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FIGURE 3-2 Android (apple) and gynoid (pear) fat distribution patterns in men and women
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TABLE 3-1 Body Mass Index (BMI) Categories BMI Less than 185 185 249 250 299 300 and greater WEIGHT STATUS Underweight Normal Overweight Obese
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FIGURE 3-3 Triglyceride chemical structure
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and unsaturated fats are usually liquids at room temperature
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Lipid Metabolism
During digestion, fats in the food are broken down in the duodenum by pancreatic lipase into free fatty acids and glycerol The intestinal epithelium absorbs these substances and reesterifies them in the smooth endoplasmic reticulum into triglycerides These triglycerides are then absorbed into the circulation and lymphatic system When they arrive in the circulation they are combined with apoprotein to form a lipoprotein, which is called a chylomicron Chylomicrons are exposed to lipoprotein lipase, which is synthesized by adipocytes and stored at the surface of endothelial cells Lipoprotein lipase cleaves the chylomicron into free fatty acids and glycerol again These free fatty acids pass into adipocytes and combine with intracellular glycerol phosphate to form triglycerides and are stored for energy Adipose tissue can also convert excessive glucose and amino acids into fatty acids when stimulated by insulin This explains why people who consume a low-fat diet or fat-free diet still gain weight if they do not reduce the total amount of calories they consume or have a high-carbohydrate diet High blood glucose can stimulate insulin synthesis and insulin can increase synthesis of lipoprotein lipase from adipocytes to help absorb triglycerides into the cells People who want to control their weight should avoid any foods that have the ability to stimulate insulin production Individuals with type II diabetes have high levels of insulin; therefore, they have a higher risk of becoming overweight or obese than nondiabetic individuals
(LDL) brings fat to the cells, while highdensity lipoprotein (HDL) brings fat from the circulation to the liver for excretion in bile High levels of LDL are associated with a high incidence of coronary artery disease and atherosclerosis HDL, or the good lipoprotein, can be elevated with exercise
Lipid Synthesis
Triglycerides are derived from foods or synthesized from excessive glucose or amino acids In humans, triglycerides are stored mainly in adipose tissue, which constitutes the body s reserve energy source However, excessive consumption of calories can lead to the synthesis and accumulation of more fat in subcutaneous tissues Unfortunately, fat storage is unlimited in the subcutaneous tissue, unlike glycogen storage in the liver and muscle Therefore, excessive fat accumulation will not only change a person s cosmetic appearance but also increase their risk for osteoarthritis, diabetes, hypertension, as well as other diseases
However, almost all people gain weight when they get older because of diminished physical activity and aginginduced changes in the chemical activity of hormones Body mass index [BMI: body weight divided by the square of height (kg/m2)] is a popular index used for determining body weight status The Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO) use this index to classify adults into four groups (Table 3-1) A normal BMI does not necessarily mean that a person has a perfect shape Many people with a BMI less than 25 have fat accumulation in some area, such as the abdomen or buttocks IMPACT OF OBESITY ON THE SKIN Obesity is responsible for changes in skin barrier function by significantly increasing transepidermal water loss, which can lead to dry skin and impaired barrier function14 Hyperfunction of sebaceous glands due to high levels of androgenlike hormone or insulin-like growth factor hormone can aggravate severity of acne and hirsutism;15,16 delay wound healing and collagen deposits in the wound healing process;17 and disturb both blood and lymphatic circulation, which can cause angiopathy 18 and lymphedema, potentially precipitating chronic leg ulcers19 Rapid weight gain can cause striae distensae (stretch marks), which are challenging to treat20 23 In addition, in intertriginous areas such as the underarms, breasts, and groin, moisture accumulation can lead to candida infection (intertrigo) It is widely known that obesity increases the risk of coronary heart disease, hypertension, hyperlipidemia, osteoarthritis, and diabetes It is also known to be directly related to increased risk of sleep apnea; breast, endometrial, and colon cancer; gallbladder disease; musculoskeletal disorders; severe pancreatitis and diverticulitis; infertility;
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