Obesity, rise

Tetrahydrolipstatin is a lipase inhibitor developed and marketed by Roche (Basel, Switzerland) as an anti-obesity drug. With the incidence of obesity rising rapidly in the industrialized nations, having reached 33% of all adults in the United States and more than a quarter of all French schoolchildren, this problem will rapidly cease to remain one of lifestyle and enter the arena of medical costs associated with the diseases stemming from obesity. 

The rising incidence of obesity has not paralleled sucrose consumption. The FDA Task Force concluded that sugars have no unique role in obesity and that dietary fat rather than carbohydrate is a significant contributor to this condition (62,67,68). However, sugar can promote weight gain in individuals with life-styles marked by excess caloric intake and insufficient exercise. 

The minimum average energy requirement for a sedentary adult to survive is around 2,000 kcal a day, which rises to 4,000 or more if the person is engaged in strenuous labor much of the day. Only a very small percentage of the U.S. population is involved in strenuous labor, yet much of the population consumes over 4,000 calorics each day, resulting in an America that is 50 percent overweight and 20 percent obese. 

The first hormonal signal found to comply with the characteristics of both a satiety and an adiposity signal was insulin [1]. Insulin levels reflect substrate (carbohydrate) intake and stores, as they rise with blood glucose levels and fall with starvation. In addition, they may reflect the size of adipose stores, because a fatter person secretes more insulin than a lean individual in response to a given increase of blood glucose. This increased insulin secretion in obesity can be explained by the reduced insulin sensitivity of liver, muscle, and adipose tissue. Insulin is known to enter the brain, and direct administration of insulin to the brain reduces food intake. The adipostatic role of insulin is supported by the observation that mutant mice lacking the neuronal insulin receptor (NDRKO mice) develop obesity. 

Familial hypertriacylglycerolemia (type IV) Overproduction of VLDL often associated with glucose intolerance and hyperinsulinemia. Cholesterol levels rise with the VLDL concentration. LDL and HDL tend to be subnormal. This type of pattern is commonly associated with coronary heart disease, type II diabetes mellitus, obesity, alcoholism, and administration of progestational hormones. 

In lean athletic individuals the amount of fat in the body may be as low as 7% of body mass but this can rise to more than 40% in obesity. The greatest... 

A 62-year-old obese woman presents to your clinic complaining of deep, aching pain in her right knee. The pain is provoked by walking and subsides with rest. She also notes that her knee is difficult to bend for 1 0 minutes after rising in the morning. The symptoms have worsened over the last several years. Your interview also reveals that she injured her knee several years ago getting out of a car. 

Two of the biggest health problems that overweight individuals face are a greatly elevated risk of heart disease and stroke. The American Heart Association (AHA) has found a direct link between these health conditions and being overweight. Heart disease is now the number-one killer of women in the United States, and the rise of overweight and obesity can be directly correlated to it.2... 

Figure 1.2 The percentage of Americans who are obese has risen significantly in recent years and is at an all-time high, as demonstrated in this map from the year 2000. The rise in obesity is seen in males and females of all ages, including children. This increase in obesity has also been seen in all racial and ethnic groups. The increase in obesity is attributed to decreased exercise and manual labor, along with consumption of larger portions of high-calorie, high-fat foods.

The biochemical and physiological effects of cortisol are snmmarised in Figure 12.10. Higher than normal concentrations of cortisol improve mood and reduce the activity of the immune system. Hence, they are routinely used to reduce chronic inflammation. There are, however, side-effects of these high levels increased levels of blood glucose, obesity and retention of water giving rise to moon face . 

After 60 hours of starvation in lean subjects, fat utilisation (i.e. ketone bodies plus fatty acids) accounts for three-quarters of the energy expenditure (Table 16.1) a value which will rise even higher as starvation continues. Much of this increase is accounted for by hydroxybutyrate oxidation (the major ketone body) since, by 60 hours of starvation, the plasma concentration of hydroxybutyrate has increased 26-fold compared with a threefold increase in the concentration of fatty acid (the glucose concentration falls by less than 30%). By eight days of starvation there has been a sixfold increase in fatty acid concentration, whereas the concentration of hydroxybutyrate has increased about 50-fold (Table 16.2). The changes in these three major fuels in obese subjects during starvation for 38 days are shown in Figure 16.10. 

Diabetes mellitus affects approximately 5 to 8% of the population. A large number of individuals are asymptomatic and do not know they have the disease. The recent rise in obesity in the United States accounts for much of the observed and anticipated rise in cases of diabetes mellitus in this country. Although insulin treatment has greatly increased the life expectancy of the diabetic patient, diabetes remains the third leading cause... 

Potatoes have been valued around the world for centuries because they are an easily cultivated, easily prepared and readily assimilated source of carbohydrate energy. The ease with which potatoes are digested has, however, become a double-edged sword, as the interrelated epidemics of metabolic syndrome and type 2 diabetes become global crises linked to rising obesity. At the same time as carbohydrates have been blamed for obesity, glucose intolerance has become recognized as a core feature of the metabolic syndrome and type 2 diabetes (Seidell, 2000). 

The mechanisms involved have been assessed in 40 women with epilepsy evaluated before and after 1 year of therapy (1166). At the end of follow-up, 15 patients were obese and had higher serum leptin and insulin concentrations than patients who did not gain weight. The rise in serum leptin is consistent with that observed in other types of obesity. 

Chronic diseases present an enormous burden to society by increasing medical costs and human suffering. Recent data estimate that physical inactivity and poor diet caused 400,000 deaths in the year 2000, ranking second only to tobacco, and it is likely that inactivity and diet will soon rank as the leading cause of death in the U.S. This number may be an underestimate given that it reflects deaths attributable only to those with obesity and physical inactivity. These health problems have been virtually nonexistent in underdeveloped countries, but they are on the rise as people change their diets and become more sedentary. 

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