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Lecture 7
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Lecture 5 page 1 2 3 4 5 6 7 8

Health Implications of Obesity
In 1985, a National Institutes of Health Consensus Conference declared that obesity was a disease with significant health implications. In June 1998, the National Heart Lung and Blood Institute issued its Guidelines for the Evaluation and Treatment of Obesity in which a task force reported on its review of over 300 randomized trials demonstrating the impact of obesity on some of the most important health problems in our nation and the world.

1. Heart Disease and Hyperlipidemia
Increased production of VLDL particles and decreased clearance of LDL particles are both associated with mild obesity. Some severely obese subjects have normal cholesterol levels, and the prevalence of hyperlipidemia is only about 10% in the severely obese (BMI > 40). Only about 5 % of all hypercholesterolemia is accounted for by defined genetic hyperlipidemias, other than common hypercholesterolemia which is a heterogeneous disease. There are 56 million Americans with cholesterol levles >200 mg/dl and 37 million with cholesterol levels greater than 240 mg/dl. Only about 3 to 4 million Americans are taking cholesterol lowering drugs, and one million Americans have heart attacks each year. It is clear that obesity caused by overnutrition is the major environmental stimulus to increased cholesterol levels.

2. Diabetes Mellitus
Diabetes mellitus (sweet urine) is the tip of the iceberg of a genetic-environmental condition characterized by obesity in greater than 80% of all patients. Recently, the criteria for diagnosis have been changed from a fasting blood sugar of >140 mg/dl to >126 mg/dl. The standard medical approach to the diabetic is to make the diagnosis of the disease and send the patient to a nurse to learn glucose monitoring, to a dietitian to be taught an exchange diet, and to a pharmacist to receive pharmacotherapy (oral agents or insulin) for their diabetes. Throughout this process there has been no consideration of the primacy of hyperinsulinemia due to excess visceral/abdominal fat. In the nutritional medicine approach, if there is no infection present or surgery planned, then glucose control must be secondary to the attempts to lose visceral fat and increase muscle mass. In fact, over 80% of all patients receiving insulin never attain normal blood glucose levels. Moreover, both insulin and oral agents increase appetite leading to weight gain and undercutting attempts at weight management. Type II diabetes mellitus is a multifactorial genetic disease which is strongly associated with obesity. Even small amounts of upper body fat (e.g. 20 pounds) can lead to insulin resistance and hyperinsulinemia. Weight loss and caloric restriction benefit the majority of type II diabetics.

3.Common Forms of Cancer
The American Cancer Society, in a study of over 750,000 individuals, developed evidence that obesity contributes to the high incidence of breast, colon, prostate, uterine, ovarian, pancreatic, gallbladder, and kidney cancer in the United States. International migration studies demonstrate that when individuals move from Japan to the U.S., their incidence of breast or prostate cancer goes up five-fold within one generation. Microscopic cancers (called carcinoma in situ or latent cancers) are found with increasing frequency in autopsies of individuals dying of other causes as they age. In fact, aging is the most important risk factor for cancer. Individuals in Japan and the U.S., have the same incidence of latent prostate and breast cancers, but these grow to be clinically detected five times more frequently in the U.S. than in Japan. In animals, the growth rate of chemically-induced cancers can be influenced strongly by changes in diet and exercise. Based on this evidence, it is believed that there is a growth-promoting effect of our diet and lifestyle based on the hormones associated with obesity (increased peptide growth factors and reproductive hormones) and the presence of pro-oxidant growth-promoting lipids (linoleic acid) in excess. Antioxidants and the gene-nutrient interaction in cancer promotion will be discussed later in the course.

4. Hypertension
The majority of hypertensive patients have mild hypertension with a diastolic blood pressure of 90 to 95 mm Hg. According to all the step-care approaches endorsed by medical organizations, diet, exercise, and lifestyle change are the first steps in treatment. However, the standard medical treatment is to use an antihypertensive drug. In fact, many patients with mild obesity-associated hypertension will normalize in the first two weeks of obesity treatment. "Give Us A Week We’ll Take Off the Weight!" The first weight loss is due in large part to urinary losses of water and sodium chloride (2 lb./quart). The amount can be estimated from extrapolating backwards from the rate of true fat and lean loss after the initial diuresis. Insulin levels decrease rapidly with calorie restriction and this accounts for the loss of water since insulin is a sodium-retaining hormone. However, it should be remembered that hypertension returns with weight gain, so that the reduction and discontinuation should be done conservatively in some patients with a strong message indicating the relationship of blood pressure and weight gain. Increased insulin production is associated with increased production of catecholamines which can promote hypertension. Insulin also retains sodium via a renal effect, so that salt retention will also be promoted in patients with upper body obesity and hyperinsulinemia.

5. Psychosocial Morbidity and Mortality
While as physicians, we are concerned with the health effects of obesity, there are major impacts of obesity on: disturbed family interactions, job performance and status, self-esteem, and sexuality. These impacts can be utilized to motivate and reinforce lifestyle changes to treat obesity.

6. Other
Gallstones, increased surgical morbidity and mortality, and osteoarthritis are associated with obesity.


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Lecture 1
:Introduction to Nutrition in Western Civilization
Lecture 2:
Dietary Macronutrients, Body Fat, and Blood Lipids
Lecture 3:
Digestion and Absorption of Macronutrients
Lecture 4:
Basic Principles of Nutrient Metabolism
Lecture 5:
Lecture 6:
Fuel Utilization During Exercise
  Lecture 7:Biochemistry of Oxidant Stress in Health and Disease Antioxidants
Lecture 8:Nutrition for the 21st Century






Nutrition 101 - Natural Remedies - Weight Management - Physician Education
Vitamins & Minerals- Nutrition & Aging - Nutrition & Disease - Research