Académique Documents
Professionnel Documents
Culture Documents
FOR HEALTH
Made by:
Raúl Bustos Hernáiz
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LESSON 1: Basic Principles in relation to body composition as a:
method to evaluate changes in EB
Introduction
Energy Balance and Body Composition Definitions
Body composition methods
o -Direct
o -Indirect
Applications
Dual X-Ray absorptiometry (DXA)
Selected bibliography
1. INTRODUCTION
Energy Balance: The difference between energy intake and energy expenditure
Basal metabolism is the minimum level of energy that the cells needs to survive
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2. EVOLUTION OF THE INDIRECT BODY COMPOSITION METHODS
BI COMPARTIMENTAL MODELS (hydrostatic weighting)
Two type of tissues: Fat tissues and fat free mass tissues
It is a limited model
ANTHOPOMETRY
Skin fold thickness and body circumferences
It’s the most commonly used field technique (easy to apply and economic)
It measures the subcutaneous fat mass and the body circunferences of one or more points of
the body
With the data you cant calculate: Body density, percentage of body fat, lean mass
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DISADVANTAGES OF THE METHOD
1. OBESITY
An excessive accumulation of fat mass in the body a as consequence of a prolonged an
sustained period of tie with a positive energy balance
1. Our energy intake is bigger than in the past but we don’t increase the energy expenditure in
the same proportion
2. Same energy intake than in the past but we have disminished the energy expenditure
3. The energy intake is lower than in the past but we disminished our energy expenditure even
more
1. According to BMI.
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2. According to %BF
Cardiovascular diseases
Hiper-lipidemia
Non-insulin dependent diabetes (NIDD)
Ictus
Mood disorders
Sleep disorders
Nutrition disorders
Gout
Osteo-arthritis
Cancer (various types)
2. DIABESITY
Diabesity is so-named because of the close association of obesity and diabetes (type2). Obesity
typically comes first and type 2 diabetes comes later. This leads many to conclude that obesity
causes diabetes.
Elevated blood glucose levels and insulin resistance are two key aspects as visceral fat mmass
Diabesity could be consider as the new 21st century social epidemic, it is predicted to be 1 out
3 in 2050 in the USA
Clinical trials show that as little as 5% weight loss is enough to prevent most obese subjects
with impaired glucose tolerance developing type 2 diabetes
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BBD can seriously affect daily life, often affecting work, social life and relationships
BIGOREXIA
It is a disorder in which a person becomes obsessed with the idea that he/she is not muscular
enough.
It is manifested by:
However, not all the body-builders should be consider bigorexics, in the same way that not all
the dancers are anorexics.
1. INTRODUCTION
Malnutrition. When a person diet has an imbalance of the essential nutrients that the body
need s to remain healthy (special role for the immune systems)
1/3 person in the world suffer from deficiency in essential nutrients. 3 most common are:
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Iron (fatigue, infection, risk of hemorraging)
Iodine (Thyroid gland)
2. In children
2. There are 41 million overweight children in the world, 10 million more than 2 decades ago
3. Wasting still threatens the lives of 50 million children around the world
2. UNDERWEIGHT
A BMI lower than 18.5 g/m2 is usually refered to as underweight
Stunted children may never regain the height lost as a result of stunting,
and most children will never gain the corresponding body weight. It also
leads to premature death later in life because vital organs never fully develop during childhood
Consequences
Decreases immune and non immune host defences, more probabilities of infectious diseases.
People who suffers underweight is not only about gross caloric intake if not intake and
absorptions of other vital nutrients
You also can be underweight with the possibility of intake good food (Anorexa nervosa and
bulimia)
3. ANOREXA NERVOSA
Is an eating disorder characterized by refusal to maintain a healthy body weight, and an
obsessive fear of gaining weight due to a distorted self image. It is a serious mental illness that
has one of the highest mortality rates of any psychiatric disorder
The condition largely affects young adolescent women with between 15 and 19 years old
making up 40% of all cases. Recently a new term for men, manorexia, has appear
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Possible signs of anorexia nervosa
Possible causes
It has seen that the initial weight loss such as dieting may be the triggering factor in developing
AN in some cases
Socio-cultural studies have highlighted the role of cultural factors, as the promotion of
thinness as the ideal female
In women, being grossly underweight car result in amenorrhea and possible complications
during pregnancy. It can also cause anemia, hair loss and osteoporosis.
4. BULIMIA
Is a disease and a type of eating disorder. It is when a person wants to starve (morir de
hambre) his or herself. People who have it feel that they are fat and want to be skinny. If they
eat a lot they try to take it back by vomiting, exercising or using drugs
RISKS OF BULIMIA
Vomit can burn the person´s mouth, throat or teeth. The inmmune system is weakened, and a
person can get muscle or heart problems
Opposited to bygorexia, anorexia nervosa has been study for many years and is already
recognize as a disease, as a probe, many scientific studies has been published until date.
The prevalence of these disorders are increased in elite athletes due to the perceived
performance improvements, perception of the paradigm of appearance and sociocultural
pressures for thinness or an “ideal” body
Athletes most at risk are for example, bodybuilders or who practise rhythmic gymnastics.
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In addition to dieting, personality factors, early start of specific training, injuries, coaching
behaviour… are important risk factors
1. INTRODUCTION
Adipose tissue produces and releases numerous proteins and substances with autocrine (same
cell) , paracrine (near the releasing cell) and endocrine( to the bloodstream) functions
It regulates body fat depots by their effects on metabolism and appetite. It also helps in
growth, reproduction, immune system, glucose metabolism and bones; metabolic
neuroendocrine hormone
The problem of that hormone in obese subjects is the lost of sensibility at the hypothalamus
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Marathon, road cycling. Decrease in leptine levels
There is controversy because the reduction of fat mass storages or this change is due to the
training effect “per se”
Factors that influence leptine secretion: fasting, food, gender, time of the day and others
Conclussions
The intensity and duration of exercise and its effects on leptine level are mediated by the
FINAL ENERGY BALANCE
Changes have to be before, during and after the exercise bout including 24-48 hours later
2.2 ADIPONECTIN
Plasma adiponectin levels are found to be lower in obese subjects than in lean subjects.
Women have 40% higher circulating levels of adiponectin than men, because androgens
appears to have an inhibitory effect on adiponectin.
Low adiponectin levels are found to be a predictor of the later development of type 2 diabetes
and myocardial infarction.
Functions
1. Insulin sensitizing
2. Anti-atherogenic (Anti-inflammatory)
3. Angiogenic (anti-bodies formation)
4. Anti-tumour
5. Decrease free fat acids (FFA)
Two receptors
Mechanisms
In the liver it activates AMPK. This made a decrease in hepatic glucose output.
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In skeletal muscle through adipoR1 cause glucose uptake and fatty acid oxidation
Conclussions
Training without a weight loss has not been found to increase plasma adiponectin levels
2.3 RESISTIN
It increases LDL in human liver. AS a result, the liver is less able to clear “bad” cholesterol.
Researches has linked resistin with inflammation and energy homeostasis
2. 4 VISFATIN (Adipomyoquine)
When more visfatin you have, less possibilities of having type 2 diabetes
When the stomach is empty, ghrelin is secreted. When the stomach is stretched, secretion
stops. It acts on hypothalamic brain cells both to increase hunger
Ghrelin and leptin receptors are found in the same place in the brain
Circulating ghrelin concentrations rise before eating and fall afterward (more strongly in
response to protein and carbohydrate than to lipids)
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GHRELIN AND LEPTIN WORK IN THE BODY
GHRELIN (APPETITE STIMULATOR) LEPTIN (APPETITE SUPPRESOR)
Secreted by the stomach Secreted by fat cells
You´re hungry, you should eat Stop eating, you are full
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3. 2 METHODS FOR MEASURING EATING BEHAVIOUR
Restraint: A tendency for individuals to restrict their food inake in order to control their body
weight
Trait disinhibition: A tendency to overeat because others are eating, due to the presence of
palatable foods and due to negative effect.
Hunger: The extent to which sensations to hunger are perceived, and the extent to which such
feelings evoke eating episodes
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Blood redistribution during exercise may be
important for suppressing ghrelin.
Type 2 diabetes, cardiovascular diseases, colon cancer, breast cancer, depression and another
defines a diseasome of physical inactivity
Physical inactivity appears to be an independent and strong risk factor for accumulation of
visceral fat, which again is a source of systemic inflammation
In response to muscle contractions, skeletal muscle releases myokines into the circulation. It
activates AMPK to increase glucose uptake and fat oxidation. In the liver increase glucose
production during exercise and lipolysis in the adipose tissue
The AMPK has emerged as an important integrator of signals that control energy balance
through the regulation of multiple biochemical pathways, as the uptake of glucose, the B-
oxidation of fatty acids and the biogenesis of glucose transporter.
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AMPK integrates stress responses such as exercise as well as nutrient and hormonal signalas to
control food intake, energy expenditure and substrate utilization at the whole body level
Calories
E-Sports
1. INTRODUCTION
Metabolism
Is the sum of all energy process in the body, both the production of energy as ell as the use of
energy.
Energy expenditure can be expressed in terms of oxygen. The term aerobic means with oxygen
and anaerobic means without oxygen
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Energy expenditure
In biology, energy cames form carbohydrates lipids and proteins, which release energy when
reacted with oxygen in respiration. The actions requires certain energy, that is the energy
expenditure
Physical activity
Includes any bodily movement produced by the skeletal muscles that results in a substantial
increase over resting energy expenditure
The average person has 3-4 hours of free leisure time per day
Exercise
Sport
The WHO says; Recent decades we have seen a change in the lifestyle, reducing our energy
expenditure at work besides a change in the diet that results in a deterioration of peoples
health
In the USA, the risk of being overweight increase by a 34% when children spend 2 or more
hours per day watching TV
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It is defined as the ratio of metabolic rate during a specific physical activity to a reference rate
of metabolic rate at rest
1 MET is considered as the resting metabolic rate obtained during quiet sitting. MET values of
physical activities range from 0,9 (sleeping) to 18 (running at 17.5 km/h)
3. CALORIES
It is defined as the energy needed to increase the temperature of 1 gram of water by 1ºC.
About 4.2 joules
Ok, now we know how to count the cost of physical activity, lets see the other part of the
balance…FOOD
Is really hard to know exactly how many kcal we are eating (per portion, per 100 g, per bag…)
Fat oxidation
Metabolic flexibility
1. INTRODUCTION
Lifestyle related diseases is increasing globally and this development is explained in part by
increased inactivity, a sedentary behaviour and a low aerobic fitness.
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By the WHO:
It requires the presence of one of:
Diabetes mellitus
Impaired glucose tolerance
Impaired fasting glucose or insulin resistance
Raised triglycerids
Reduced HDL cholesterol
Raised blood pressure
Raised fasting plasma glucose
Note: If BMI is >30 kg/m, central obesity can be assumed and waist circumference does not
need to be measured
Max. muscle mitoc. Oxidative capacity / max muscle oxygen uptake capacity
Is not well defined, but most often it is associated with blood lipid profile, blood pressure and
insulin sensitivity.
Positive changes in some metabolic variables were observed in all individuals after training.
The ability to oxidize fats during exercise is also used to study the metabolic fitness
Nowadays it is well known that just at the moment that a person start to exercise fat oxidation
start
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How do we know which substrate are we using? The respiratory quotient.
If RQ is >1 means that C02 production can´t be compensated by the inhaled 02 (Anaerobic
threshold)
During resting, one of the most influential factor on the RQ is the diet
If the person is in the fasting situation, the RQ tends to be close to 0-7(saving glucose
disposals), but if the subject is the post-pandrial situation a higher amount of glucose is oxidize
to avoid the glucose blood levels to increase too much
In the 90s one of the most controversial debates in exercise physiology was related with the
Cross over concept that tried to determine the equilibrium between fat and carbohydrate use.
Fat oxidation reaches its maximum level at the intensity when appears fat max. If we follow
increasing this intensity, the contribution of fat decreases
One of the main adaptations in terms of substrate oxidation is a curve displacement up-words
and right-words (Fat max goes to the right)
There are many factors that influence fat oxidation during exercise:
Duration, Fitness Level, Intensity, muscle mass, V02 max, gender, fat mass, glycogen storages
This is important because the inability to increase reliance upon fat oxidation may be related
to the pathogenesis of obesity.
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Las mitocondrias de los músculos de los obesos OXIDAN mejor que las mitocondrias de los
sujetos controles que tienen un nivel de fitness similar
Las mitocondrias de los músculos de los diabéticos OXIDAN mejor que las mitocondrias de los
sujetos controles
3. Summary
Resting RER seems to predict the ability to oxidaze fat during exercise (FatMax)
Obese (and also diabetics) does not seems to have a reduced ability to oxidaze fat during
exercise while fasting
Thus, the metabolic inflexibility theory should be modified using data only from studies that
matched their subjects according to fitness levels (VO2max).
Fat oxidation needs further research in order to be confirmed as a useful metabolic fitness
indicator
Tofi is a slim person but he has a bad healthy. He has fat in the visceral organs.
Tofi has more probability of dead thatn foti in relation with cardiovascular disease
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Better been in shape but fat, than thin but with a bad health
Some obese persons do not develop at short term the metabolic complications of obesity that
are thought to be causally linked to cardiovascular events or premature mortality.
In the EEUU 10% of adults have obese BMI and are healthy compared with who are metabolic
unhealthy and have a normal BMI who are 8%
26% of adults hve normal BMI and are healthy, whereas 21% have obese BMI and are
unhealthy
LESSON 7
The nutrition: The importance and contribution of the fat
content in the diet. The Miracle Diets: Atkins Diet, Ketogenic
Diets, South Beach Diet
Introduction: typical diet distribution
Dietary fat importance
The Miracle Diets:
o Low fat diet: The Ornish Diet
o Low CH – High Fat Diet: Ketogenic diets
o Low CH – High Protein Diet: Atkins Diet / Dukan Diet
o South Beach Diet
1. INTRODUCTION
The most common diet distribution is:
- Carbohydrates (55-60%)
- Proteins (15-20%)
- Fats (25-30%)
Until 50s a high fat diet was recommended. At 70s a fat reduction was consider as a way to
prevent heart diseases.
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His best study follow 121700 female registered nurses since 1970s to asses risk factors for
cancer and cardiovascular diseases
A eight-year study of 49000 postmenopausal women investigate link between low fat diet and
health
1st chapter: Dr Willet. Diets high in fat are not the primary cause of excess body fat.
2nd chapter: George Bray and Popkin. If you reduces fat you will reduce your body weight
3rd chapter: Willet. Chapter 2 is based on short-term studies. Total energy intake determines
body fat accumulation Saturated and trans fats should be replacing by poliinsaturated and
monoinsatured fats. Thanks of these trans-fats were legally avoided
Trans fat is the common name for unsaturated fat with trans-isomer fatty acids. Trans fats may
be mono or polyunsaturated but never saturated
The process of hydrogenation adds hydrogen atoms to unsaturated fats, eliminating double
bonds and making them saturated fats
The consumption of trans fats increases the risk of coronary heart disease
4rd chapter. Astrup: A reduction in dietary fat without intentional restriction of energy intake
causes weight loss
6th chapter. Willet. Dietary fat is not a major determinant of body fat
7th chapter. Astrup. Dietary fat is a major player In obesity but not the only one
Astrup agreed(A) with Willet in some points and disagreed (D) in others:
1. Meta-analisis of randomized trial is the highest ranking level of scientific evidence (D)
2. In the long term. Subjects without help will gradually return to the high fat diet eaten by
their family and friends (A)
8th Chapter. Replacing saturated fats by poliinsaturated is the best option to prevent CHD
9th chapter. Reduce dietary fat in long-term may be an important strategy for weight
maintenance
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2. MOST FAMOUS DIET
2.1 THE ORNISH DIET
Low fat vegetarian diet with less than 10% of calories from fat, 15-20% from protein, 70-75%
from carbohidrates.
All nuts, seeds, avocado, chocolate, olive and oils are eliminated except a small amount of
canola oil.
Bad carbs are those that the body digest quickly (high glycemic
index) and good carbs are unprocessed food like vegetables,
beans, and whole grain (low glycemic index)
MEDIUM GI (56-69) whole wheat products, basmati rice, sweet potato, sucrose
HIGH GI (70 OR MORE) Baked potatoes, watermelon, white bread, ost white rices, corn flakes,
cereals, glucose
It replaces trans-fats and saturated fats by unsaturated fats and omega-3 fatty acid which
contribute to HDL cholesterol.
The diet excludes the fatty portions of red meat and poultry
Phase 1 (First two weeks). It eliminates all sugars, processed carbohydrates, fruits, and some
vegetables. Its purpose is to eliminate the hunger cycle and a significant weight loss
Phase 2 continuoes as long as the dieter wishes to lose weight. It re introduces most fruit and
vegetables and some whole grains as well.
Phase 3. Is the maintenance phase and lasts for life. There is no specific list of permitted and
prohibited foods.
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2.3 THE KETOGENIC DIET: LOW CH- HIGH FAT
The body produce ketones when blood glucose decrease (fasting situation), an increase of the
glucagon levels produce the increase in the lipolysis and thus a rise in the FFA.
In the fasting continue Acetil CoA produce in the liver by the oxidation of FA is transformed
into “acetoacetate”
These two intermediates plus the acetone are named ketonic bodies which in fasting situation
are used by many peripheriacal tissues.
Once we eat again and the blood glucose rise, the “ketonic state” is broken
In 1951, Livingstone informed that thanks to the KD 54% of his patients maintain their
symptons under control and almost 26% reduce them
There are 3 main types of KD: the most used LCT, the less used MCT (often produces intestinal
problems) , and a mix KD for kids
Lipid profil we see a favourable response to KD in cardiovascular risk factors (LDL, HDL…) most
likely due to the weight loss.
High in good quality saturated fats and no more than 50 g of carbohydrates per day
Who should bant? Obese, high blood pressure, type 2 diabetes, hypertension,
hypercholesterolemia…
Paleo is low on carbs, the revolution goes even lower, and includes dairy in its eat-your-fill-list
a no no for paleoites
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Pre maintenance. Carbohydrates are increased in 10 grams each week, the key goal is to find
the Critical Carbohydrate Level for Maintenance, this is the maximum number of
carbohydrates you can eat each day without gaining weight
Lifetime maintenance. This phase is intended to carry on the habits acquired in the previous
phases.
The attack phase. 3 kg in 2-7 days. Eat as much as they want of 72 protein-rich fods
The cruise phase. Addition of 28 specific vegetables. 1 kg of weight loss per week.
The consolidation phase. During this time, fruit bread, cheese and starchy foods are
reintroducen in two meals a week
The stabilization phase: protein day once a week, eating oat bran every day and maing a
commitment to “take the stairs”.
In the same line “El mono Obeso” talks about the human evolution and the appearance of the
opulence diseases
3. SUMMARY
1. What is perfectly known is that diet only involve one of the two major components of the
energy balance: the energy intake
2. If a wrong diet and lifestyle is present, it can temporary work, but when the diet is stopped
and the subject returns to the original lifestyle and diet, the chances of relapse are enormous
3. In the long term, behaviour modifications of diet and lifestyle are needed to succeed
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4. Due to the changes in the nutritional habits, the energy intake is not what we eat, we are
also what we drink
5. No matter which diet you use, at the end the “hipocaloric” content will determine your
weight loss
Summary
Lean and obese subjects increment the oxidation of fat as a consequence of a high fat load
1. INTRODUCTION
In Europe EMEA (European Medicines Agency) approve o deny new drugs, in EEUU it´s done by
the FDA
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3. Drugs to increase body metabolism
4. Others
Catecholamines and their derivatives are the main tools used for this
Also, drugs blocking the cannabinoid receptors may be a future strategy for appetite
suppression
2. NOR ADRENERGICS
They act at the central nervous system liberating or involving nor-adrenaline and thus altering
the transmission of nerve impulses through neurotransmitors regulation
They exerts its behavioural effects by modulating several key neurotransmitters in the brain,
including dopamine, serotonin, and nor adrenaline
b. Metanphetamine
c. Fenmetracine
They were banned in the 70s because they cause addiction and abuse.
3. SEROTONIGERNICS
They act on the agonist of the serotonin receptors and inhibit their absorption
1. Fenfluramine
2. Dexfenfluramine (Redux)
Both drugs were withdrawn in 1997 after report of heart valve disease and pulmonary
hypertension, including cardiac fibrosis
4. NORADRENERGICS + SEROTONINERGICS
The most famous is Sibutramine. It was approbed for the treatment of obesity in 1997. It was
sold under a variety of brand names including Reductil, Meridia and Sibutrex
This pill was prohibited in January 2010 because in patients with cardiovascular disease and
type 2 diabetes showed an increased risk of cardiovascular events, such as stroke.
Another famous was Rimonabant. Is an inverse agonist for the cannabinoid receptor CB1. Its
main effect is reduction in appetite. On 2009 was withdrawn.
Lorcaserin (Lorqess) has serotorgenic properties and is a weightloss drug. It has less adverse-
effects than the others
The most famous drug is Orlistat (Alli in spain). Its prevent the absorption of fats from the
human diet. Although the benefits are not impactant (2-3 kg more in a year)
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It has side effects like fecal incontinence or bowel movements. Are not bought without a
prescription.
APPROVED WITHDRAWN
PHENTOTERMINE FENFLURAMINE
ORLISTAT SIBUTRAIMNE
LORCASERIN RIMONABANT
PHENTERMINE AWAITING DECISION
BUPROPION+NALTREXONE
Nowadays, only Orlistat and now Liraglutide(analogue of the GLP-1 that secretes intestine in
response to the presence of food) are used as anti´obesity drugs in spain
Since 2012, a number of new drugs have become available, like the mediators of the gut-brain
axis, which is involved in appetite regulation
In the market, there are many other products not recognize as legal drugs but used as
nutritional supplements and/or weight loss products.
Is the indigestible portion of plant foods having two main components, soluble that is
fermented in the colon into gases, and insoluble that is metabolically inert easing defecation
Glucomannan has been sold like the effects of fiber, but the FDA has not approved any
products with it.
CAFFEINE
Is an stimulant of the central nervous system. It has diuretic properties. The overdose of it can
cause fidgeting, anxiety, excitement…
Green tea has thermogenic properties similar to the ephedrine (reduce nutrients absorption
and activates lipolysis); same properties like chitosan or bionarval
CARNITINE
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It is a compound that is required for the transport of fatty acids from the cytosol into the
mitochondria during the breakdown of lipids. Highest concentrations of it are found in red
meat and dairy products.
Although L-carnitine has no scientific evidence to show that it improves weight loss. Like side
effects are hyperactivity, insomnia or nausea
Only three legal supplements have received significant attention over the years: creatine,
carnitine and sodium bicarbonate.
6. SUMMARY
Current anti-obesity drugs aim to reduce food intake by either curbing appetite or suppressing
the craving for food but they almost always have dangerous side effects
1. BARIATRIC SURGERY
Bariatric surgery is the term encompassing all of the surgical treatments for morbid obesity
Any gastric bypass procedures leads to a market reduction in the functional volume of the
stomach, accompanied by an altered physiological response to food
A gastric bypass first divides the stomach into a small upper pouch a much larger, lower
remnant pouch and then re-arranges the small intestine to allow both pouches to stay
connected to it
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The resulting weight loss, markedly reduces co-
morbidities. The long term mortality rate of gastric
bypass patients has been shown to be reduced by up to
40%
However, complications are common and surgery-related death occurs within one month in
2% of patients
An increasing number of these operations are now performed by limited access techniques,
termed laparoscopy(small incisions)
Benefits include shortened hospital stay, reduced discomfort, shorter recovery time and
minimal risk on incisional hernia. Nowadays is the most commonly employed gastric bypass
technique.
-Gastric bypass,Rouxen-Y(proximal)
-Gastric bypass,Rouxen-Y(distal)
The gastric bypass reduces the size of the stomach by well over 90% (1000 ml to 150 ml)
Is usually formed from the part of the stomach which is least susceptible to stretching. That
prevengs any significant long-term change in volume. When the patient ingest food, the wall of
the stomach pouch stimulates nerves telling the brain that the stomach is full
Changes in circulating hormone levels (ghrelin) after gastric bypass have benen hypothesized
to produce reductions in food intake and body weight in obese patients
Mortality
Since 7% for laparascopic procedures to 14.5% for open incisions operations, during the 30
days following surgery
Contraside effects
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Emotional disorders. Many have depression in the following months due to change in the role
food plays. Energy levels in the period net will be low
SKIN REMOVAL
RESULTS
Gastric Bypass makes a weight loss of 565 to 80% of excess body weight and reduces co-
morbid conditions:
Hiperlipidemia
Hipertension
Obstructive sleep apnea
Type 2 diabetes
Compared with gastric bypass, adjustable gastric banding has lower weight loss efficacy, but
also leads to fewer serious adverse effects.
The silicone balloon is placed and filled with liquid (600 ml) so it partially
fills the stomach and creates a feeling of fullness. The maximum time a
balloon can be left in place is 6 months before be removed
In Brasil 323 with BMI 43kg/m2 lost an average of 48% of their excess weight.
2. OTHER OPTIONS
2.1 The liposuction (cosmetic surgery) that removes fat from many different sites on the
human body. The safety of the technique relates in the amount of tissue removed and the kind
of anesthesic, also the patient´s health
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Large quantites are more than 5 litres
It is done in men in abdomen and flanks, and in women in abdomen and thighs.
Fat is removed via a cannula (a hollow tube) and aspirator (a suction device). They are
categorized by the amount of fluid injection and by the mechanism in which the cannula works
Is the standard method. A small canula is inserted through a small incision. The surgeon pushes
it carefully through the fat layer breaking up the fat cells
Used a cannula with mechanized movement, so that the surgeon does not need to make as
many manual movements
Are more risk of seromas (pockets of fluid). Is a good choice for working on more fibrous areas,
like the upper back or male breast area. There is slightly less blood loss.
RISKS
3. NON INVASIVE
3.1 Cryolipolysis is a medical device used to destroy fat cells. IT causes cell death of
subcutaneous fat tissue without apparent damage to the overlying skin
3.2 Ultrasound The new technology focuses the ultrasound frequencies to only target fat cells
in the body and essentially melts away the fat.
3.3 Cavitation (ultrasound) Waves at a frequency rate (35-40 khz) produce fat tissue
cavitation.
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3.5 Slimming creams
Those creams have ingredients that when applied on the skin encourages it to increase the
circulation, getting rid of toxins and excess water
The truth is that there are no scientific proof that cellulite creams are effective with it.
Cellulite Is a storage pattern of superficial fat. But is not the result of toxins (is the natural
anatomic contour characteristic of many women`s thighs and buttocks) It is unrelated to
weight gain or loss.
The only one that has been minimally probed is retin-a (tretinoin) for the acne treatment
Health: Obesity has been associated with chronic diseases and health conditions such
as heart disease, diabetes, cancer..
Because of the increased risk of bariatric surgery including anesthesia
The subects are unable to perform at work
Esthetic issues
Obesity is associated with premature death. Life expectancy is reduced by 6.5 years comparing
BMI of 40-45 kg/m2 to normal weight people.
The reduction is bigger when BMI is 45-50 (9), 55-60(10) and 60-65(14)
2. Those that maximize fat loss and minimize the fat free mass loss
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Guidelines and recommendations for an optimal and safe weight loss
1. Prolonged fasting that severely restrict the energy intake are scientifically non desirable and
can be dangerous from a medical point of view.
2. Diets and prolonged fasting that seriously restrict the energy intake normally result ingreat
loss of water, electrolytes, minerals… with a minimum fat loss
3. Moderate energy restrictions (500-1000 kcal less than needed) results in a lower water,
electrolytes, minerals and fat free mass losses and are less prone to cause bad nutrition
4. Dynamic exercise of the bigger muscles helps to maintain the FFM, including lean mass and
bone mass, and helps to maximize weight loss. The weight loss that results of an increased
energy consumption is mainly due to fat loss
5. The sustained weight loss should not exceed 1kg per week, including an exercise program
and also an eating behaviour modification program
1. Energy intake should not be lower than 1200 kcal/day in adults including variety of foods
3. Producing a negative energy balance of aprox 500-1000 kcal per day less than needed (max
1 kg per week)
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THE FINAL GOAL IS MAINTAIN FFM AND REDUCE FM
Two studies
1st. Minnosota trial demonstrate that a 45% reduction in daily calories (24 weeks) produce at
week 12 a reduction of 11.5 kg which only 5.3 were fat. After 24 weeks another 4.1 kg (15.6k
total) were lost and only 2.8 kg were fat (8.1 kg total)
2st. A moderate restriction (500-1000 kcal day) after 8 weeks a mean of 6.4 kg were obtained
of which 89% were FM and only 11% were FFM
Including physical activity in the weight loss program normally produce an increase in the
energy expenditure and collaborate in the maintenance or increase of the FFM while the FM is
reduced.
It is true that diet induces bigger weight loss than exercise alone and produces higher
reductions in systolic blood pressure, total cholesterol and blood glucose levels
It is true that exercise alone can also produce weight loss even in the absence of caloric
restriction
The real question is not what is more effective way to lose weight if not How should I perform
a healthy weight loss?
The use of rapid weight loss and frequent weight fluctuation among athletes have been
considered a problem for years. A high proportion of athletes are using extreme weight-
control methods.
The most urgent needs are: develop sport-specific educational programs for athletic trainers,
modifications to regulations and research related to minimum percentage body fat and
judging patterns.
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And after a success weight loss… what´s next?
Thus, a weight loss program should not be just a plan to lose weight, it should include
behavioural changes.
Knowing that:
1.6 Can genetic risk associated with complex diseases be offset by behavioural changes?
Almost 50% of the risk of those with the highest risk of developing CVD can be reduced by a
favourable lifestlye
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