Management of Adult

Obesity
Dr. Margarita Ochoa-Maya, MD, CDE
Advanced Health and Wellbeing, PC
www.AdvancedHealthNH.com

OBESITY IS A DISEASE
Obesity affects 1 in three Americans
2 out of 3 adults in the United States are overweight
The medical cost of OBESITY:
Between $147 BILLION to $210 BILLION per year

Obesity is estimated to cause 111,909 to 363,000

deaths/yr
June 2013: American Medical Association and American
Association of Clinical Endocrinologists (AACE)
recognized OBESITY as a DISEASE

THE DEFINITION OF OBESITY

Obesity is:
A chronic disease
Influenced by determinants such as:
Genetic and family history
Culture and both familial and personal environment
Behavior and emotions
Hormones

Body mass that exceeds a pre-defined value

multifactorial

OBESITY, A REAL PROBLEM FOR

THE NEW MILLENIUM
Obesity is a reality we are all facing today, It is a
DISEASE and it is an EPIDEMIC!

The World Health Organization

The National Heart, Lung and Blood Institute of the National Institutes of Health

The American Medical Association

1 IN 3 Americans is affected by obesity, and weight

disorders

25% of Adult Americans have excess weight and are obese

The prevalence of obesity has increased more than

50% in the past decade

OBESITY, A REAL PROBLEM FOR THE

NEW MILLENIUM
It is estimated that more than 93 million Americans are affected
by obesity
It is also estimated that this number will climb to 120 million within the
next 5 years

This epidemic needs to be addressed as it is a ticking time

bomb for the future development of complications and
chronic illness:
Impact the biological, psychological and spiritual wellbeing of the
individual
Impact the family unit and the community
Impact economy
Impact the future of humankind

THE LINK BETWEEN WEIGHT MANAGEMENT AND

GENETICS, ENVIRONMENT AND HORMONES

GENETICS
ENVIRONMENT
INTERNAL ENVIRONMENT
Psychological Stress
Physical Stress
Behavior
EXTERNAL ENVIRONMENT
Use of pesticides, herbicides, and other hormone disruptors

BIOLOGY AND HORMONES

THE LINK BETWEEN WEIGHT

MANAGEMENT AND HORMONES
HORMONAL DISORDERS LINKED TO OBESITY
INCLUDE:
Hypothyroidism
Polycystic Ovarian Syndrome
Low Testosterone in Men
Menopause in women
Excessive steroids produced by the Adrenal Glands:
Cushings Syndrome
Sleep Cycle Disorders: Sleep Apnea

THE LINK BETWEEN WEIGHT

MANAGEMENT AND HORMONES
HORMONAL BALANCE IS NECESSARY FOR HEALTHY WEIGHT
MAINTENANCE:
Central Nervous System and the Brain
Cognitive choices in food
Gastrointestinal System
From chewing and the speed of eating to absorption and
elimination
Reproductive System
The influence of ESTROGEN, PROGESTERONE and
TESTOSTERONE on weight management, fertility and longevity

HISTORICAL, CULTURAL AND

ARTISTIC ASPECTS OF OBESITY

Throughout history of mankind, food shortage and malnutrition have

been the recurrent theme

Advances in public health, paired with the increased amount,

quality, and variety of food, has had an impact on increased
longevity and body size.

Being under-nourished as well as obese has social implications and

connotations

Corpulence and increased "flesh" have been desirable across

the centuries as a sign of wealth

After the Second World War, overabundance of easily accessible food,

coupled with reduced physical activity resulted in increased body weight

During the post war era, this positive connotation on being fat
or robust was reflected in the arts, literature, and medical
opinion of the times

HISTORICAL, CULTURAL AND

ARTISTIC ASPECTS OF OBESITY

During the 17th Century, Dr. Tobias Venner first used the term
OBESITY in a study published in 1650

During the 19th Century, Dr. William Wadd LINKED overindulgence

at the table with dangerous conditions that resulted in OBESITY

He linked diet and dietary patterns with obesity and disease

His treatment approach was to remove the food that lacked meaningful
nutrients

During the year 1842, Dr. Burney stated that despite the
sensation of hunger was felt in the stomach, it originated in the
BRAIN.

He separated the concepts of HUNGER AND APPETITE

He stated that both doctors noted that dietary changes should be based on the
individual's unique requirements concerning age, gender, and activity level.

HISTORICAL, CULTURAL AND

ARTISTIC ASPECTS OF OBESITY

During the 20th Century the incidence and frequency of obesity

began to increase and become widespread

Weight issues in women were addressed specifically by Dr. Stein

and Leventhal in 1935

They described a syndrome specific to women characterized by obesity and

infertility and named it Polycystic Ovarian Syndrome (PCOS)

They claimed PCOS was one of the leading causes of anovulatory infertility

They also reported the beneficial effects of weight loss as a treatment of such
illness

In the 1940's, Metropolitan Life Insurance, published a chart

where the ideal weights for various heights estimated an ideal

Insurance companies realized the connection between weight and life

expectancy and increased premiums for the obese and the stigma around
obesity began.

HISTORICAL, CULTURAL AND

ARTISTIC ASPECTS OF OBESITY
In June of 1956 Late President Eisenhower
created the Presidents Council on Youth Fitness

It was a public awareness campaign that brought to light the increasing

problem with obesity

It was a pioneer for further studies that would address the world of obesity, and
various diet and exercise programs emerged

By 1996, researchers recognized that weight

needed to be addressed in the setting of a
persons height

The Body Mass Index (BMI) was created

BMI is a statistical calculation and index which would predictably determine if a

person is obese or not based on not only their weight but in relation to their
height

WEIGHT MANAGEMENT AND

OBESITY IN THE 21ST CENTURY
Obesity is the epidemic of the 21st century
Obesity poses a major public health issue. There are
increased personal, familial, social, and economic costs
associated with obesity.
obesity is no longer a problem of adults, the rate at
which obesity is affecting children is exponential, and younger
and younger children are being affected by obesity

The World Health Organization estimates that

globally:
More than 1 billion overweight adults that have a BMI greater
than 27
Of those that are obese, 300 million have a BMI greater than
30.

THE STIGMA OF OBESITY

Individuals affected by weight problems and
obesity often have to face obstacles beyond the
health risks associated with obesity itself
Emotional suffering is one of the most painful parts of
being obese
Today, excess weight is regarded as unattractive
and often associated with negative stereotypes
People of all ages and cultures face social
stigmatization, may be targeted by bullies, or shunned
by their peers
Weight is again tightly linked to social behavior
and acceptance and is considered a reason for
discrimination.

THE STIGMA OF OBESITY

Stigmatization is present in elementary, high school, college, and
the workplace
Overweight students are viewed as self-indulgent, lazy, and are
usually excluded from social activities
Peer victimization is reported in as many as 63% of girls
and 58% of boys
At least 30% of overweight girls and 24% of overweight boys
report being teased by peers at school
Teachers report that students affected by obesity are perceived
as untidy, more emotional, less likely to succeed in school, and
more likely to have family problems
Overweight children are less likely to be accepted into
private schools and college despite equivalent application
rates and academic achievement

CONSEQUENCES OF HEALTH
AND OBESITY BIAS
PSYCHOLOGICAL EFFECTS: Shame, Anxiety, Low Selfesteem, Poor body image, Poor inter-personal relationships,
Depression, Post-traumatic Stress Disorder
SOCIAL EFFECTS: Social rejection by peers, isolation, less
community involvement, poor quality of interpersonal
relationships, increased divorce rate and potential negative
impact on family life, potential negative impact on decreased
and or poor academic outcomes.
PHYSICAL HEALTH EFFECTS: Unhealthy weight control
practices, binge eating, avoidance of physical activity, higher
rates of injury during physical efforts, less endurance and
physical activity tolerance.

FACTORS TO BE CONSIDERED WHEN

ADDRESSING THE OBESITY EPIDEMIC
Genetics
Parenting and family life
Psychological skills of the
individual and the family
Knowledge and education
about food, health and
health prevention
Socioeconomic status

Spiritual life

Physical activity

Cultural influences in
choices of food and
activities
Familial influences in
availability of food
Who prepares the food in
the household

THE ROLE OF MONEY AND

OBESITY
Lower-cost foods make up a greater proportion of the
diet of lower-income individuals
In U.S. Department of Agriculture (USDA)
studies, female recipients of food assistance had:
More energy-dense diets
Consumed fewer vegetables and fruit
Were more likely to be obese
(Darmon N, Drewnowski A: Does social class predict diet quality? Am J Clin Nutr
87:11071117, 2008).

CHILDHOOD OBESITY
The overall prevalence of
childhood obesity continued to
increase during the first half of
this decade:

Childhood obesity in
2004:

Non-Hispanic Blacks:

20% in boys

in 2000: 14%
in 2004: 17%
in 2012: 21%

Mexican Americans:

22% in boys

24% in girls
19%, in girls

Non-Hispanic Whites:

16% average for both

(Harris KM, Gordon-Larsen P, Chantala K, Udry R: Longitudinal trends in race/ethnic

disparities in leading health indicators from adolescence to young adulthood. Arch
Pediatr Adolesc Med 160:7481, 2006)

PHYSICAL ACTIVITY AND

OBESITY

People tend to model the physical activity of their parents

Exercise habits follow familial clusters
With increasing age the trend demonstrates
physical activity decreases
Increased television, computer, and internet viewing
times
Decreased sleep time is associated with increased
obesity rates

BODY COMPOSITION: In order to measure the

body, we need to understand its components first
The body is composed of:
Muscle tissue
Fat tissue
Connective Tissue
Skeletal bones and teeth
Brain and nerves
Contents of digestive tract, including intestinal gas, air in the lungs,
urine, lymph, and blood.
Most of the human body is made up of water. The cells are made up
of 65-90% water by weight. Therefore, it isn't surprising that most of a
human body's weight will have a tight representation to their total water
weight.

THE DIFFERENT KINDS OF FAT AND

THEIR RELATIONSHIP WITH OBESITY
THERE ARE TWO KINDS OF FAT
ESSENTIAL FAT: Essential for all physiologic functioning and reproduction
It is stored in small amounts in the bone marrow, heart, lung, liver, spleen,
kidneys, muscles, and fat-rich tissues such as the brain and the nervous
system.
STORAGE FAT: Also called adipose tissue. It is an expendable source if energy
in the subcutaneous tissue and around the organs. There are two types:
White adipose tissue: Functions to store energy, protect abdominal organs,
and insulate the body to preserve the heat. It comes directly from the food
we eat and the fat in the diet
Brown adipose tissue: Is abundant in in infants and it slowly disappears
with age. It regulates energy expenditure and promotes energy
consumption, generates heat, increases metabolism, and promotes weight
loss. It is called brown because it is full of mitochondria

THE BMI CENTERED DEFINITION

OF WEIGHT AND OBESITY

In the 19th century the Belgian statistician Dr. Adolphe Quetelet

developed the body mass index

BMI-based definition is easy to use and it is particularly convenient for

statistical purposes and use in research.

The most commonly used definitions, established by the World Health

Organization (WHO) in 1997 and published in the year 2000; provide the
current classification of obesity based on the BMI.

POTENTIAL PITFALLS:

It considers weight and height yet it does not consider SHAPE

Ignores LEAN BODY MASS as a measure of MUSCLE MASS and BODY FAT
percentage as well as WATER WEIGHT and water retention

BODY MASS INDEX

CLASSIFICATION
BODY MASS INDEX

CLASSIFICATION

<18.5

Underweight

18.5 24.9

Normal weight

25.0 29.9 (27)

Overweight

30.0 34.9

CLASS I OBESITY

35.0 39.9

CLASS II OBESITY

> 40.0

CLASS III OBESITY

Some modifications to the WHO definitions have been made by particular bodies. The
surgical literature breaks down class III obesity into further categories, though the exact
values are still disputed. (Sturm R (July 2007). "Increases in morbid obesity in the USA:
20002005". Public Health 121 (7): 4926.)

BODY COMPOSITION ANALYSIS:

Essential Body Fat

The percentage of essential fat is 25% in men, and 1013% in women.

There is no single ideal percentage of body fat for everyone, it is highly

individualized and the levels of body fat vary based on sex and age as well as degree
and kind of physical activity

The American Council on Exercise (not an official government agency) shows how
average percentages differ according to the specified groups and categories:

DESCRIPTION

WOMEN

MEN

Atheletes

14-20%

6-13%

Fitness

21-24%

14-17%

Obese

32% +

25% +

The leanest athletes typically compete at levels of about 613% for men or 1420%
for women, the average person has a fat level of 28% for men and 22% for
women

WAIST TO HIP RATIO

FAT DISTRIBUTION: the way in which the fat is distributed in the body also
has an influence on the risk of disease

WAIST TO HIP RATIO: Measurements of the waist and of the hips and
observing their relationship is an anthropometric measurement used often to
determine central obesity - fat in the abdominal region and the hips

This measure has been widely used in research and has been shown to be
comparable and sometime better than BMI in its power to predict the risk of
metabolic abnormalities such as type II diabetes and cardiovascular disease.

The waist to hip ratio is commonly used in clinical practice and is a measure
used to predict future medical problems and complications of obesity

Measurements that have increased risk of diabetes, cardiovascular

disease, and / or other serious illness in men and women:
MEN

WOMEN

Waist Circumference

>40 inches

>35 inches

Waist to Hip Ratio

>1.0

>0.8

THE LINK BETWEEN OBESITY AND

GENES
Weight problems and obesity are a consequence of
interplay between a persons own genetic predisposition,
and the environment in which it lives. These factors
affect multiple genes.
To look at genes associated with being or becoming obese:
Genes that regulate appetite, genes responsible for
metabolism and energy balance
As of 2006, more than 41 sites on the human
genetic code were linked to the development of
obesity
Particularly if the environment was conducive to activate
the genetic predisposition. Environment has been
associated with a 40-70% involvement in the
development of obesity.

THE LINK BETWEEN OBESITY AND

INHERITANCE PATTERNS: To identify genetic abnormalities that
GENES
present in the form of obesity
GENETIC CLUSTERS
PARTICULAR GENE ABNORMALITIES
The thrifty gene hypothesis: It postulates that human
evolution has had periods of famine, alternating with periods of
abundance.
This may make people prone to obesity. During periods of
abundance, there is a predisposition to store energy and
promote obesity, and this would prove advantageous in
preparing for the times to come.
Once a society or culture established a stable food supply, would
create an epidemic in obesity.

GENETIC SYNDROMES OF
WELL ESTABLISHED GENETIC SYNDROMES: Early onset of severe
OBESITY
obesity, when a child younger than 10 years of age has a BMI greater
than THREE standard deviations above normal
7% harbor single locus mutation
SYNDROMIC OBESITY: obesity associated with a genetic disorder
Down Syndrome (Down syndrome is not always associated with
obesity, yet it increases the risk for obesity)
Prader-Willi syndrome
Bardet-Biedl syndrome
Cohen syndrome
Ayazi syndrome
MOMO syndrome

GENETIC SYNDROMES OF
OBESITY
Other genes associated with obesity include:
Leptin Deficiency (OMIM 164160 Locus 7q31.3)
Leptin Receptor Deficiency (OMIM 601007 Locus 1p31)
Pro-hormone Convertase-1 Deficiency (OMIM 600955 Locus 5q15-q21)
Pro-opio-melanocortin Deficiency (OMIM 609734 Locus 2p23.3)
Melanocortin -4 Receptor (MC4R) Polymorphism (OMIM 155541 Locus
18q22)

METABOLISM: THE LINK BETWEEN

HORMONES AND WEIGHT
Metabolism is the act of maintaining life through the use of
energy
It is a collection of chemical reactions that allow organisms to grow,
reproduce, and maintain its structure and relate to their environment
Anabolism: creation and production of energy sources to be stored
and used later
Catabolism: breaking down and using up energy
Metabolic rate: The heat that is liberated during metabolic chemical
reactions
Calorie(s): A unit of measure that defines the quantity of energy released
from different foods or expanded by different functions of the body.
Energy balance: the difference between the amount of calories one eats
and the amount of calories the body uses

METABOLISM: THE LINK BETWEEN

HORMONES AND WEIGHT
The relationship between metabolic rates, energy balance, and
weight changes is very complex.
Hormones are inherently attached to the word metabolism and in turn,
metabolism is tightly linked to body weight, body function and optimal
performance
Hormones, proteins, and other chemicals are crucial for
controlling energy expenditure, food intake, and body weight
The brain centers regulate energy expenditure and tissues throughout
the body by communicating with the gastrointestinal system, adipose
tissue, and muscles to control energy expenditure and energy intake
we cannot predict the effect of altering only one of these
factors on body weight as a whole

FACTORS THAT INFLUENCE ENERGY

EXPENDITURE

Resting Metabolic Rate: contributes ~70% of daily energy expenditure (active

physical activity contributes 5-10%) This means that a significant component of
energy usage and consumption is fixed)

The energy cost of metabolizing and storing food

The temperature effect of the body during rest, illness and exercise

Adaptive thermogenesis: The adaptation of temperature and energy

regulation happens in the brown fat

Brown fat uses stored energy to create heat and therefore promotes weight loss

White fat stores energy in the form of lipids (fat molecules)

The balance between white fat and brown fat is being actively investigated

We do know that brown fat decreases with age, and the balance between both varies in
response to chronic caloric intake as well as genetic predisposition

INFLUENCES IN FOOD CHOICES

Individual Preference: exposure, past experiences, traditions and rituals
Social Influences: cultural shared beliefs and values, marketing
Cultural Preference and identity within a group
Religious Preferences and Holidays
Economic Influences on affordability and allocation of money
Environmental influences:
Social: parental, school and work environment
Internal: emotions and feelings, boredom
Biological environment: Illness, puberty, menstrual cycle, pregnancy,
aging
Political Influences: taxation, industrialized farming, subsidies and food
labeling

NOURISHMENT AND THE

DIFFERENCES WHEN DISCUSSING
OBESITY
Nourishment is the food or other substances needed for growth
health and prevention of disease.
Malnutrition is when a person does not have a diet that
contains the right amount of nutrients or is unable to
absorb them from the gastrointestinal tract.
Poor nutrition can also refer to under-nutrition which means the
person is not getting enough nutrients, despite adequate intake
of calories.
This happens when a person consumes a lot of empty calories
without good nutritional value.

NOURISHMENT AND THE

DIFFERENCES WHEN DISCUSSING
OBESITY
SIGNS OF UNDER-NUTRITION INCLUDE:
Weak muscles, decreased muscle mass
Chronic fatigue, chronic muscle soreness
Low mood, depression, flat affect, and the opposite sudden
irritability and mood changes
Increase in illnesses and infections due to an altered immune
state
Decreased healing of skin
Changes in hair texture, quality and color

NOURISHMENT AND THE

DIFFERENCES WHEN DISCUSSING
OBESITY
FACTS:
30 percent of American diets fall short of such common plant-derived nutrients as
magnesium, Vitamin C, Vitamin E, and Vitamin A
80 percent of Americans are running low on Vitamin D
9 out of 10 people are deficient in omega-3 fats, which are critical for
PREVENTING inflammation and controlling blood sugar levels
Obesity is highly prevalent both in the United States and worldwide and
is projected to surpass tobacco use as the most economically important
modifiable risk factor in public health and disease
Multiple genetic, environmental and behavioral factors contribute to the
increasing trend in obesity
The increased availability of low cost, high-calorie, nutrient-poor foods
over the past four decades is a key component to the rise in obesity
worldwide

GUT INTEGRITY AND OBESITY

GUT INTEGRITY AND OBESITY

Disruption of gut lining
Improper absorption
Inflammation
Permeable gut- NDBP
Food Intolerances
Food Allergies

THE LINK BETWEEN HORMONES AND

WEIGHT
Body weight is regulated by hormones and the nervous system in
which together they orchestrate a balance between energy intake and
energy expenditure

Under normal circumstances:

When a person is overfed, appetite would fall and energy expenditure should rise

When a person is food deprived, appetite increases and energy expenditure falls
If this exquisite balance is disturbed, weight imbalance and obesity ensues.

Appetite is influenced by psychological factors, cultural factors, and

familial behaviors

Hormones that have effects on the brain, the gastrointestinal system,

the pancreas, the liver and the adrenal glands include:

APPETITE STIMULATORS: leptin, insulin, glucose, ketones, cortisol, ghrelin, peptide

Y, cholecystokinin, neuropeptide Y, MCH, AgRP, Orexin, Endocannabinoids

APPETITE CONTROLLERS: MSH, CART, GLP-1, and Serotonin

THE LINK BETWEEN THE BRAIN, FOOD AND

HEALTH: hormones that make the connection

Sight , smell, texture and environment are all sensed by the brain first

The brain prepares the body for food, anticipate and desire food

Notice the difference between HUNGER, APPETITE AND SATIETY and MOOD

Food stimulates the pleasure and reward centers of the brain

Energy balance requires an ability of the brain to detect the status of

energy stores and match energy intake with expenditure

THE GLUCOSE BALANCING HYPOTHESIS: Insulin and Glucagon

THE FAT BALACING MODEL: Leptin, Ghrelin, Adiponectin,

THE NUTRIENT MODEL: Gastrointestinal absorption, hormones and function of the

individual organs: Gastrin, Cholecystokinin, VIP, and Secretin

INTEGRATION OF THE MODELS: The brain integrates the limbic and cerebral
connections to feeding with the biologic needs for energy use

Kennedy GC. The role of depot fat in the hypothalamic control of food intake in the rat.
Proc R Soc Lond B Biol Sci. 1953;140:57896

GASTROINTESTINAL HORMONES

The gastrointestinal tract secretes hormones that control of feeding and

they have a direct access to the brain

CHOLECYSTOKININ (CCK) : The Satiety Hormone

THE HORMONE NEUROPEPTIDE Y (NPY) Hyperphagia

INSULIN and GLUCAGON

GLUCAGON LIKE PEPTIDE (GLP-1)

THE HORMONE OXYNTOMODULIN- Induces Satiety, and energy

expenditure

derived from proglucagon and co-secreted with GLP-1 by intestinal L-cells after
nutrient ingestion

PEPTIDE YY (PYY) 3-36- Decrease food intake

AMYLIN Co-secreted with insulin

GHRELIN: Made in the stomach induces hunger when fasting

HORMONES FROM THE ADIPOSE

TISSUE
LEPTIN:
Made by the Adipocyte to communicate to the brain about
energy stores crosses the blood-brain barrier
Effects on the hypothalamus, brain stem, and feeding and satiety
centers (PVN)
Stimulates the secretion of Neuropeptide Y (NPY)
The concentrations of leptin in fat tissue and plasma parallel the
total mass of fat tissue and triglyceride content.
Leptin decreases the inhibitory tone of -amino butyric acid (GABA)
released under the influence of NPY, and has potent anorexigenic action.
Leptin decreases with visual food stimuli
A fall in Leptin INDUCES HYPERPHAGIA, and increases NPY
A rise in Leptin after feeding SUPPRESSES APPETITE

HORMONES FROM THE ADIPOSE

TISSUE
ADIPONECTIN: adipocyte complement-related protein

The adiponectin gene (APM1) has been mapped to chromosome 3q27

Made by the Adipocyte to communicate to the brain about

energy stores DOES NOT cross the blood-brain barrier
STIMULATES ENERGY EXPENDITURE
REDUCES FOOD INTAKE
ENHANCES INSULIN SENSITIVITY IN MUSCLE AND LIVER
INCREASES FREE FATTY ACID OXIDATION AND DEGRADATION
DECREASES BLOOD GLUCOSE BY PROMOTING INSULIN SENSITIVITY

The concentrations of ADIPONECTIN is reduced in obesity and

INCREASE when fasting.
Adiponectin Deficiency induces INSULIN RESISTANCE and
HYPERLIPIDEMIA
Has been associated with increased cardiovascular disease,
vascular injury and atherosclerosis

SLEEP OBESITY AND CHRONIC

ILLNESS
Sleep deprivation has a direct and negative impact on a persons
health, their work, and work performance

Decreases the ability to concentrate

Impacts interpersonal relationships and limit social interactions and activities

There are more than 70 sleep disorders described in the medical literature

Facts about Sleep related Disease:

Sleep problems account for an estimated $16 billion in medical costs each year and
cause lost productivity at work Large indirect costs

At least 40 million Americans suffer from chronic, long-term sleep disorders each year

1 in 3 people in the United States has used some kind of a sleep aid

Problems like stroke and asthma attacks tend to occur more frequently during the
night and early morning, perhaps due to changes in hormones, heart rate, and other
hormonal shifts of the circadian rhythm.

Neurons that control sleep interact closely with the immune system, thus sleep
deprivation is associated with immune problems.

PSYCHOLOGICAL CAUSES OF WEIGHT

DISORDERS

Obesity is one of the nation's fastest-growing and most troubling health

problems today

Emotions are tightly linked to eating, and for that matter, under-eating
and overeating

What we do and don't do often results from how we think and feel- stress and
anxiety

Unless a person is able to make the realization that their emotions are
linked to their appetite and what they eat, and address these emotions
with healthy coping skills, serious health problems may be a
consequence of emotional eating.

EATING DISORDERS

Hormones are closely linked to appetite, mood, and impulse control, which are
all altered in people with eating disorders

ANOREXIA NERVOSA: People with anorexia nervosa have a distorted body

image that causes them to see themselves as overweight even when they're
dangerously thin.

They tend to be perfectionistic, and often refuse to eat, exercise compulsively, and
develop unusual habits such as refusal to eat in public or in front of others. Anorexia
nervosa is usually associated with significant weight loss, and can even cause death
from starvation.

BULIMIA NERVOSA: People with bulimia nervosa eat excessive quantities, but
later purge their bodies of the food and calories they just consumed and fear.

They use prolonged fasting, laxatives, enemas, or diuretics, throw up (vomit) or

excessively exercise. These acts are often done in secrecy and are associated with
feelings of disgust and shame as they binge, soon to be relieved of the tension and
negative emotions once their stomachs are empty again or purge.

EATING DISORDERS

BINGE EATING DISORDER: People with binge eating disorder experience frequent
episodes of out-of-control eating.

The difference between bulimia and binge eating is that binge eaters do not purge their
bodies of the excess calories consumed.

People with bulimia are often impulsive and eat to overcome psychic pain and escape
problems in their day-to-day lives.

A study of obese people with binge eating problems found that more than half also had a
history of major depression.

Additional research shows that obese women with binge-eating disorder who experienced
teasing about their appearance later developed body dissatisfaction and depression.

Binge eating is characterized by:

Recurrent episodes of eating during a discrete period of time (at least 2 days a week over
a 6 month period

Eating quantities of food that are larger than most people would eat during a similar
amount of time

A sense of lack of control during the episodes of excessive eating

Emotions of guilt or distress following the episodes of excessive eating

FEEL GOOD AND STRESS

Brain chemicals can primarily influence emotions
HORMONES
These hormones are the key players that control appetite and
hunger- If out of balance, they may get triggered to stimulate
excessive eating
Hormones that help us feel good:
Serotonin, Dopamine, Gamma-amino butyric acid (GABA)
Endorphins, Acetylcholine, Tyrosine, Nitric oxide
Hormones associated with stress:
Adrenaline, Epinephrine, Norepinephrine
Cortisol: corticosterone
Insulin
Neuropeptide Y

FOOD OBSESSION AND FOOD

ADDICTION
Compulsive overeating is real, it happens and it is very hard to talk about

If a person is overtly preoccupied with food and feels that sometimes eating gets
out of control, knowing that there is a light at the end of the tunnel is reassuring

As physician, identifying this problem is very difficult

There is a lot of shame and denial around this problem and it is very hard to diagnose if
the person does not acknowledge this is happening

An unhealthy relationship with food hard to diagnose, it lacks diagnostic criteria

In fact, there are guidelines that apply for substance addiction, process addiction, and
disordered eating in general, yet awareness and the ability to start a conversation can be
difficult

Talking about it promotes education about healthier eating, promotes healthy habits for
those who choose unhealthy lifestyles and at high risk for obesity, and those seeking help
for their obesity problems.

Food addiction is one of the proposed causes of the obesity epidemic in the United
States, and around the world.

MEDICATIONS AND SURGERY USED TO

TREAT OBESITY

PRESCRIPTION MEDICATION FOR THE TREATMENT OF OBESITY

METFORMIN

DPP-4 INHIBITORS AND GLP-1 ANALOGS

PHENTERMINE

PHENTERMINE AND TOPAMAX- QSIMIA

LORCASERIN- BELVIQ

WELLBUTRIN AND NALTREXONE- CONTRAVE

BARIATRIC SURGERY

GASTRIC BYPASS: Y EN ROUX

GASTRIC BANDING

GASTRIC SLEEVE

QUESTIONS??
THANK YOU
Margarita Ochoa-Maya, MD