Copy (2) of final obesity

Biochemistry department
Obesity
By
Ahmed El-Shaeer

Obesityis a medical condition in which excess body fat has
accumulated to the extent that it may have an adverse effect
on health, leading to reduced life expectancy and/or increased
health problems.
How to know your weight is good or not?
The answer is very simplified by your weight and height only in
the following law to calculate Body mass index
BMI= Weight (Kgs)/Height (m2)
The perfect body is not exceed 25% or low 20% of his/her
bodyweight
UNDERWEIGHT You are under optimum weight for your height. You could
afford to gain a little weight.
Less than 19
NORMAL You have a healthy weight for your height.20 - 25
OVERWEIGHT You are over optimum weight for your height. You may be
facing health problems, so losing some weight would be a good idea.
26 - 30
OBESE You are over optimum weight for your height. You may be facing
health risks, so see your doctor to help you achieve a healthier weight.
31 +

The past table locates you in the classification of your weight if
you exceed 30% you are obese and classified into
Actually measuring a person's body fat
percentage is not easy and is often
inaccurate, so require special
equipment such as hydrostatic
weighing and Dual-energy X-ray
absorptiometry (DEXA).
Why morbid obesity is considered disease
producing……
At this weight obesity starts to cause many diseases
Hypertension (High blood pressure)
Diabetes.
Coronary artery disease. (Heart blood vessel occlusion)
Respiratory problems ( anywhere between breathing
difficulties, snoring, asthma, and up-to respiratory failure)
Gall stones.
Chronic back pain and disc prolapse.
Knee, ankle pains and degenerative joint diseases.
Fertility problems (anywhere between irregular period,
infertility, to major problems during pregnancy for the
mother and baby.
Dyslipidemia (high blood cholesterol and triglycerides).
Some types of cancer are seen much more frequently in
the morbidly obese and depression and social withdraw.
Severe
class I obesity
30.0–34.9
Morbid
class II obesity
35.0–39.9
Super
class III obesity
≥ 40.0

Causes
- Diet:
At an individual level, a combination of excessive food energy
intake and a lack of physical activityare thought to explain most
cases of obesityespecially if the diet is high in fat. For example,
fast food, fried food, and sweets have high energy density
(foods that have a lot of calories in a small amount of food).
Epidemiologic studies have shown that diets high in fat
contribute to weight gain.
By mechanism high glucose not needed for energy convert into
fatty acids then lipids and glucagon in the muscles and livers
lead to high overweight rate ,so Some scientists believe that
simple carbohydrates (sugars, fructose, desserts, soft drinks,
beer, wine, etc.) contribute to weight gain because they are
more rapidly absorbed into the bloodstream than complex
carbohydrates (pasta, brown rice, grains, vegetables, raw fruits,
etc.) and thus cause a more pronounced insulin release after
meals than complex carbohydrates. This higher insulin release,
some scientists believe, contributes to weight gain.

- Frequency of eating:
Scientists have observed that people who eat small meals four
or five times daily, have lower cholesterol levels and lower
and/or more stable blood sugar levels than people who eat less
frequently (two or three large meals daily). One possible
explanation is that small frequent meals produce stable insulin
levels, whereas large meals cause large spikes of insulin after
meals.
- Genetics:
A person is more likely to develop obesity if one or both
parents are obese. Genetics also affect hormones involved in
fat regulation. For example, one genetic cause of obesity is
leptin deficiency. Leptin is a hormone produced by adipose fat
cells and also in the placenta. Leptin controls weight by
signaling the brain (C.N.S) to eat less when body fat stores are
too high. If for some reason, the body cannot produce enough
leptin or leptin cannot signal the brain to eat less, this control
(sensation of feeding) is lost, and obesity occurs. The role of
leptin replacement as a treatment for obesity is currently being
explored there are another mediator called ghrelin shares in
control of appetite.

- Psychological factors:
Some people, emotions influence eating habits. Many people
eat excessively in response to emotions such as boredom,
sadness, stress, or anger. While most overweight people have
no more psychological disturbances than normal weight
people.
-Medications:
Medications associated with weight gain include certain
antidepressants, anticonvulsants such as carbamazepine and
valproate, diabetes medications such as insulin, sulfonylureas,
and thiazolidinedione), certain hormones such as oral
contraceptives and most corticosteroids such as prednisone.
Weight gain may also be seen with some high blood pressure
medications and antihistamines. The reason for the weight gain
with the medications differs for each medication. If this is a
concern for you, you should discuss your medications with your
physician rather than discontinuing the medication, as this
could have serious effects.

-Diseases:
Hypothyroidism
This is a condition where the thyroid glandproduces too little
thyroid hormone. Thyroid hormone regulates our metabolism,
so too little hormone slows the metabolism and often causes
weight gain.The most common causesare Hashimoto's
thyroiditis (autoimmune disease) and may due to Viral and
bacterial infections.The most accompanied symptoms are dry
skin, weakness, heavy and irregular menstrual period, etc.
Doctors usually prescribe thyroid hormone pills to treat
hypothyroidism or surgical removal of tumors if are found.
Cushing's syndrome
This condition results when the adrenal glands which produce
an excess amount of a steroid hormone called cortisol. This
leads to a build-up of fat in characteristic sites such as the face,
upper back, and abdomen.
If corticosteroid medicine is the cause of Cushing's syndrome,
your doctor will help you lower your dose or gradually stop
taking it.If you are well enough to have surgery, surgical
removal of the pituitary tumor or benign adrenal tumors offers
the best chance for recovery.

Depression
Some people with depression overeat or neural disorder e.g.
neurotransmitters disorders, which can lead to obesity.
There are other diseases can cause excess weight gain for
example growth hormone deficiency , the eating disorders ,
insulin resistance and infectious agents (GIT flora) mainly study
of the effect of infectious agents on metabolism is still in its
early stages.
IS a sex type male or female share in rate of
weight gain or loss?
The Answer depends on the ability of body
metabolism.Women have less muscle than men. Muscle burns
(metabolizes) more calories than other tissue (which includes
fat). As a result, women have a slower metabolism than men,
and hence, have a tendency to put on more weight than men,
and weight loss is more difficult for women. As we age, we tend
to lose muscle and our metabolism slows; therefore, we tend
to gain weight as we get older particularly if we do not reduce
our daily caloric intake.
Not onlythis cause, but hormones share in weight gain. Women
tend to gain weight especially during certain events such as
pregnancy, menopause, and in some cases, with the use of oral
contraceptives. However, with the availability of the lower-
dose estrogen pills, weight gain has not been as great a risk.

Management
Before anything in control or loss your weight, you must put in
your mind by faith that you can do it and bears all difficult that
you will face to get new easily life free from diseases.
There are many examples of lose their weight and they said
*I spent my life trying to lose weight. I tried everything, even an operation of the
stomach. Nothing worked except for OA: Overeaters Anonymous. I have lost all my
weight, and it's not coming back. For me, food is an addiction, and I need to work
through a 12-step group. It's an incredible program that changed my life. There are
meetings all over the world. Good luck.
*The best thing that has worked for me is to write everything I have eaten or drank in the
day. It would help me control what I ate because I would think twice about eating certain
things.
*I lost 100 pounds by drinking large amounts of water during meal time, which helped me
cut back my food intake. When I went off the diet after reaching my goal, I started slowly
gaining. I didn't have a plan for post-diet. Now, 108 pounds later at 308 pounds I'm looking
at losing again.
*7 years ago I went from 230 pounds to 175 in a matter of days. I had high volumn
liposuction done, then Tummy tuck. I went from a size 24 to a size 12. Today 7 years latter I
am a size 8 and weigh 165 pounds. Since the surgeries I exercise mostly walking once a week
for 30 minutes. I watch what I eat. I eat small portions of food and an apple before each
meal. I eat meat 3 times a week.
From past success, experience and advises we get strategy
based on guidelines before and till after loss weight because
more than95% of the people who lose weight regain the weight
within five years.

Firstphysical activity and exercise:
Physical activity and exercise help burn calories. The amount of
calories burned depends on the type, duration, and intensity of
the activity. It also depends on the weight of the person. A 200-
pound person will burn more calories running 1 mile than a
120-pound person, because the work of carrying those extra 80
pounds must be factored in. But exercise as a treatment for
obesity is most effective when combined with a diet. Another
advantage of regular exercise as part of a weight-loss program
is a greater loss of body fat versus lean muscle compared to
those who diet alone.
The National Health and Examination Survey (NHANES I)
showed that people who engage in limited recreational activity
were more likely to gain weight than more active people. Other
studies have shown that people who engage in regular
strenuous activity gain less weight than sedentary people.
Other benefits of exercise include
improved blood sugar control and increased insulin
sensitivity (decreased insulin resistance),
reduced triglyceride levels and increased "good" HDL
cholesterol levels,
lowered blood pressure,
A reduction in abdominal fat and reduced risk of heart
disease.

Recommendations and Precautions:
1- Perform 20-30 minutes of moderate exercise five to seven
days a week. Types of exercise include walking, stationary
bicycling, walking or jogging on a treadmill, stair climbing
machines, jogging, and swimming.
2- Start slowly and progress gradually to avoid injury, excessive
soreness, or fatigue. Over time, build up to 30 to 60 minutes of
moderate to vigorous exercise every day.
3- People are never too old to start exercising. Even frail,
elderly individuals (70-90 years of age) can improve their
strength and balance.
4- After any exercises, you can compensate your minerals by
fresh vegetables not preferred fruits due to its high calories and
low fibers.
The following people should consult a doctor before vigorous
exercise:
Men over age 40 or women over age 50.
Individuals with heart or lung disease, asthma, arthritis, or
osteoporosis.
Individuals who experience chest pressure or pain with
exertion, or who develop fatigue or shortness of breath easily.
Individuals with conditions or lifestyle factors that increase
their risk of developing coronary heart disease, such as high
blood pressure, diabetes, cigarette smoking, high blood
cholesterol, or having family members with early onset heart
attacks and coronary heart disease.

Second dietand healthy food:
The goal is to establish realistic weight-loss goals. While the
ideal weight corresponds to a BMI of 20-25, this is difficult to
achieve for many people. Thus, success is higher when a goal is
set to lose 10%-15% of baseline weight as opposed to 20%-30%
or greater.
The higher the initial weight of a person, the more quickly
he/she will achieve weight loss. This is because for every 1
kilogram (2.2 pounds) of body weight, approximately 22
calories are required to maintain that weight. So for a woman
weighing 100 kilograms (220 pounds), he or she would require
about 2,200 calories a day to maintain his or her weight, while
a person weighing 60 kilograms (132 pounds) would require
only about 1,320 calories. If both ate a calorie-restricted diet of
1,200 calories per day, the heavier person would lose weight
faster. Age also is a factor in calorie expenditure. Metabolic
rate tends to slow as we age, so the older a person is, the
harder it is to lose weight.
When carbohydrates are restricted, people often experience
rapid initial weight loss within the first two weeks. This weight
loss is due mainly to fluid loss. When carbohydrates are added
back to the diet, weight gain often occurs, simply due to a
regain of the fluid and excess CHO convert into fats
accumulated in the body.

Diet guidelines:
Take To Avoid
Balanced nutritious foods Vitamins deficiencies andother
diseases of malnutrition.
Eating low energy dense foods
include vegetables, fruits, lean
meat, fish, grains, beans and diet
soft drinks.
excesscaloriesnotneeded
A healthy diet should have less
than 30% fat. Fat contains twice as
many calories per unit weight than
protein or carbohydrates.
Artificial sweeteners:
Saccharin and aspartame are sugar
substitutes that provide little or no
calories. They may be used as a
substitute for table sugar.
Fructose, sorbitol, and xylitol may
be used as alternatives to sugar,
but they provide more calories
than saccharin and aspartame.
"Take complex Carbohydrates
causesimple carbohydrates cause
excessive insulin release by the
pancreas, and insulin promotes
growth of fat tissue"
People with phenylketonuria (a serious genetic disease in which an
individual is unable to break down and eliminate an amino acid,
phenylalanine) should not use aspartame because it contains
phenylalanine.
Excessive use of sorbitol also may cause diarrhea.

Thirdpointmedication in the management of
obesity:
Medication that used in treatment of obesity should be used
only in patients who have health risks related to obesity.
Medications should be used in patients with a BMI greater than
30 who have other medical conditions that put them at risk for
developing heart disease. They should not be used for cosmetic
reasons. Medications should only be used as an adjunct to diet
modifications and an exercise program and they are classified
into synthetic and Natural.
Syntheticmedications in this category divide into two classes:
First class Second class
Mechanism of
action
Increasing the levels of
neurotransmitters at the
junction called (synapse)
between nerve endings in the
brain.
Inhibiting the action of lipase
enzymes.
Mode of action These medications decrease
appetite and create a
sensation of Hunger and
fullness (satiety) are
regulated by brain chemicals
called neurotransmitters.
Preventing the intestinal
absorption of fat by 30%.
Side effect They cause symptoms that
mimic the sympathetic
nervous system, so the major
side effects high blood
pressure, headache, insomnia,
nervousness, heart attack and
stroke.
They have minimal or no
systemic side effects.
A long-term decrease in fat
absorptioncan cause
deficiency of fat-soluble
vitamins (such as vitamins A,
D, E, K).
Examples -Sibutramine,Fenfluramine
(the fen of fen/phen) and
dexfenfluramine
-Orlistat (Xenical, alli)

The first class of medications was taken off the market since
2010 due to its bad side effects.
Thereare new drugs were produced in the market:
-Qsymia
Which is a combination of phentermine and topiramate
extended release, butit is important to note that
"Qsymia"canlead to birth defects,other possible serious side
effects include increased heart rate, eye problems (glaucoma),
and suicidal thoughts. In patients with diabetes, low blood
sugar was also a concern when taking "Qsymia".Ask the doctor
before starting any synthetic medication.
-Belviq
In June 2012, the FDA approved Belviq (lorcaserin
hydrochloride) as a weight loss medication. The medication
works by controlling appetite (via serotonin activation) from its
receptor C2.
The predominant side effects were headache and dizziness, as
well as fatigue. In patients with diabetes, low blood sugar was
also a concern when taking Belviq.
It is first new drug that approved from about 13 years by FDA
and there is a report by American channel "C.N.N" about the
story of approval this drug that was dismissed for approval in
2010 after the clinical trials on the animals showed that drug
haveside effects tumor in breast and problems in heart valves, -
-but nowadays showed that tumors not reach to the upper limit
of the danger that may cause bad cases which can prevent the
approval of the drug and the same to the another side effect of
problems in heart valves.

Natural medications:
Herbal weight loss products or preparations are even more
misleading. These products may contain a combination of:
Fat burners Weight-loss teas
These agents are stimulants, which
theoretically increase the metabolism and
help thebodybreak downfat.E.g:
Ma huang (a botanical source of
ephedrine),
White willow (a source of salicin),
Hoodia gordonii, and/or Guarana
or kola nut (a source of caffeine),
Ginger,
Cinnamon,
Fennel,
Kiwi,
Green apple pineapple,
Celery.
Contain strong botanical laxatives (Senna,
cascara sagrada) and diuretics
(Rhamnuspurshiana) that cause diarrhea and
loss of water from the body.
Minerals Others
Chromium also is a popular ingredient in
weight-loss products, but there is no
evidence that chromium has any effect on
weight loss(may be to its effect on insulin
regulation).
Guar gum preparations have also been
promoted as a weight-loss agent. Guar gum is
thought to work by leading to a feeling of
fullness early in the meal. It has not been
scientifically proven and has been associated
with abdominal pain, gas, and diarrhea.
Red grapesis thought to decrease fats in blood
Any food rich in fibers due to the thermic effect
will be greater than any normal foods and easily
loss excess lipids and not easily get other fats
For example Mango which is 40% containing
fibers.
All of the products discussed above are not considered drugs and are
therefore not regulated by the Food and Drug Administration. As a
result, there is little information on their effectiveness or safety. You
should discuss any weight loss products you are planning on taking or
are taking with your health care.

The last choice is a role of surgery in the
treatment of obesity:
The National Institute of Health consensus has suggested the
following guidelines for surgery in obese patients:
Patients with a BMI of greater than 40
Patients with a BMI of greater than 35 who have serious
medical problems such as sleep apnea, that would
improve with weight loss.
Before anysurgery is necessary to preview the patient
comprehensively to include this preview performance evaluation
and examination of hormonal accurately, and a careful analysis
of the nature of life and eating habits of the patient, and must be
verified and documented previous attempts at weight loss.
We must know the risks of surgery before starting any type of
surgery to put it in the last choice.
The risks of surgery include:
Complications of infection
Blood clots in the lower extremities (deep vein
thrombosis) and in the lungs (pulmonary embolism).
Anesthesiarisk.
Specific long-term risks related to obesity surgery include
lack of iron absorption and iron deficiencyanemia.
Vitamin B12 deficiency can also develop and could lead to
nerve damage (neuropathies).
Rapid weight loss may also be associated with gallstones.

There are different types of surgery to get loss of morbid or
super obesity for examples:
Adjustable gastric banding:
This surgery is carried out in general by laparoscopy technique
(laparoscopy) and which is the mode of ring made of soft
silicon, 2 cm below the point of the corner of the stomach with
the esophagus. There is a flexible tube is connected between
the ring and Blower (PORT), which is implanted in the
abdominal wall under a layer of fat under the skin, whereby it is
possible inflatable this episode and how tight control of this
part of the stomach. This method is based on a simple principle
of reducing the size of the stomach, leading to a feeling of
fullness even after eating a small meal.
Gastric bypass:
The stomach is divided into the upper part of the stomach and
which is smaller than the lower section of the stomachThis
upper section are connected to the small intestine and so that
we can overcome the proximal section and who has a greater
capacity to absorption. This surgery is more complex than its
predecessor and requires to be held a high degree of
experience and skill. Laparoscopic surgery is a process or
surgeon open and require, in most cases, longer recovered.
Liposuction Surgery:
Aims liposuction to remove excess fat in certain areas of the
body, in order to improve the appearance of the body in terms
of aesthetic and reduce waist circumference as well as other
areas in the oceans of the body. In the surgical process is the
use of a special device, which is pumping off small parts of
excess fat tissue and accumulated by vacuum pump.

Obesity surgery needs a professional health care especially in
the role of anesthesia of patient as in the case of surgical
liposuction, so they found different techniques to destroy fat
cells for examples:
Normal waves
That developed to concentrated waves and the last technology
is reached to low-level lasers (also known as “cold lasers”).
Cold laser
Does not have to be emitted at high temperatures, so it can
penetrate the epidermis without burning it or causing any
damage to the tissue and travel through the skin and puncture
fat cells.
The normal fatty cells takes the lipids from outer membrane
through its pores as single units and converts it to triple units
for trapping it then prevents it from go out again, so here rays
works on widening the pores of the cells to be able the fat cells
leak and the fatty waste is expelled from the system through
normal bodily functions. There is another theory that rays can
destroy the covalent bonds between the triple units then single
units can leak directly out by easy way.
Ultrasonic
We can use it in getting loss of excess fat that cannot be
removed by the normal surgery. It depends on destroying fat
cells
Finally the more developed techniques the lowest side effects.

Conclusion:
Obesity is a chronic condition. Too often it is viewed as a
temporary problem that can be treated for a few months with
a strenuous diet. However, as most overweight people know,
weight control must be considered a lifelong effort to be safe,
effective and obesity not mean starvation.
The best and the safest ways to lose fats and keep it off are
through a commitment to a lifelong process of proper diet and
regular exercise.
Medications should be considered helpful adjuncts to diet and
exercise for patients whose health risk from obesity clearly
outweigh the potential side effects of the medications.
Medications should be prescribed by doctors familiar with the
patients' conditions and with the use of the medications.
Medication(s) and other "herbal" preparations with unproven
effectiveness and safety should be avoided, but the major
doctors supplied their patients with approved herbal
supplement that improve body case.
The loss weight plan must be put without any effect on
immunity improvement.

The increment in thermogenesis is regulated by catechol
amines such as norepinephrine. Researchers are also
investigating the possibility of increasing the amount of brown
adipose tissue in the body, a site of thermogenesis
(Thermogenesis is the process of heat production in organisms
and is regulated mainly by thyroid hormone, the sympathetic
nervous system and by movement of the muscles).
The surgery role to get loss of obesity is easy way, but its risks
are very high and patient cannot change his life style after
surgery easily, but Bariatric surgery results in durable weight
loss and amelioration of obesity-associated co-morbidities,
particularly type 2 diabetes mellitus and reduced mortality
results showed a 65% cure rate, but actually still have danger
rate.
Doctor must tell his patient the best food to increase his body
with good immune system, balanced minerals and low fats gain
exactly with this sequence immunity treatment first before
obesity itself.
Patient must have knowledge about a health food i.e. when he
takes excess calories he must know what he will do in these
situations by his experience in weight loss plan to be able to get
loss the excess gained calories.
Patient must continue with his/her different past doctors
without stopping and have ability to continue his loss weight
program before and after the loss required weight.

Reference:
http://www.medicinenet.com
"National Health and Nutrition Examination Survey."
http://www.cdc.gov/nchs/nhanes.htm.
www.wikipedia.org
http://www.webmd.com/diet/medical-reasons-obesity
http://thechart.blogs.cnn.com/2012/06/27/fda-approves-drug-to-
treat-some-obese-overweight-adults/

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