PATHOGENESIS OF COMMON OBESITY

Obesity can result from increased energy intake, decreased energy expenditure, or a combination of the
two. Thus, identifying the etiology of obesity should involve measurements of both parameters. However, it is
difficult to perform direct and accurate measurements of energy intake in free-living individuals; and the
obese, in particular, often underreport intake. Measurements of chronic energy expenditure are possible

SPECIFIC SYNDROMES ASSOCIATED WITH OBESITY

Cushing's syndrome
Although obese patients commonly have central obesity, hypertension, and glucose intolerance, they lack
other specific stigmata of Cushing's syndrome (Chap. 342). Nonetheless, a potential diagnosis of Cushing's
syndrome is often entertained. Cortisol production and urinary metabolites (17OH steroids) may be
increased in simple obesity. Unlike in Cushing's syndrome, however, cortisol levels in blood and urine in the
basal state and in response to corticotropin-releasing hormone (CRH) or ACTH are normal; the overnight 1-
mg dexamethasone suppression test is normal in 90%, with the remainder being normal on a standard 2-
day low-dose dexamethasone suppression test. Obesity may be associated with excessive local reactivation

Acute care settings

Acute Care Settings
In acute-care settings, anorexia, various diseases, test procedures, and medications can compromise dietary intake. Under such circumstances, the
goal is to identify and avoid inadequate intake and assure appropriate alimentation. Dietary assessment focuses on what patients are currently eating,
whether or not they are able and willing to eat, and whether or not they experience any problems with eating. Dietary intake assessment is based on
information from observed intakes; medical record; history; clinical examination; and anthropometric,

What are the factors that alter the need of eating

FACTORS ALTERING NUTRIENT NEEDS
The DRIs are affected by age, sex, rate of growth, pregnancy, lactation, physical activity, concomitant diseases, drugs, and dietary composition. If
requirements for nutrient sufficiency are close to levels indicating excess, dietary planning is difficult.
Physiologic Factors
Growth, strenuous physical activity, pregnancy, and lactation increase needs for energy and several essential nutrients. Energy needs rise during
pregnancy due to the demands of fetal growth and during lactation because of the increased energy required

ESSENTIAL NUTRIENT REQUIREMENTS

ESSENTIAL NUTRIENT REQUIREMENTS
Energy
For weight to remain stable, energy intake must match energy output. The major components of energy output are resting energy expenditure (REE)
and physical activity; minor sources include the energy cost of metabolizing food (thermic effect of food or specific dynamic action) and shivering
thermogenesis (e.g., cold-induced thermogenesis). The average energy intake is about 2600 kcal/d for American men and about 1900 kcal/d for
American women, though these estimates vary with body size and activity level. Formulas for estimating REE

When and how to begin weaning ? and what types of food to introduce in weaning ?, How to start weaning ?

When and how to begin weaning ? 

The age of 4-6 months is ideal to begin weaning as :

1- iron stores of the baby become depleted at this age 

2- Caloric intake of breast milk alone is not sufficient . 

3- Digestive enzymes of the baby become mature

Factors indicating adequate breast feeding and minor problems with Breast feeding and its mangement .

Indicators of adequate breast feeding 

For the mother :

- Marked filling before breast feeding ( indicate good breast filling ) . 

- Let down sensation ( milk flow from one breast while nursing from the other ) . 

How to asses the Nutritional status of the baby

There are 4 ways by which we can asses the nutritional status of any baby as stated by the WHO :

1- Anthropometric measures : 

These are measures indicating the nutritional status of the baby :-

- Height for the age : for every child there is growth curve by which we can know if the baby is normal , low normal , etc..... , If the height is decreased in relation  to the age this indicate chronic malnutrition . 

-Weight for the age : if decreased it indicate acute malnutrition 

- Skin fold test : by punching the skin of the baby we can detect loss in the subcutaneous fat if present .