Unhealthy eating habits

Physiology of Appetite
1. Neuronal control
  1. Satiety center
    1. Ventromedial nucleus (MAIN)
      1. Activation --> Complete satiety
      2. Destruction --> Continued eating
    2. Paraventricular nucleus
      1. Lesion --> excessive eating
  2. Feeding center
    1. Lateral Hypothalamic nucleus (MAIN)
      1. Activation --> Increase intake
      2. Destruction --> Decrease intake
    2. Dorsomedial nucleus
      1. Lesion --> Depress eating behavior.
  3. Arcuate nucleus mediates the communication between the brain & the GIT & Adipose tissue
    1. Satiety
      1. 1. Afferent fibers from the GIT/adipose will relay in POMC
      2. 2. The hormones within the POMC neurons (a-MSH and CART) will stimulate the satiety centers in the hypothalamus
      3. 3. The hypothalamus will stimulate the NTS
      4. 4. The NTS will stimulate the DMN
      5. 5. Vagal efferent nerves will be sent to the GIT--> release of insulin, decrease GI motility, etc
    2. Feeding
      1. 1. Afferent fibers from the GIT/adipose will relay AGRP and NPY
      2. 2.They will stimulate the feeding nuclei in the hypothalamus
      3. 3. The hypothalamus will inhibit the NTS
  4. Neurohormonal control of food intake
2. Hormonal control
  1. Short term
    1. Involved during every meal from start to finish
    2. Neurohormonally regulated
      1. Makes sure the right amount of food is eaten
      2. Regulates digestion and absorption
      3. Initiates satiety
    3. Involes hormones: Ghrelin, CCK, PYY, and Incretins (GIP; GLP-1)
  2. Long term
    1. Involved with nutrient stores, making sure they are maintained
    2. Neurally regulated
      1. If nutrient stores are low --> hunger increases (same vice versa)
      2. If temperature is low--> hunger increases
Obesity
1. Epidemiology
2. Definition
  1. The state of being grossly fat or overweight.
3. Causes
  1. Unhealthy eating habits
  2. Lack of physical activity
  3. Genetics
  4. Medical reasons
4. Lab investigations
  1. HCO3 : Increased respiratory rate, CO2 in blood is LOW, HYPERVENTILATION , acidosis and to compensate _ the kidneys will make metablic compensatory alkalosis
  2. Glu, fasting : insulin resistance- decreased glucose uptake which leads to increased glucose production = HYPERGLYCEMIA
  3. TG: increased VLDL production, decreased peripheral TG clearance = HYPER TG
  4. Impaired insulin inhibition of VLDL and glucose production
5. Complications
  1. Poorly controlled hypertension
  2. Type 2 diabetes
  3. MI
  4. Hypertensive retinopathy
  5. osteoarthritis
  6. metabolic syndrome
    1. What it it?
      1. A cluster of conditions occurring together, increasing the risk of cardiovascular diseases, stroke and diabetes.
    2. Symptoms
      1. Visceral obesity
      2. Low HDL-Cholesterol
      3. High triglycerides
      4. Insulin resistance
      5. Hypertension
    3. Risk factors
      1. Age.
      2. Race. In the United States, Mexican-Americans appear to be at the greatest risk of developing metabolic syndrome.
      3. Obesity.
      4. Diabetes.
      5. Other diseases. cardiovascular disease, nonalcoholic fatty liver disease or polycystic ovary syndrome.
    4. IDF Criteria for metabolic syndrome:
    5. Treatment
      1. Healthy lifestyle adoption
      2. Medications to control blood pressure, high blood sugar, and cholesterol levels
  7. non-alcoholic fatty liver disease (NAFLD)
  8. Acute cholecystitis due to gallstones
6. Management
  1. Pharmacological
    1. Orlistat
      1. Mechanism of action
        Inhibits lipase (Gastric & pancreatic) --> Peripherally acting.
        Therefore, decrease in fat breakdown & absorption.
      2. Adverse effect:
        Flatulence.
        Diarrhea (Specifically steatorrhea) Fatty/oily stool.
        Fecal incontinence.
  2. Surgical
    1. Bariatric surgery
      1. 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.
      2. 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.
      3. Types
      4. Eating after bariatric surgery
      5. Long-term risks for patients
        Dumping syndrome.
        Low blood sugar.
        Malnutrition.
        Vomiting.
        Bowel obstruction.
        Hernias
        Ulcers.
  3. European Guidelines For Obesity Management in Adults

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Unhealthy eating habits

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