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Talking about fatness without fat shaming

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  • CT Talking about fatness without fat shaming

    27% of the British population is obese according to today's news headlines.

    Fat storage got our hunter gather ancestors through subsistance on plant food while waiting for the next kill. Nowadays hunter gathering happens in the supermarket. I don't ask patients what they weigh, the actual figure is fairly meaningless, I ask if their weight is steady after which most start volunteering information and asking questions. Unexplained weight loss may be a red flag. Some of my patients have to "make weight" for work or sport. Many of my patients are not eating enough (plant food) and when they ask if they can have certain entertainment foods, I tell them that they can if they can fit it in on top of their 10 a day of different coloured leaves, vegetables and fruit. Because the discussion starts during history taking, they very soon become comfortable around it.

    Yesterday, one of my patients who has cord compression amongst her co morbidities volunteered that she was having difficulty with the upper limb stretch I had asked her to do in the supermarket and that she didn't think that it was just because her dresses are getting tighter. Our conversation has now reached the free flowing stage and I told her that last time I was in theatres watching open surgery the subcutaneous fat layer reminded me of bubble wrap and it could possibly restrict movement if there was sufficient wrapped around a limb, this led to a lot of experimental movement and the observation that the new sensation didn't feel the same as the nerve glides or the tight dress.

    Most of my patients don't know that fat is an important endocrine tissue, that some of their fat is brown and can generate heat and that fat plays a role in inflammatory processes. Bubble wrap is superfluous when it is so easy to put on and take off layers of clothing........shoulder pain permitting!
    Jo Bowyer
    Chartered Physiotherapist Registered Osteopath.
    "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

  • #2
    Most people can lose ten pounds, if it makes a difference to pain levels, some might consider optimising BMI before going ahead with total knee replacement.
    Jo Bowyer
    Chartered Physiotherapist Registered Osteopath.
    "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

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    • #3
      Fat expansion through norepinephrine catabolism

      http://stke.sciencemag.org/content/10/505/eaar4569.full

      Certain macrophage populations limit norepinephrine-induced lipolysis in adipose tissues in response to aging or obesity.

      Fasting or cold exposure triggers the release of the catecholamine norepinephrine from sympathetic neurons that innervate adipose tissues. Norepinephrine promotes the lipolysis of triglycerides, a process that reduces white adipose tissue mass and overall adiposity and enables brown adipose tissue to produce heat. Fasting-induced lipolysis is impaired in adipose tissue in the elderly, which Camell et al. (see also Czech) found was due to the degradation of norepinephrine by adipose tissue macrophages (ATMs). Aging increased the expression of genes encoding norepinephrine-degrading enzymes, such as monoamine oxidase A (MAOA), in ATMs, an effect that depended on the NLRP3 inflammasome and GDF-3 (growth differentiation factor 3), a transforming growth factor–family member. Treating aged mice with an MAOA inhibitor increased adipose tissue concentrations of norepinephrine and rescued fasting-induced lipolysis. In another paper, Pirzgalska et al. characterized a population of macrophages associated with sympathetic neurons that were distinct from ATMs (and that was also identified by Camell et al.). These macrophages, which the authors called SAMs (sympathetic neuron–associated macrophages), took up norepinephrine through the transporter SLC6A2 and catabolized it through MAOA. Diet- or genetically induced obesity in mice increased the number of SAMs, which expressed genes encoding proinflammatory cytokines at sympathetic fibers. Of the cells in the hematopoietic lineage, Slc6a2 expression was specific to SAMs, and ob/ob mice that received Slc6a2–/– bone marrow cells had increased circulating concentrations of norepinephrine and weighed less than did ob/ob mice that received control bone marrow cells. Immunohistochemistry analysis showed the presence of macrophages that were positive for SLC6A2 and MAOA in human sympathetic ganglia. Thus, certain macrophage populations limit lipolysis in adipose tissue in response to aging or obesity by acting as a sink for norepinephrine.
      Brown fat rocks!, there's a nice patch of it in the upper thoracic region, some of my patients think that they can feel it switching on. No need for "energy medicine" and made up stories when real life physiology is so engaging.
      Jo Bowyer
      Chartered Physiotherapist Registered Osteopath.
      "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

      Comment


      • #4
        UCP1-independent signaling involving SERCA2b-mediated calcium cycling regulates beige fat thermogenesis and systemic glucose homeostasis

        https://www.nature.com/articles/nm.4429

        Uncoupling protein 1 (UCP1) plays a central role in nonshivering thermogenesis in brown fat; however, its role in beige fat remains unclear. Here we report a robust UCP1-independent thermogenic mechanism in beige fat that involves enhanced ATP-dependent Ca2+cycling by sarco/endoplasmic reticulum Ca2+-ATPase 2b (SERCA2b) and ryanodine receptor 2 (RyR2). Inhibition of SERCA2b impairs UCP1-independent beige fat thermogenesis in humans and mice as well as in pigs, a species that lacks a functional UCP1 protein. Conversely, enhanced Ca2+ cycling by activation of α1- and/or β3-adrenergic receptors or the SERCA2b–RyR2 pathway stimulates UCP1-independent thermogenesis in beige adipocytes. In the absence of UCP1, beige fat dynamically expends glucose through enhanced glycolysis, tricarboxylic acid metabolism and pyruvate dehydrogenase activity for ATP-dependent thermogenesis through the SERCA2b pathway; beige fat thereby functions as a 'glucose sink' and improves glucose tolerance independently of body weight loss. Our study uncovers a noncanonical thermogenic mechanism through which beige fat controls whole-body energy homeostasis via Ca2+ cycling.
        Very few know about beige fat, practitioners or patients. I suspect that it works better in those who have a more active (old fashioned) lifestyle. Housework isn't what it was, it used to be a really effective workout.
        Jo Bowyer
        Chartered Physiotherapist Registered Osteopath.
        "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

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