOLIC EXPENDITURE BASAL METABOLIC EXPENDITURE ADAPTATIVE THERMOGENESIS ADAPTATIVE THERMOGENESIS PHYSICAL ACTIVITY PHYSICAL ACTIVITY STOCK (ADIPOSE T.) Almost fixed We can intervene here

10. Leptin Appetite Energy expenditure NPY

11. Leptin Appetite Energy expenditure NPY

12. DxIMC (Kg/m 2 ) Underweight<18,5 Normal 18,5-24,9 Overweight25,0-29,9 Grade 1 obesity30,0-34,9 Grade 2 obesity 35,0-39,9 Grade 3 obesity >=40 Diagnosis of overweight and obesity

13. > 90 cm > 80 cm > 90 cm > 80 cm Waist circumference Men Women > 0,95 > 0,8 > 0,95 > 0,8 Increased risk Waist/hip ratio Men Women Diagnosis of central obesity

14. Planning a diet Caloric content of: Fats Adipose tissue Proteins Alcohol Carbohidrates Cal/g 4 7 3,85 7 1 9 Lean mass

15. Characteristics of macronutrients Ability to induce the end of feeding Ability to supress hunger Energetic density Ability to be stored in the body Fat CH Prot Low MediumHigh LowHigh Low HighNoneLow Planning a diet

16. Metabolic pathway to transfer excess energy to another compartment Self-regulation (ability to induce its own oxidation) Contribution to total calories in typical western diet No Yes LowHigh Low Characteristics of macronutrients Fat CH Prot Planning a diet

17. Time (months) Weight loss (Kg) 14 12 10 8 6 2 4 0 14121086241618 0 Med Sci Sports Exerc 1985 17:466-71 Suspension of dietary intervention