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Impact Of Obesity On The Development Of Endocrine Disease

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Previously undiagnosed endocrine disease is almost never the cause of obesity. Hypothyroidism is rare as a cause, and thyroxine replacement seldom produces dramatic weight loss. Hyperphagia and weight gain are sometimes seen in thyrotoxicosis. Cushing’s syndrome is a rare cause of obesity, but it is important to consider this possibility when assessing obese patients. Adults with growth hormone deficiency exhibit increased body fat and reduced lean body mass, which can be corrected by growth hormone replacement. Obesity is often a feature of polycystic ovary syndrome, but not a consequence of polycystic ovaries

Hypothalamic obesity

It is exceedingly rare for previously unrecognized hypothalamic disease to present as obesity. Tumours in the hypothalamic region (notably craniopharyngiomas and pituitary macroadenomas with suprasellar extension) often damage the ventromedial hypothalamic regions that regulate energy intake and expenditure. Similar lesions may also occur following trauma or surgery. Such patients often exhibit marked hyperphagia but also have autonomic imbalance leading to hyperinsulinaemia, which can exacerbate weight gain by promoting fat deposition

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Physical activity may be reduced as a result of somnolence or associated visual loss. Endocrine disturbances (particularly growth hormone deficiency and hypogonadism) may contribute to an unfavourable body fat distribution, increasing metabolic risk in this group

Drugs

Many drugs (notably centrally acting drugs, such as anticonvulsants, and neuroleptic agents) promote weight gain. The mechanisms depend on the agent concerned and are not well understood, but may involve both central effects on appetite (thought to be the case with neuroleptics) and peripheral metabolic effects (with oral hypoglycaemic drugs and protease inhibitors) Patients taking such drugs must be informed of this side-effect and of dietary measures to prevent it. In some cases, alternatives are available that do not promote weight gain.

Eating disorders and psychiatric causesobesity is a common underlying problem with the psychiatric disease bulimia nervosa through episodic binge-eating, which may be accompanied by self-induced vomiting. Voluntary overeating is sometimes a response to psychological stress, for example to previous sexual abuse in young women (Stunkard and Wadden, 2014) Although many obese patients say they feel depressed (mainly about their weight) and they eat to excess when they feel this, this symptom is not the same as true endogenous depression and these problems are not helped by antidepressant drugs (Stunkard and Wadden, 2014)

Of the 1119 new patients admitted to the ICU between November 2012 and August 2013, 230 had recorded BMI data. Of these, the majority of patients were male (58%), either overweight or obese (75.2%) with a mean age of 56.8 years. Out of the patients with a normal BMI, 32.7% were in the neurosurgery specialty, compared to only 11.1% of obese patients. Whereas, out of the patients who were classified as underweight, 37.5% were in the general surgical/gastro/liver/renal specialty compared to only 15.7% of overweight patients. With 75% of the sample overweight or obese Australian ICU patients may have higher BMI than those of the general Australian population. Therefore there may be hidden ICU costs attributable to the presence and management of this cohort. No medical specialty was associated with higher BMI than another within this ICU population sample, however it may be that larger patient numbers may have detected differences (Australia New ZealandIntensive Care Society, 2013)

Impact of increased body mass index on sepsis mortality

At least 25 % of adults admitted to intensive care units (ICU) in the United States have overweight, obese, or morbidly obese body mass indices (BMIs), while bacterial sepsis is commonly the cause for these admissions. Although an obese BMI reduces overall life expectancy, it is unclear whether it also impacts the acute outcome of ICU patients in general, or with sepsis specifically (Angus et al, 2001) While identifying such an association has important prognostic and therapeutic implications, this is difficult because an obese BMI is one of several variables potentially influencing ICU outcomes. Studies addressing this question provide conflicting and unclear results

A recent analysis of seven studies of septic patients found an obese BMI increased, decreased, or had no effect on survival. However, two of the studies included non-ICU and ICU patients for whom the overall risk of death would have differed. Furthermore, one study included children and adults, and another study did not account for other baseline variables. Based on the adverse effects of an obese BMI on long term health, an increased BMI would also worsen short-term outcomes in adult patients with sepsis requiring ICU care. To examine this question, a meta-analysis of studies was performed in adult patients admitted to the ICU (participants) and treated for sepsis, severe sepsis, or septic shock (interventions/exposures)

Sepsis and severe sepsis are the most common cause of death among critically ill patients admitted in medical intensive care units. As per the Centers for Disease Control and Prevention National Center for Health statistics report, septicemia was the 11th leading cause of death in the United States in 2010. Between 2003 and 2007, the number of patients hospitalized for severe sepsis increased by 71%, at an annual rate of 17.8% per year. In addition to high mortality and morbidity, severe sepsis is associated with increased health care expenditures. In 2007, the health care costs for patients admitted for severe sepsis exceeded $24 billion, an increase of 57% since 2003

Obesity is one of the major public health problems. Current estimates suggest that 69% of adults in United States are either overweight or obese with approximately 35% obese. Furthermore, overweight and obesity are major contributors to chronic diseases. Obesity has been shown to be associated with an increased all cause mortality, myocardial infarction, diabetes mellitus, and hypertension (Prescott et al., 2014). The high prevalence of obesity in the general population has led to a higher number of obese patients being hospitalized in ICUs.

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