The role of FTO gene polymorphism in weight loss: An evidence-based case report
Ade Gafar Abdullah, Isma Widiaty, Cep Ubad Abdullah in Medical Technology and Environmental Health, 2020
Weight loss is a complex process that can be achieved only if there is an energy deficit, either by modulation of energy intake or energy expenditure. FTO gene expression is known to play a role in the arcuate nucleus (ARC) of the hypothalamus, which is primary to the regulation of hunger and satiety (Yang et al. 2017). Individuals with FTO polymorphism showed an increase in high-calorie, high-fat diets and sugar intake (Crovesy & Rosado 2019). Recent evidence suggests that lipid metabolism is dependent on N6-methyladenine (m6A) methylation, which is under-methylated in FTO gene polymorphism. This dysregulation in the nuclear level (mRNA) causes abnormal gene expression, decreases ghrelin mRNA (the only orexigenic hormone) and peptide levels (Wu et al. 2020). FTO expression also regulates IRX3 and IRX5 homeobox gene expression, affecting the mitochondrial metabolism of fat (de Araujo et al. 2019).
Dietary Therapy of Obesity
Susan L. McElroy, David B. Allison, George A. Bray in Obesity and Mental Disorders, 2006
As noted in the introduction, weight loss occurs when calories consumed are less than calories expended, producing a calorie deficit. Typically, a calorie restriction of 500 to 1000 kcal/day from the habitual diet is recommended to produce a weight loss of approximately 1 to 2 pounds/week. This often translates into a diet of 1000 to 1200 kcal/day for most women; and a diet between 1200 and 1600 kcal/day for men and heavier women (5). Although several energy expenditure equations are available to more accurately calculate caloric requirements (discussed further), there is little need to employ them in the early counseling process. Recommendations regarding the composition of calories has been addressed by the Institute of Medicine (IOM) report on macronutrients (7). These guidelines recommend an adult diet that has 45% to 65% of calories from carbohydrates, 20% to 35% from fat, and 10% to 35% from protein. The guidelines also recommend daily fiber intake of 38 g (men) and 25 g (women) for persons over 50, and 30 g (men) and 21 g (women) for those under 50. The IOM report highlights a very important point when it comes to macronutrients—rather than endorsing a fixed ratio of calories from carbohydrates, fat, and protein, we need to think in terms of safe and acceptable macronutrient ranges. Within these ranges, however, there is a large body of literature suggesting that reduction of fat is an effective approach for control of obesity (8,9).
Prevention of Alzheimer’s disease
Howard H. Feldman in Atlas of Alzheimer's Disease, 2007
Midlife obesity appears to increase the risk of later dementia. In a study of men and women initially aged 40–45 and followed from a baseline evaluation in 1964–73 to 1994, initially obese individuals had a 74% increased risk of dementia.30 There have been similar findings for later life obesity. These observations are consistent with dietary interventions in animal models of AD, where caloric restriction and intermittent fasting have been found to protect neurons against AD degenerative processes.31 There may also be danger in excessive weight loss, with several studies linking undernutrition and declining body mass to AD.32 In these studies, however, it is not clear whether weight loss is a very early symptom of dementia rather than having a causal role. Because avoidance of over- and undernutrition has broader health benefits, it is advisable even though direct effects on dementia risk remain uncertain.
Obesity treatment: a role for occupational therapists?
Published in Scandinavian Journal of Occupational Therapy, 2021
Christina Jessen-Winge, Pia Maria Ilvig, Hans Jonsson, Heather Fritz, Kim Lee, Jeanette Reffstrup Christensen
The Danish National Board of Health recommends that municipal weight loss programmes are conducted using a multidisciplinary team. However, the results of this study demonstrated that not all programmes followed those recommendations [18]. While the guidelines do not specify how many disciplines constitute a ‘multidisciplinary’ team, it is surprising that only 12 (5.1%) of the programmes included three or more health care professionals from different disciplines, and 69 (29.5%) of the programmes were conducted by only one health care professional. Weight loss is a complex process involving physiological, psychosocial, behavioural, occupational, and functional factors. Given the complex aetiology of obesity, a multidisciplinary approach may be better suited to address the problem [23]. Treating secondary diseases caused by obesity is very expensive for Danish municipalities. Thus, following the recommendations of the Danish National Board of Health and conducting weight loss programmes using a multidisciplinary team of health care professionals will most likely reduce municipality costs in the long run, as well as improve citizen quality of life [18].
Exploring the wider benefits of semaglutide treatment in obesity: insight from the STEP program
Published in Postgraduate Medicine, 2022
Patrick M. O’Neil, Domenica M. Rubino
In addition to the well-established benefits of weight loss in reducing the risks of obesity-related complications, weight loss can also lead to wider improvements of crucial relevance to people with obesity. Weight loss alongside improved functioning and well-being can provide important benefits for people with obesity and positively impact their daily lives [68]. In the STEP trials, substantial weight loss was observed with once-weekly subcutaneous semaglutide 2.4 mg, together with significant improvements in weight- and health-related QOL, cravings, and control of eating. There were also additional weight loss benefits, including improvements in body composition. The authors believe that despite the added expense of treatment with semaglutide 2.4 mg, the considerable degree of improvements across a multitude of outcomes would translate to a longer-term reduction in the burden of obesity on the healthcare system and will strengthen the argument for broader insurance cover in the future. These findings help to encourage primary care providers to be informed of the wider day-to-day benefits beyond weight loss, including day-to-day functional improvements, that can be achieved with semaglutide 2.4 mg treatment for people with overweight or obesity.
Combined medical strategies for the management of type 2 diabetes mellitus and obesity in adults
Published in Expert Opinion on Pharmacotherapy, 2021
Mohamad Sirri Tarazi, Samir Touhamy, Beverly G. Tchang, Alpana P. Shukla
Sodium glucose transporter 2 inhibitors (SGLT-2i) are a newer class of anti-diabetic agents that reduce hyperglycemia by increasing urinary glucose excretion via inhibition of the SGLT-2 transporter in the proximal tubules of the kidneys. Under normal physiologic conditions, the kidney filters around 180 g of glucose per day: 90% is reabsorbed by the SGLT-2 transporter, and the remaining 10% is reabsorbed by the SGLT-1 transporter. The net result is that no glucose appears in the urine. In diabetes, the capacity of those transporters to reabsorb glucose is increased, leading to consistent hyperglycemia in these patients; therefore, the use of SGLT-2i helps to diminish hyperglycemia by inducing glucosuria. The weight loss mechanism of SGLT-2i is mainly attributed to its glucosuric effect, resulting in a loss of 60 to 70 g of glucose in normoglycemic individuals [60] and calorie wasting through the urine. Weight loss, however, is less than expected or desired, possibly due to the adaptive mechanisms of increased appetite and calorie intake [61]. However, if SGLT-2i are combined with other agents that address obesity through different mechanisms, weight loss is enhanced [62,63]. Unlike GLP-1RAs, which differ in the magnitude of the weight loss effect, SGLT-2 inhibitors induce a uniform average weight loss of 2–4% when compared to placebo (Table 2). Newer agents that exhibit dual SGLT-1 and SGLT-2 inhibition have been shown to produce more weight loss [64–66].
Related Knowledge Centers
- Body Weight
- Diabetes
- Obesity
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- Physical Fitness
- Physical Appearance
- Management of Obesity