Obesity is a condition characterized by an excessive and abnormal accumulation of body fat, which can lead to several health problems, such as cardiovascular disease, hyperlipidemia, hypertension, and diabetes mellitus. This condition has become a significant public health epidemic and has worsened over the past years.
The causes of obesity are complex and multifactorial, and it is the second most common preventable cause of death after smoking. The body mass index (BMI) is the commonly used method to classify obesity, which is calculated as body weight in kilograms differed by height in meters squared.
However, the BMI may not be as accurate for Asians, and older adults as a normal BMI may not always reveal underlying excess fat. Hence, other methods, such as assessing skin thickness in specific areas of the body, may be used to estimate obesity. Another method to assess fat mass is the DEXA scan, a dual-energy radiographic absorptiometry scan.
Epidemiology
Obesity is a significant issue in the United States, with almost one-third of adults and 17% of adolescents considered obese, according to 2012 data from the CDC. One out of every five adolescents, one out of every six elementary school-age children, and one out of 12 preschool-age children are also classified as obese.
Certain ethnic groups, particularly African Americans, experience higher rates of obesity than Caucasians and Hispanics. The prevalence of obesity also varies by region, with southern states having the highest rates.
However, obesity is not limited to the United States, as it is a growing concern worldwide, affecting around 500 million adults globally, with the numbers increasing at an alarming rate. Obesity poses significant health risks and increases the likelihood of developing diabetes, heart disease, and stroke.
Anatomy
Pathophysiology
Obesity has been linked to numerous health conditions, including cardiovascular disease, diabetes, and various cancers. Studies have shown that genetics, specifically the FTO gene, plays a significant role in obesity. Leptin, a hormone that regulates food intake and body weight, is often resistant in those with obesity, and adipose tissue can cause systemic inflammation, leading to insulin resistance and higher triglyceride levels.
The accumulation of fatty acids in the heart muscle can cause left ventricular dysfunction, and obesity can impact the renin-angiotensin system, leading to higher blood pressure. Visceral obesity, where fat accumulates around internal organs, increases the risk of cardiovascular disease. Some individuals with a BMI over 30 kg/m2 are metabolically healthy, meaning they do not exhibit insulin resistance or dyslipidemia. Adipocytes, or fat-storing cells, produce prothrombotic and inflammatory substances, including adipokines, which can increase the risk of stroke.
Obesity can cause macrophages to invade adipose tissue and produce adipokines, leading to chronic inflammation and altered lipid and glucose metabolism, which further increases the risk of cardiometabolic problems. Adiponectin, a hormone produced by adipocytes, has anti-inflammatory and insulin-sensitizing properties. Lower levels of adiponectin in circulation are associated with visceral obesity.
Etiology
Obesity results from an imbalance between energy intake and energy expenditure. This imbalance leads to excessive weight gain and is influenced by various factors, including cultural, genetic, and societal factors. Evidence suggests that genetics play a significant role in obesity, with multiple genes associated with adiposity and weight gain.
Other factors that contribute to obesity include a sedentary lifestyle, sleep disturbances, endocrine disorders, medications, and overconsumption of carbohydrates and high-sugar foods. In addition, a decrease in energy metabolism can also contribute to weight gain. Several syndromes are associated with obesity, including Prader-Willi syndrome and MC4R syndromes.
Prader-Willi syndrome is a rare genetic disorder resulting in constant hunger and a slower metabolism. MC4R syndrome is caused by mutations in the MC4R gene, which can result in a reduced ability to control appetite and a slower metabolism. Other less common syndromes associated with obesity include Bardet-Beidl syndrome, fragile X syndrome, Alstrom syndrome, and Wilson Turner congenital leptin deficiency.
Genetics
Prognostic Factors
Obesity is a primary health concern due to its significant morbidity and mortality rates. People classified as obese have a higher risk of experiencing adverse cardiac events and stroke. In addition, the quality of life is often poor for individuals with obesity. Several factors can contribute to the worsening of morbidity in obese patients, including the age at which obesity first develops.
Research has shown that individuals who become obese at a younger age are at a greater risk of developing serious health conditions later in life. The amount of central adiposity, or fat stored around the abdomen, is also a significant factor in obesity-related morbidity. The severity of obesity is another factor that contributes to morbidity.
Individuals with severe obesity, defined as a body mass index (BMI) greater than 40, are at a much higher risk of developing health complications than those with a lower BMI. Gender also plays a role in obesity-related morbidity. Research has shown that men tend to have more visceral fat, linked to a higher risk of developing metabolic disorders and cardiovascular disease.
In contrast, women tend to have more subcutaneous fat, less strongly associated with these conditions. Finally, race has a role in obesity-related morbidity. Research has shown that certain racial and ethnic groups, such as Black, Hispanic, and Native American populations, are more likely to be obese and to experience health complications related to obesity compared to White populations.
Whenever it is tolerated, and further weight loss is needed
3 mg/day daily subcutaneous (SC) injection
Reduce to 1 mg subcutaneously (SC) daily if not tolerated; titrate to 2 mg subcutaneously (SC) once daily if greater weight loss is desired
May be increased up to 1-3 mg daily
the Maximum dose per day is 3 mg
Tablets: Take 10 mg orally every 12 hour
Extended-release tablets: Take 20 mg orally daily Dosage ModificationsRenal impairment
Mild (creatinine clearance of >50 ml/min): dose alteration not necessary
Moderate (creatinine clearance of 30 to 50 ml/min): Use carefully
Severe (creatinine clearance <30 ml/min): Not advised Hepatic impairment
Mild to moderate: dose alteration not necessary
Severe: Use carefully
Dravet Syndrome (Orphan)
Dravet syndrome therapy is designated as an orphan
Start with 0.5-1 mg each day in the morning
Increase the dose to 1.5-2 mg/day after a week, based on the response of the patient
Keep a maximum dose of not more than 3 mg each day in divided doses
Duration of treatment ranges from 4-6 weeks to a maximum of 12 weeks
For >6 years: 5 mg initially oral tablet/solution once daily, increase gradually 2.5 mg every week until required response is obtained
Maintain 5 to 40 mg/day in divided doses after initial recovery
<12 years: Safety and efficacy not established
>12 years:
Initial dose: 25 to 50mg tablet orally once a day
Maintenance dose: 25 to 50mg tablet orally thrice a day
Not safe and efficacious for children less than 12 years
For more than 12 years (Saxenda only)- 0.6 mg subcutaneously daily
Increase the dose by 0.6 mg/day, on weekly basis until 3 mg/day dose is reached
Maintenance dose- 3 mg/day, reduce to 2.4 mg/day if unable to tolerate
Discontinue the dose, if the patient does not show reduction in BMI by a minimum of 1% from the baseline
Not safe and efficacious for children less than 12 years
For more than 12 years (Saxenda only)- 0.6 mg subcutaneously daily
Increase the dose by 0.6 mg/day, on weekly basis until 3 mg/day dose is reached
Maintenance dose- 3 mg/day, reduce to 2.4 mg/day if unable to tolerate
Discontinue the dose, if the patient does not show reduction in BMI by a minimum of 1% from the baseline
1 mg subcutaneously (SC) daily 2 weeks
If 1 mg every day is not tolerated, decrease the dosage to 0.5 mg SC each day
If 0.5 mg daily is tolerated for at least a week, titrate the dosage to 1 mg daily
Age: >12 years
2 mg subcutaneously (SC) daily 2 weeks
Whenever it is tolerated, and further weight loss is needed
3 mg/day daily subcutaneous (SC) injection
Reduce to 1 mg subcutaneously (SC) daily if not tolerated
Titrate to 2 mg subcutaneously (SC) once daily if greater weight loss is desired
May be increased up to 1-3 mg daily
the Maximum dose per day is 3 mg
For more than 12 years-
Start with 0.5-1 mg each day in the morning
Increase the dose to 1.5-2 mg/day after a week, based on the response of the patient
Keep a maximum dose of not more than 3 mg each day in divided doses
Duration of treatment ranges from 4-6 weeks to a maximum of 12 weeks
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Obesity is a condition characterized by an excessive and abnormal accumulation of body fat, which can lead to several health problems, such as cardiovascular disease, hyperlipidemia, hypertension, and diabetes mellitus. This condition has become a significant public health epidemic and has worsened over the past years.
The causes of obesity are complex and multifactorial, and it is the second most common preventable cause of death after smoking. The body mass index (BMI) is the commonly used method to classify obesity, which is calculated as body weight in kilograms differed by height in meters squared.
However, the BMI may not be as accurate for Asians, and older adults as a normal BMI may not always reveal underlying excess fat. Hence, other methods, such as assessing skin thickness in specific areas of the body, may be used to estimate obesity. Another method to assess fat mass is the DEXA scan, a dual-energy radiographic absorptiometry scan.
Obesity is a significant issue in the United States, with almost one-third of adults and 17% of adolescents considered obese, according to 2012 data from the CDC. One out of every five adolescents, one out of every six elementary school-age children, and one out of 12 preschool-age children are also classified as obese.
Certain ethnic groups, particularly African Americans, experience higher rates of obesity than Caucasians and Hispanics. The prevalence of obesity also varies by region, with southern states having the highest rates.
However, obesity is not limited to the United States, as it is a growing concern worldwide, affecting around 500 million adults globally, with the numbers increasing at an alarming rate. Obesity poses significant health risks and increases the likelihood of developing diabetes, heart disease, and stroke.
Obesity has been linked to numerous health conditions, including cardiovascular disease, diabetes, and various cancers. Studies have shown that genetics, specifically the FTO gene, plays a significant role in obesity. Leptin, a hormone that regulates food intake and body weight, is often resistant in those with obesity, and adipose tissue can cause systemic inflammation, leading to insulin resistance and higher triglyceride levels.
The accumulation of fatty acids in the heart muscle can cause left ventricular dysfunction, and obesity can impact the renin-angiotensin system, leading to higher blood pressure. Visceral obesity, where fat accumulates around internal organs, increases the risk of cardiovascular disease. Some individuals with a BMI over 30 kg/m2 are metabolically healthy, meaning they do not exhibit insulin resistance or dyslipidemia. Adipocytes, or fat-storing cells, produce prothrombotic and inflammatory substances, including adipokines, which can increase the risk of stroke.
Obesity can cause macrophages to invade adipose tissue and produce adipokines, leading to chronic inflammation and altered lipid and glucose metabolism, which further increases the risk of cardiometabolic problems. Adiponectin, a hormone produced by adipocytes, has anti-inflammatory and insulin-sensitizing properties. Lower levels of adiponectin in circulation are associated with visceral obesity.
Obesity results from an imbalance between energy intake and energy expenditure. This imbalance leads to excessive weight gain and is influenced by various factors, including cultural, genetic, and societal factors. Evidence suggests that genetics play a significant role in obesity, with multiple genes associated with adiposity and weight gain.
Other factors that contribute to obesity include a sedentary lifestyle, sleep disturbances, endocrine disorders, medications, and overconsumption of carbohydrates and high-sugar foods. In addition, a decrease in energy metabolism can also contribute to weight gain. Several syndromes are associated with obesity, including Prader-Willi syndrome and MC4R syndromes.
Prader-Willi syndrome is a rare genetic disorder resulting in constant hunger and a slower metabolism. MC4R syndrome is caused by mutations in the MC4R gene, which can result in a reduced ability to control appetite and a slower metabolism. Other less common syndromes associated with obesity include Bardet-Beidl syndrome, fragile X syndrome, Alstrom syndrome, and Wilson Turner congenital leptin deficiency.
Obesity is a primary health concern due to its significant morbidity and mortality rates. People classified as obese have a higher risk of experiencing adverse cardiac events and stroke. In addition, the quality of life is often poor for individuals with obesity. Several factors can contribute to the worsening of morbidity in obese patients, including the age at which obesity first develops.
Research has shown that individuals who become obese at a younger age are at a greater risk of developing serious health conditions later in life. The amount of central adiposity, or fat stored around the abdomen, is also a significant factor in obesity-related morbidity. The severity of obesity is another factor that contributes to morbidity.
Individuals with severe obesity, defined as a body mass index (BMI) greater than 40, are at a much higher risk of developing health complications than those with a lower BMI. Gender also plays a role in obesity-related morbidity. Research has shown that men tend to have more visceral fat, linked to a higher risk of developing metabolic disorders and cardiovascular disease.
In contrast, women tend to have more subcutaneous fat, less strongly associated with these conditions. Finally, race has a role in obesity-related morbidity. Research has shown that certain racial and ethnic groups, such as Black, Hispanic, and Native American populations, are more likely to be obese and to experience health complications related to obesity compared to White populations.
Whenever it is tolerated, and further weight loss is needed
3 mg/day daily subcutaneous (SC) injection
Reduce to 1 mg subcutaneously (SC) daily if not tolerated; titrate to 2 mg subcutaneously (SC) once daily if greater weight loss is desired
May be increased up to 1-3 mg daily
the Maximum dose per day is 3 mg
Tablets: Take 10 mg orally every 12 hour
Extended-release tablets: Take 20 mg orally daily Dosage ModificationsRenal impairment
Mild (creatinine clearance of >50 ml/min): dose alteration not necessary
Moderate (creatinine clearance of 30 to 50 ml/min): Use carefully
Severe (creatinine clearance <30 ml/min): Not advised Hepatic impairment
Mild to moderate: dose alteration not necessary
Severe: Use carefully
Dravet Syndrome (Orphan)
Dravet syndrome therapy is designated as an orphan
Start with 0.5-1 mg each day in the morning
Increase the dose to 1.5-2 mg/day after a week, based on the response of the patient
Keep a maximum dose of not more than 3 mg each day in divided doses
Duration of treatment ranges from 4-6 weeks to a maximum of 12 weeks
For >6 years: 5 mg initially oral tablet/solution once daily, increase gradually 2.5 mg every week until required response is obtained
Maintain 5 to 40 mg/day in divided doses after initial recovery
<12 years: Safety and efficacy not established
>12 years:
Initial dose: 25 to 50mg tablet orally once a day
Maintenance dose: 25 to 50mg tablet orally thrice a day
Not safe and efficacious for children less than 12 years
For more than 12 years (Saxenda only)- 0.6 mg subcutaneously daily
Increase the dose by 0.6 mg/day, on weekly basis until 3 mg/day dose is reached
Maintenance dose- 3 mg/day, reduce to 2.4 mg/day if unable to tolerate
Discontinue the dose, if the patient does not show reduction in BMI by a minimum of 1% from the baseline
Not safe and efficacious for children less than 12 years
For more than 12 years (Saxenda only)- 0.6 mg subcutaneously daily
Increase the dose by 0.6 mg/day, on weekly basis until 3 mg/day dose is reached
Maintenance dose- 3 mg/day, reduce to 2.4 mg/day if unable to tolerate
Discontinue the dose, if the patient does not show reduction in BMI by a minimum of 1% from the baseline
1 mg subcutaneously (SC) daily 2 weeks
If 1 mg every day is not tolerated, decrease the dosage to 0.5 mg SC each day
If 0.5 mg daily is tolerated for at least a week, titrate the dosage to 1 mg daily
Age: >12 years
2 mg subcutaneously (SC) daily 2 weeks
Whenever it is tolerated, and further weight loss is needed
3 mg/day daily subcutaneous (SC) injection
Reduce to 1 mg subcutaneously (SC) daily if not tolerated
Titrate to 2 mg subcutaneously (SC) once daily if greater weight loss is desired
May be increased up to 1-3 mg daily
the Maximum dose per day is 3 mg
For more than 12 years-
Start with 0.5-1 mg each day in the morning
Increase the dose to 1.5-2 mg/day after a week, based on the response of the patient
Keep a maximum dose of not more than 3 mg each day in divided doses
Duration of treatment ranges from 4-6 weeks to a maximum of 12 weeks
medtigo
Obesity
Updated :
March 8, 2023
Obesity is a condition characterized by an excessive and abnormal accumulation of body fat, which can lead to several health problems, such as cardiovascular disease, hyperlipidemia, hypertension, and diabetes mellitus. This condition has become a significant public health epidemic and has worsened over the past years.
The causes of obesity are complex and multifactorial, and it is the second most common preventable cause of death after smoking. The body mass index (BMI) is the commonly used method to classify obesity, which is calculated as body weight in kilograms differed by height in meters squared.
However, the BMI may not be as accurate for Asians, and older adults as a normal BMI may not always reveal underlying excess fat. Hence, other methods, such as assessing skin thickness in specific areas of the body, may be used to estimate obesity. Another method to assess fat mass is the DEXA scan, a dual-energy radiographic absorptiometry scan.
Obesity is a significant issue in the United States, with almost one-third of adults and 17% of adolescents considered obese, according to 2012 data from the CDC. One out of every five adolescents, one out of every six elementary school-age children, and one out of 12 preschool-age children are also classified as obese.
Certain ethnic groups, particularly African Americans, experience higher rates of obesity than Caucasians and Hispanics. The prevalence of obesity also varies by region, with southern states having the highest rates.
However, obesity is not limited to the United States, as it is a growing concern worldwide, affecting around 500 million adults globally, with the numbers increasing at an alarming rate. Obesity poses significant health risks and increases the likelihood of developing diabetes, heart disease, and stroke.
Obesity has been linked to numerous health conditions, including cardiovascular disease, diabetes, and various cancers. Studies have shown that genetics, specifically the FTO gene, plays a significant role in obesity. Leptin, a hormone that regulates food intake and body weight, is often resistant in those with obesity, and adipose tissue can cause systemic inflammation, leading to insulin resistance and higher triglyceride levels.
The accumulation of fatty acids in the heart muscle can cause left ventricular dysfunction, and obesity can impact the renin-angiotensin system, leading to higher blood pressure. Visceral obesity, where fat accumulates around internal organs, increases the risk of cardiovascular disease. Some individuals with a BMI over 30 kg/m2 are metabolically healthy, meaning they do not exhibit insulin resistance or dyslipidemia. Adipocytes, or fat-storing cells, produce prothrombotic and inflammatory substances, including adipokines, which can increase the risk of stroke.
Obesity can cause macrophages to invade adipose tissue and produce adipokines, leading to chronic inflammation and altered lipid and glucose metabolism, which further increases the risk of cardiometabolic problems. Adiponectin, a hormone produced by adipocytes, has anti-inflammatory and insulin-sensitizing properties. Lower levels of adiponectin in circulation are associated with visceral obesity.
Obesity results from an imbalance between energy intake and energy expenditure. This imbalance leads to excessive weight gain and is influenced by various factors, including cultural, genetic, and societal factors. Evidence suggests that genetics play a significant role in obesity, with multiple genes associated with adiposity and weight gain.
Other factors that contribute to obesity include a sedentary lifestyle, sleep disturbances, endocrine disorders, medications, and overconsumption of carbohydrates and high-sugar foods. In addition, a decrease in energy metabolism can also contribute to weight gain. Several syndromes are associated with obesity, including Prader-Willi syndrome and MC4R syndromes.
Prader-Willi syndrome is a rare genetic disorder resulting in constant hunger and a slower metabolism. MC4R syndrome is caused by mutations in the MC4R gene, which can result in a reduced ability to control appetite and a slower metabolism. Other less common syndromes associated with obesity include Bardet-Beidl syndrome, fragile X syndrome, Alstrom syndrome, and Wilson Turner congenital leptin deficiency.
Obesity is a primary health concern due to its significant morbidity and mortality rates. People classified as obese have a higher risk of experiencing adverse cardiac events and stroke. In addition, the quality of life is often poor for individuals with obesity. Several factors can contribute to the worsening of morbidity in obese patients, including the age at which obesity first develops.
Research has shown that individuals who become obese at a younger age are at a greater risk of developing serious health conditions later in life. The amount of central adiposity, or fat stored around the abdomen, is also a significant factor in obesity-related morbidity. The severity of obesity is another factor that contributes to morbidity.
Individuals with severe obesity, defined as a body mass index (BMI) greater than 40, are at a much higher risk of developing health complications than those with a lower BMI. Gender also plays a role in obesity-related morbidity. Research has shown that men tend to have more visceral fat, linked to a higher risk of developing metabolic disorders and cardiovascular disease.
In contrast, women tend to have more subcutaneous fat, less strongly associated with these conditions. Finally, race has a role in obesity-related morbidity. Research has shown that certain racial and ethnic groups, such as Black, Hispanic, and Native American populations, are more likely to be obese and to experience health complications related to obesity compared to White populations.
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