endogenous breakdown of protein, occurs from the skeletal muscles, gastro intestinal trad and liver primarily but other organs also suffer

called diet courses for the obese. 3. Role of adipose tissue hpoprotein lipase (ATLA). Recall, there are several types of lipoprolein lipases in our body, ATLA being one of them ATLA hydrolyses the triglycerides of lipoprolem and the fatly acids (FA) thus released are incorporaled into the adipose tissue cells (adipocyles). Obese people, in general, have excessive concentrations of ATLA. 4. Role of brown fat. Brown fat (chap 7.10) has been discussed earlier In the adult, the amount of brown fat is usually meager. Nevertheless, brown fat activity causes development of great heat, ie, brown fat acltvities cause calorigenesis and this in turn raises the BMR, which in turn raises the energy output and reduction of body fat. Obese persons have no brown fal in their body (in contrast to normal persons who have some, although meager, quantity of il). 5. Psychological factors. Habits Many persons eat when il is time for the meal' no matter, whether he is feeling hungry or not This often leads to excess energy input. Some persons will eat whenever he finds 'good food', no matter whether he is hungry or not Some psychiatric persons (eg, some cases of depression) often over eat. It is important to remember depression n extremely common in Ihe present day society and many such cases are never suspecled even to be suffering from depression Dangers of obesity. Alherosclerosis, hypertension, diabetes mellitus, mammary cancer, gall slones are some diseases which are associated with obesity. Some well known adages, reflecting Ihe observation and wisdom of Ihe lay people may be quoted : (i) people dig Iheir own graves by their teeth, (ii) longer the belt, shorter is the life, (iii) (diabeles is), fat man's folly (iv) if you wanl to eal for longer number of days, eat less each day, and so on. Diabetes deserves special mention The maturity onset (NIDDM) diabetes (chap 6.6) commonly occurs in the obese persons. It is now known that in the obese (i) the insulin receptors, in the membranes of the target cells, are loo few in number and (ii) there is a deficiency of post receptor events - the two features precipitate the onsel of NIDDM type of diabetis. Body wt reduction usually reduces Ihe ferocity of the diabeles. In obesity, the blood vessels in tie adipose tissue, (i) have lo grow (to keep pace with Ihe growth of Ihe tissue), as well as (n) are compressed (by Ihe growing mass of the lissue) - the two factors combine to raise Ire peripheral resistance increase of BP. Reducton of body wt Ihus usually reduces the BP. Treatment, Physiological basis Obesity is very difficult to correct. Ullimately speaking, the aim is lo see thai energy input becomes less than the energy out put. (It is to be understood that there is no known method by which Ihe hypothalamic set point can be readiusted in man Therefore, basically the treatment of obesity is symptomatic). Common forms of treatment are 1 Energy input is reduced, either by short bouls of starvation (provided the person has no diabeles prone to kelosis or peptic ulcer) or mcessant reduced food intake. 1,2 or even 3 days of starvations are usually well tolerated. High calorie foods like fat, sugar etc must be slopped So called soft drinks often contain high calories Various diel courses (to reduce obesity) has now become a soil of industry in the affluent wesl. 2. Drugs are, for various reasons not popular. Thyroxme (almosl obsolete) and amphetamine (a banned drug in India, because of its addictive properties) were once very popular . Amphetamine, by acting on Ihe hypothalamus reduces appelite and is thus an well known anorexant. B. Surgical Various surgical procedures have developed to tackle extreme obesity. One commonly done is, small intestinal bypass surgery, where eunum is anastomosed with a loop of ileuin near its terminal (so that a good deal of small intestine is by passed). Result is, ultimately speaking, diminished energy input. Very oflen the patient becomes a chronic sufferer from various after effects of this operation. Role of exercise in Ihe treatment of obesity should be mentioned. All obese persons should increase his (her) energy oulput by increasing Ihe physical exercise, but only very hard work is needed lo reduce even a moderate amounl of fat. Therefore, one should not have great expectations from exercise alone STARVATION Though semistarvalion or under nutrition is very common in the developing world or in persons suffering from coma, cancer esophagus or psychological disorders, starvation until death is not so common Short term starvation (hunger strikes), however, is quile common. In the following passages, il will be presumed that the starving person continues to get hi§ water and mineral supply normally. Pathophysiology The glycogen reserve of an average man is only about 400 gm and in complete absence of food, it can supply Ihe calorie needs of the body for only a few hours. So fal mobilization from adipose tissue occurs early and continues until exhaustion Proteins of the body are also mobilized, primarily to supply the energy needs and also to meet various functions of ammo adds. The protein mobilization, called the endogenous breakdown of protein, occurs from the skeletal muscles, gastro intestinal trad and liver primarily but other organs also suffer. Heart muscle is relatively spared Loss of brain tissue is minimal (dealh due to starvation causes only about 5% loss from Ihe brain). As depot fat becomes more and more exhausted, more and more proteins are mobilized. As a result, blood urea (normal value, 20-40) mg/100 ml blood) begins to rise as starvation proceeds The high degree of lip id mobilization produces kelosis . The urine therefore now contains the ketone bodies (acetone, aceloacetc acid, hydroxybutyric acid) and becomes +ve to Rothera's Tesl The water conlent of Ihe body falls sharply Maximum possible duration of starvation is uncertain It obviously depends upon Ihe storage of body fal, and the ability lo combat acidosis and nitrogen retention Terence Mc Swiney, the Mayor of Cork, Ireland, undertook a fas unto death for political reasons in 1920, and died on Ihe 74th day. Acharya Vinoba Bhave, who stopped even water intake, died on the 5th day, and he was over 90 years. 1. Gross anatomy of the kidney. 2. Nephron and its structure. 3. Blood supply of the kidney. 4 Juxtaglomerular apparatus. 5. Juxta medullary nephron. Gross anatomy of the kidney (Fig. 8.1.1.) There are two kidneys,