ARTICLE REVIEW

BY: AARTI PATEL

M E C H A N I S M S , PAT H O P H Y S I O L O G Y,
AND MANAGEMENT OF OBESITY
INTRODUCTION
• Facts:
– Seven of the top 10 leading causes of death and disability in the US are chronic diseases
– People who are overweight or obese account for more than two thirds of the U.S.
population
• Management of overweight or obesity in the clinical setting, alone or in
combination with a chronic disease

Chronic-
Combining form- chron/o- time
Suffix- ic- pertaining to
Meaning: pertaining to a long time
DISEASE
• Obesity as a disease
– Body Mass Index (BMI) of 30 or higher
• the weight in kilograms divided by the square of the height in meters
– Positive energy balance and weight gain
• Overweight
– BMI 25-29.9
MECHANISMS
• Environment
– Increasing food supplies and consumption
– Unhealthy foods and large portions
– Lack of physical activity due to occupation
– Spending leisure time with sedentary activities
• Genetic Factors
– High rate of heritability of BMI
• Energy Balance Dysregulation
– Genes and environment both affect energy balance
– Increase in food intake leads to a positive energy balance  increase in weight
PATHOPHYSIOLOGICAL FEATURES
• Anatomical Effects
– Excess adipose tissue
• Coexisting chronic diseases
• Affects joints  osteoarthritis
– Accumulation of fat molecules
– Volume increases in muscles and organs
• Metabolic and Physiological Effects
– Over activity of the sympathethic nervous system
• High blood pressure  heart disease, stroke, kidney diseases
• Psychological Effects
– Increased prevalence of mood, anxiety, other disorders
Pathophysiological
Osteoarthritis Prefix- path/o- disease
Prefix- Osteo- bone Physiologic- natural
Root- arthr/o- joint Adipose Al- pertaining to
Suffix- itis- inflammation Prefix- Adip/o- fat Meaning:
Meaning: Chronic inflammation of Suffix- Ose- full of Functional changes associated
bones and joints due to Meaning: Full of Fat with a disease or syndrome.
degenerative changes in cartilage
S O M E PAT H W AY S
THROUGH WHICH
EXCESS ADIPOSITY
LEADS TO MAJOR
R I S K FA C TO R S A N D
COMMON CHRONIC
DISEASES.
Common chronic diseases are
shown in red boxes.

Apnea
Prefix- a- lack of
Suffix: -pnea breathing
Meaning: Temporary lack of
breathing.

Gastroesophageal
Prefix- gastr/o- pertaining to the stomach
Root- esophag/e- pertaining to the
esophagus
Suffix- al- pertaining to
Meaning: Pertaining to the stomach and
esophagus
CLINICAL CARE Pharmacotherapy
Prefix- pharmac/o- drug, medication
Suffix- therap/y- treatment
Meaning: Treatment with drugs
• Treatment
– Lifestyle intervention
• High-intensity behavioral counseling
– 14 or more visits in 6 months
• Less-intensive for those low at risk for disease
• Behavioral therapy
Gastrectomy
Prefix- gastr- pertaining to the stomach
– Regular records of food intake, physical activity, and weight
Suffix- ectomy- a surgical operation or
– Pharmacotherapy removal of a body part. Resection,
• For those who are obese or overweight with a coexisting condition excision
• One for short term Meaning: surgical removal of a part of
• Five new for long term the stomach
– Bariatric Surgery
• 3 types
– Laparoscopic adjustable gastric banding
– Roux-en-Y gastric bypass Bariatric
– Vertical-sleeve gastrectomy Prefix- bari- weight
Suffix- ic- pertaining
Laparascopic Meaning: pertaining to weight
Prefix- lapar/o- pertaining to the abdominal
wall
Suffix- scope- instrument for viewing
Meaning: An instrument for viewing the
abdominal wall
RESPONSE TO WEIGHT LOSS
• Moderate weight loss: 5 to 10% reduction
• Helps with disease prevention in high-risk persons

• Clinical trials that prove a decrease in blood pressure

• Effective but not all risk factors respond equally well
• Clinical trials that show it did not reduce morbidity and mortality associated with
cardiovascular disease
– Medical therapies must be used with weight loss to control coexisting conditions
• Weight regain is common
Cardiovascular
Prefix- cardi- pertaining to the heart
Suffix- vascular- with blood vessels
Meaning: Pertaining to the blood
vessels of the heart
BARRIERS TO TREATMENT
• Slow recognition among health care providers that obesity requires long-term management
• Inadequate physician training in nutrition and obesity
• Limited referral of patients with severe obesity to experienced surgeons
• Lifestyle interventions
– Need long-term behavioral counseling
– Weight regain
– Lack of effective and accessible lifestyle programs
• administered locally or remotely
• low cost to diverse populations
• Pharmacotherapy
– Disappointment with moderate weight loss
– Cost
• Bariatric Surgery
– Losses of 16 to 32% of baseline weight may lead to disease remission
CONCLUSION
• Overcoming the challenge
– Create the conditions for healthy living in our modern environment
• Only practitioners cannot manage this alone
– Management interventions described here are likely to benefit the patients who receive them
• Prevention AND treatment
WORKS CITED
• Heymsfield, S. B., Wadden, T. A. (2017). Mechanisms, Pathophysiology, and Mangement of
Obesity. New England Journal of Medicine, 376 (3), 254-266. http://dx.doi.org/
10.1056/NEJMra1514009
• Chabner, D. (2014). The Language of Medicine, 11th Ed. Saunders.
• [Digital image]. (n.d.). Retrieved September 18, 2017, from
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