Obesity

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Web Resources for Obesity
Relevant Clinical Literature
Pubmed on Obesity
RCT with Obesity   from Pubmed
Systematic reviews of Obesity   from Pubmed
Obesity in N Eng J Med, Lancet, JAMA, BMJ   from Pubmed
Obesity in Cochrane Collaboration   from Pubmed
TRIP Database on Obesity
Google Scholar on Obesity
Bandolier on Obesity
UK Guidance
NeLH on Obesity
NHS Evidence on Obesity
Centre for Reviews and Dissemination databases -DARE & NHS EED (evaluates reliability of research)
Nice Guidance on Obesity
Prodigy Guidance on Obesity
Other Wikis
Medpedia on Obesity (Less technical, good quality control)
Wikipedia on Obesity (Less technical, ? quality control)

ΕΤΥΜΟΛΟΓΙΑ

Latin:Obesus - fat

Excess weight. Arbitrarily defined as a BMI >30. Generally a result of excess calorie intake in relation to energy expenditure. In England, the 2004 Health Survery showed that 23.8% of the population was classified as obese.

Distribution of body mass may also be important, with some evidence suggesting that a "pear-shaped" fat distribution - with the fat predominantly on the buttocks and legs - may be less associated with some diseases than an "apple-shaped" fat distribution, with more abdominal fat; or that waist measurements may be more significant than body weight.

Apart from mortality[1], raises risk of several other diseases with most of the cardiovascular risk being related in turn to secondary diabetes mellitus and hypertension.

Relative risk of malignancy in obese non smokers
Relative risk of malignancy in obese non smokers

Contents

Aetiology

Extremely complex interaction between genetics, environment and individual behaviour. Examples of such factors follow to give a flavour rather than suggest any are important in an individual. The hypothalamic leptin/melanocortin pathway is only thought to be important in a minority.

Genetics

Monogenetic

Polygenetic

Environment

Behaviour

(Eating behaviour can be genetically determined[12])

  • Intake of high energy foods
  • Intake alcohol

Treatment

Obesity as a contraindication to treatment

Obesity may:

  • Reduce the likelihood that a treatment will work, sometimes to the extent that it is not worth providing, or may not be cost-effective.
  • Increase the risk of adverse reactions.

Obesity may therefore be a relative or absolute contraindication.

For example, when considering the use of combined oral contraceptives:[13]

  • A body mass index of Body mass index ≥ 30 - 34 kg/m2 comprises "A condition where the advantages of using the method generally outweigh the the theoretical or proven risks";
  • A body mass index 35 – 39 kg/m2 comprises "A condition where the theoretical or proven risks usually outweigh the advantages of using the method"; and
  • A body mass index ≥ 40 kg/m2 comprises "A condition which represents an unacceptable health risk if the contraceptive method is used".

References

  1. ↑ Adams KF, Schatzkin A, Harris TB, Kipnis V, Mouw T, Ballard-Barbash R, Hollenbeck A, Leitzmann MF. Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old. N Engl J Med. 2006;355(8):763-78.
  2. ↑ Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. The New England journal of medicine 2003;348:1625-38.(Direct link – subscription may be required.)
  3. ↑ Farooqi IS, Keogh JM, Yeo GS, Lank EJ, Cheetham T, O'Rahilly S. Clinical spectrum of obesity and mutations in the melanocortin 4 receptor gene. The New England journal of medicine 2003;348:1085-95. (Direct link – subscription may be required.)
  4. ↑ Lubrano-Berthelier C, Dubern B, Lacorte JM, Picard F, Shapiro A, Zhang S, et al. Melanocortin 4 receptor mutations in a large cohort of severely obese adults: prevalence, functional classification, genotype-phenotype relationship, and lack of association with binge eating. The Journal of clinical endocrinology and metabolism 2006;91:1811-8. (Direct link – subscription may be required.)
  5. ↑ Gibson WT, Farooqi IS, Moreau M, DePaoli AM, Lawrence E, O'Rahilly S, Trussell RA. Congenital leptin deficiency due to homozygosity for the Delta133G mutation: report of another case and evaluation of response to four years of leptin therapy. The Journal of clinical endocrinology and metabolism. 2004 Oct; 89(10):4821-6.(Link to article – subscription may be required.)
  6. ↑ Farooqi IS, Keogh JM, Kamath S, Jones S, Gibson WT, Trussell R, Jebb SA, Lip GY, O'Rahilly S. Partial leptin deficiency and human adiposity. Nature. 2001 Nov 1; 414(6859):34-5.(Link to article – subscription may be required.)
  7. ↑ Farooqi IS, Wangensteen T, Collins S, Kimber W, Matarese G, Keogh JM, et al. Clinical and molecular genetic spectrum of congenital deficiency of the leptin receptor. The New England journal of medicine 2007;356:237-47. (Direct link – subscription may be required.)
  8. ↑ Herbert A, Gerry NP, McQueen MB, Heid IM, Pfeufer A, Illig T, et al. A common genetic variant is associated with adult and childhood obesity. Science 2006;312:279-83. (Direct link – subscription may be required.)
  9. ↑ Turnbaugh PJ, Ley RE, Mahowald MA, Magrini V, Mardis ER, Gordon JI. An obesity-associated gut microbiome with increased capacity for energy harvest. Nature 2006;444:1027-31. (Direct link – subscription may be required.)
  10. ↑ Santos JL, Boutin P, Verdich C, Holst C, Larsen LH, Toubro S, et al. Genotype-by-nutrient interactions assessed in European obese women : A case-only study. European journal of nutrition 2006;45:454-62. (Direct link – subscription may be required.)
  11. ↑ Chagnon YC. Susceptibility genes for the side effect of antipsychotics on body weight and obesity. Curr Drug Targets. 2006;7(12):1681-95
  12. ↑ Branson R, Potoczna N, Kral JG, Lentes KU, Hoehe MR, Horber FF. Binge eating as a major phenotype of melanocortin 4 receptor gene mutations. The New England journal of medicine 2003;348:1096-103. (Direct link – subscription may be required.)
  13. ↑ Clinical Effectiveness Unit of the Faculty of Family Planning and Reproductive Heath Care. UK medical eligibility for contraceptive use (UKMEC 2005). London: Faculty of Family Planning and Reproductive Heath Care of the Royal College of Obstetricians and Gynaecologists, 2006 (see p13)
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