MANAGING UNCERTAINTY IN OBESITY

*Corresponding author: Raghavendra Rao M.V
Avalon University School of Medicine, Curacao, Central America
ISSN: 0976-3031
Research Article

MANAGING UNCERTAINTY IN OBESITY

Raghavendra Rao M.V1., Kumar Ponnusamy1., Sireesha Bala1., Sripada Pallavi T2., Krishna
Sowmya M3., Anandan Dayanadan6., Ramanaiah C.J4., Mahendra K Verma5., Reshma
Fateh1., Amin Fateh1., Samir Fatteh1., Tarig Fadlallah Altahir Ahmed1
and Sateesh Babu A1
1Avalon University School of Medicine, Curacao, Central America
2Apollo Institute of Medical Science and Research Institute, Jubilee Hills, Hyderabad, Telangana, INDIA
3Burjeel Hospital, Abu Dhabi, United Arab Emirates
4Amina Hospital Sharjah, United Arab Emirates
5Acharya Nagarjuna University, Guntur, Andhra Pradesh, India No conflict of interest
6Molecular Nanomedicine Research Unit, Sathyabama Institute of Science and Technology, Chennai- India
DOI: http://dx.doi.org/10.24327/ijrsr.2018.0909.2779

ARTICLE INFO ABSTRACT

Are we ignorant about our own health? Managing uncertainty in obesity? Diseases in the overweight
is the growing health issue around the world and is reaching epidemic proportions in some nations.
Body fat represents stored energy, and obesity occurs when the homeostatic mechanisms controlling
energy balance become disordered. In developed countries, there is a common nutritional disorder in
which there is an accumulation of excess body fat. Clinically, obesity is present when body mass
index exceeds 30. It occurs when energy intake exceeds energy expenditure. Obesity is most
commonly due to overeating than the caloric requirements. Obesity can be encountered with other
diseases namely certain metabolic disorders, and endocrine disorders. Obesity is defined as an
excess adipose tissue. Accurate quantification of body fat requires sophisticated techniques not
usually available in clinical practice. Physical examination is usually sufficient to detect excess body
fat. Physical examination is usually sufficient to detect excess body fat. Don’t cut fat and maintain
your weight. Reducing fat might not be as “heart-smart” as it sounds.

INTRODUCTION

Obesity is the most common metabolic problem in
industrialized countries. In the USA, 32% of adults are
classified as overweight, and 22.5% of these individuals are
obese. (.1) Both overweight and obese subjects are at an
increased risk for cardiovascular diseases(2) obesity also has
serious social and psychological consequences, and affects all
ages and socioeconomic groups (3)The successful management
of obesity is possible through lifestyle changes in diet and
physical activity alone than gastrointestinal surgery and
pharmacological interventions. (4) One of the natural molecules
known to prevent or retardate oxidation is -lipoic acid ( -LA)
thus, the lipoic acid/dihydrolipoic acid (LA/DHLA) redox
a couple has received considerable attention(5) Obesity is a
global epidemic disease and is recognized as a major public
a health problem in India. There is an immediate need to treat the
issue as Obesity is the major causative factor for many noncommunicable
diseases. (6)
The main function of carnitine in the body is facilitation lipid
oxidation by transporting long-chain fatty acids into the inner
mitochondria region where they undergo ?-oxidation (7). Since
acylCoAs cannot cross cell walls, carnitine comes into place to
help with the transportation through the mitochondrial wall
(8) in humans, carnitine is absorbed in the small intestinal
mucosa by sodium-dependent active transport and by
passive transport (9). Nonesterified carnitine (NEC), acidsoluble
acylcarnitine (ASAC), and acid-insoluble acylcarnitine
(AIAC) concentrations were lower in the differentiated 3T3-L1
Available Online at http://www.recentscientific.com

International Journal of
Recent Scientific
Research International Journal of Recent Scientific Research
Vol. 9, Issue, 9(E), pp. 29019-29023, September 2018
Copyright © Raghavendra Rao M.V, et al 2018, this is an open-access article distributed under the terms of the Creative
Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the
original work is properly cited.
DOI: 10.24327/IJRSR
CODEN: IJRSFP (USA)
Article History:
Received 6th June 2018
Received in revised form 15th
July 2018
Accepted 12th August 2018
Published online 28th September 2018
Key Words:
Acid soluble acylcarnitine (ASAC), Leptin,
lipoic acid/dihydrolipoic acid (LA/DHLA),
Corticotropin-releasing factor (CRF) neurons,
L-Carnitine
High-density lipoproteins (HDLs),-
Cocaine- and amphetamine-regulated
transcript (CART), ‘Adipokines’,
Raghavendra Rao M.V et al., Managing Uncertainty in Obesity

29020 | P a g e
cells. In addition, the exogenously added carnitine inhibited the
increases in triglyceride and total lipid levels (10)
In humans, carnitine is absorbed in the small intestinal mucosa
by sodium-dependent active transport and by passive transport
(11) In blood, carnitine does not need protein for a carrier, and
is present in the free or acylcarnitine form. (12) Stress and
emotional brain networks foster eating behaviors that may lead
to obesity. Stressors, by activating a neural stress-response
network, bias cognition toward increased emotional activity
and degraded executive function. (13) The increased amount of
perceived stress experienced by individuals in modern society
affects feeding behavior (14) In fact, a recent study showed that
sadness favored eating of high fat/sweet, hedonically rewarding
foods, whereas intake during a happy state favored dried fruit
(15). . Elevated stress hormones and palatable food intake and
the consequent accretion of fat may serve as feedback signals
that reduce perceived stress (16). Leptin as a key fat hormone
that stimulates secretion of the anorexigenic and sympatheticstimulatory
neuropeptides and inhibits secretion of the
orexigenic and parasympathetic-stimulatory neuropeptides.
(17,18) Childhood obesity is a risk factor for a number of
chronic conditions including the metabolic syndrome and
cardiovascular diseases(19) Its prevalence increased rapidly
from the mid-1980s in developed countries, although there is
evidence that in the late 1990s and early 2000s, it reached a
plateau or a small decrease occurred. (20).

History

Hippocrates wrote that “Corpulence is not only a disease itself
but the harbinger of others” (22)The Indian
surgeon Sushruta (6th century BCE) related obesity to diabetes
and heart disorders(24) He recommended physical work to help
cure it and its side effects. For most of human history, mankind
struggled with food scarcity. (23) It was common among high
officials in Europe in the Middle Ages and the Renaissance
(25) as well as in Ancient East Asian civilizations. (26) Tobias
Venner is credited with being one of the first to refer to the
term as a societal disease in a published English language
book. (27) It was realized that the military and economic might
of nations were dependent on both the body size and strength
of their soldiers and workers (32).
During the 20th century, as populations reached their genetic
potential for height, the weight began increasing much more
than height, resulting in obesity. In the 1950s increasing wealth
in the developed world decreased child mortality, but as body
weight increased heart and kidney disease became more
common (28) During this time period, insurance companies
realized the connection between weight and life expectancy and
increased premiums for the obese. (22)Many cultures
throughout history have viewed obesity as the result of a
character flaw. The obese or fat character in Ancient Greek
comedy was a glutton and figure of mockery. During Christian
times the food was viewed as a gateway to the sins
of sloth and lust. (21) In modern Western culture, excess
weight is often regarded as unattractive, and obesity is
commonly associated with various negative stereotypes. People
of all ages can face social stigmatization and may be targeted
by bullies or shunned by their peers. (29)
The weight that is viewed as an ideal has become lower since
the 1920s. This is illustrated by the fact that the average height
of Miss America pageant winners increased by 2% from 1922
to 1999, while their average weight decreased by 12 % (30)On
the other hand, people’s views concerning healthy weight have
changed in the opposite direction. In Britain, the weight at
which people considered themselves to be overweight was
significantly higher in 2007 than in 1999. (31) These changes
are believed to be due to increasing rates of adiposity leading to
increased acceptance of extra body fat as being normal. (31)
Obesity is still seen as a sign of wealth and well-being in many
parts of Africa. This has become particularly common since
the HIV epidemic began some attribute the Venus figurines to
the tendency to emphasize fertility while others feel they
represent “fatness” in the people of the time. This continued
through much of Christian European history, with only those of
low socioeconomic status being depicted as obese. (21)
During the Renaissance, some of the upper class began
flaunting their large size, as can be seen in portraits of Henry
VIII of England and Alessandro dal Borro. Rubens (1577–
1640) regularly depicted full-bodied women in his pictures,
from which derives the term Rubenesque. (33) During the
19th century, views on obesity changed in the Western world.
After centuries of obesity being synonymous with wealth and
social status, slimness began to be seen as the desirable
standard (21)

Significant Gap in Research

At the beginning of the 20th century, it was observed that patients
with damage to hypothalamus tended to gain weight. In the
The 1940s, it was also shown that discrete lesions in the
hypothalamus of rodents caused them to become obese. As
early as 1953, Kennedy proposed, on the basis of experiments
on rats, that a hormone released from the adipose tissue acted
on the hypothalamus to regulate body fat and food intake. It is
also observed that mice could become obese as a result of
mutations in certain genes At least five of these are
characterized including the ob (Obesity) tub (tubby) fat and ab
(diabetes) genes. Mice that are homozygous for mutant forms
of these genes ob/ob mice and db/db mice-eat excessively, have
low energy expenditure, become grossly fart and have
numerous metabolic and other abnormalities.(34)Most of the
obese patients are asymptomatic. When obesity is marked,
exertionaldyspnea, depression and easy fatigability are likely to
occur. Marked obesity may be associated with alveolar
hypoventilation leading to C02 retention which may account
for the above features In obese patients Pink striate are
commonly seen on abdomen, thighs, buttocks, breasts,
particularly in young women. When obesity is massive
exertional dyspnea and tachypnea may be seen. Intertrigo is
quite common in the folds below the breast and in the inguinal
regions. Sometimes systemic hypertension may be present due
to associated disorders like D M. (35). Obesity can be
encountered with other diseases namely certain metabolic
disorders, and endocrine disorders. Obesity is defined as an
excess adipose tissue. Accurate quantification of body fat
requires sophisticated techniques not usually available in
clinical practice. Physical examination is usually sufficient to
detect excess body fat. (36)Obesity is the most common
metabolic problem in industrialized countries. In the USA, 32%
of adults are classified as overweight, and 22.5% of these
individuals are obese. (37)
International Journal of Recent Scientific Research Vol. 9, Issue, 9(E), pp. 29019-29023, September 2018
29021 | P a g e

Major Advances and Discoveries

The discovery of functions of the distributed cell groups of
corticotrophin-releasing factor (CRF) neurons, the motor
neurons for activation of the pituitary and adrenal, as well as
the tight interrelationships between calories, body weight,
energy stores and the HPA axis have occasioned revisions in
our thinking. (38) The obese and overweight subjects who are
doing regular physical activity require extra L-Carnitine for the
transport of fatty acids which are used for energy
production. (39)Tuft’s University scientists recently put 11
middle-aged men and women volunteer on a variety of
average, reduced and low-fat diets, which provided only 15%
of fat from calories (a diet so strict it ’s almost impossible in a
real-life situation) did you have a positive effect on blood
cholesterol and triglyceride levels. But a reduced-fat diet, a
more realistic way of eating, only affected those levels if
accompanied by weight loss. In fact, the investigators
concluded, cutting fat without losing weight actually increased
triglyceride levels and decreased high-density lipoproteins
(HDLs) – the “good” cholesterol that helps protect against heart
disease. Eat fat for a healthier body. So while excess fat isn’t
healthy, fat isn’t a dirty word. Without some fat-soluble
vitamin (including A, D, E, and K). Certain fats, like olive oil
and the omega-3 fatty acids found in salmon may help prevent
heart disease. And most people say a little simply makes food
taste, look and smell more. (40)Excess adiposity (obesity) and
excess body weight is associated with an increased incidence of
several of the most important diseases of humans, including
type 2 diabetes, dyslipidemias, cardiovascular disease,
hypertension, And cancer. Obesity is defined as an
accumulation of adipose tissue that is of sufficient magnitude
to impair health.
Ideas where the research go next?
Scientists have discovered the precise brain mechanism that
causes the body to hold onto fat, raising hopes of a cure
for obesity. For the first time, lab trials have explained how the
brain’s ability to sense insulin in the body, levels of which are
raised after a meal, is coordinated with expending or
conserving energy. Researchers at Monash University in
Australia have described the findings as “very exciting”, and
said they highlight targets for potential fat-inhibiting medicines
for people who cannot help putting on weight. (41)Recent
evidence suggests that development of obesity involves
hormones and neurotransmitters (such as leptin, cocaine- and
amphetamine-regulated transcript (CART), and ghrelin) that
regulate appetite and energy expenditure. These hormones act
on specific centers in the brain that regulate the sensations of
satiety. Mutations in these hormones or their receptors can lead
to obesity. (42) The endogenous IL-6 prevents obesity and
enhances glucose tolerance (Wallenius et al 2002, Nat Med
8:75, cited more than 500 times in WoS). We also showed
evidence that this effect is exerted at the level of the CNS and
involves increased leptin sensitivity. We have shown that IL-6-
/- mice have reduced endurance and energy expenditure during
exercise (Fäldt et al 2004, Endocrinology 145:2680). These
results suggest that the increase in muscle-derived IL-6
observed in plasma of experimental animals and humans is
necessary for normal exercise capacity. We found that the
levels of IL-6 in CSF differs in many ways from CSF leptin. I
found evidence that CSF IL-6 is locally produced rather than
serum derived. Moreover, body fat-regulating regions in the
CNS may be exposed to insufficient IL-6 levels in more
severely obese humans (43)Obesity is a major public health
problem in developed countries and an emerging health
problem in developing nations such as India. Globally, the
World health Organization estimates that 2015, 700 million
adults Will be obese. In certain countries, obesity coexists with
malnutrition in individual families.

Current Debate

The best way to predict the future is to create it. Complications
of obesity. Obesity has adverse effects on both mortality and
morbidity. Changes in mortality re difficult to analyze due to
the confounding Effects of lower body weight in cigarette
smokers. However, it is clear that the lowest mortality rates are
seen in Europeans in the BMI range 18.5-24 kg/m2 (and at
lower BMI in Asians). It is suggested that obesity at age 40
years can reduce life expectancy by up to 7 years for nonsmokers
and by 13 years for smokers. Coronary heart disease is
the major cause of death but cancer rates are also increased in
the overweight, especially colorectal cancer in males and
cancer of the gallbladder, biliary tract, breast, endometrium, and
cervix in females. Obesity has little effect on life expectancy at
> 70 years, but these obese do spend a greater proportion of
their active life disabled. Epidemic obesity has been
accompanied by an epidemic of type 2 diabetes and
osteoarthritis, particularly of the knee. Although an increased
body Size results in greater bone density through increased
mechanical stress, it is not certain whether this translates to a
lower incidence of osteoporotic fractures. Obesity may have
profound physiological consequences, compounded by
stigmatization of the obese in many societies. Body fat
distribution for some complications of obesity, the distribution
rather than the absolute amount of excess adipose tissue
appears to be important. Increased intra-abdominal fat causes
central (abdominal’ ‘visceral’ ‘android’ or apple-shaped’)
obesity, which contrasts with subcutaneous fat accumulation
causing ‘generalized’ (‘ganoid’ or pear-shaped) obesity; the
former is more common in men and is more Closely associated
with type 2 diabetes, the metabolic syndrome, and
cardiovascular disease. The key difference between these
depots of fat may lie in their vascular anatomy, with intraabdominal
fat draining into the portal vein and thence directly
to the liver. Thus many factors which are released from adipose
Tissue (including free fatty acids; ‘adipokines’, such as tumor
necrosis factor-?, adiponectin and resist in; and steroid
hormones) may be at higher Concentration in the liver and
hence induce insulin resistance and promote type 2
diabetes. (44)

CONCLUSION

At its simplest level, obesity is a disease of caloric imbalance
that results from an excess intake of calories that exceeds their
consumption by the body. However, the pathogenesis of
obesity is complex and incompletely understood. Ongoing
research has identified intricate humoral and neural
mechanisms respond to genetic, nutritional, environmental, and
physiologic signals, and trigger a metabolic response through
the stimulation of centers located in the hypothalamus. There is
little doubt that genetic influences play an important role in
weight control, but obesity is a disease that depends on the
Raghavendra Rao M.V et al., Managing Uncertainty in Obesity

29022 | Page
the interaction between multiple factors. After all, regardless of
genetic makeup, obesity would not occur without the intake of
food. (45) The majority of the drugs approved to treat obesity
have short-term indications of usage. However, some of the
newer medications approved for short-term usage are the
anorexiants phentermine and diethylpropion. There is a much
larger list of anorexiants used off-label for weight loss; the
lipase inhibitor, orlistat, has been available for several years,
and other lipase inhibitors are being considered for
approval. Recently, a serotonin agonist, lorcaserin, and a
combination drug, phentermine, and topiramate were
also approved for the treatment of obesity. Drugs for obesity
are considered effective if they demonstrate at least a 5%
greater reduction in body weight as compared to placebo (no
treatment)…

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How to cite this article:
Raghavendra Rao M.V.2018, Managing Uncertainty in Obesity. Int J Recent Sci Res. 9(9), pp. 29019-29023.
DOI: http://dx.doi.org/10.24327/ijrsr.2018.0909.2779
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