1b Obesity Flashcards
What is obesity?
A condition of abnormal or excessive fat accumulation in adipose tissue, due to the extent that health is impaired
What is the BMI range for obesity?
BMI > 30
How do you calculate BMI?
weiht in kg / height in m squared
What factors are not taken to account in BMI calculations that can make the result misleading?
Body muscle
Body fat percentage
Body fat distribution
Different demographics
What are some factors which can influence obesity?
Environment
Genetics
Ability to play outside
Car use
Screen time
Education Level
Educational achievement
Poverty
Social Deprivation
What are the co-morbitidies associated with obesity?
Stroke
Depression
MI
Sleep apnoea
Bowel cancer
Diabetes
Hypertension
OA
Gout
What single gene mutation is most likely to cause obesity?
Melanocortin 4 receptor genes
What is leptin resistance?
In some obese people,the brain does not respond to leptin, so they keep eating despite adequate (or excessive) fat stores, a concept known as ‘leptin resistance’
This causes the fat cells to produce even more leptin.
Describe the symptoms associated with leptin deficiency?
Infertility
Stunted growth
Decreased body temperature
Decreased energy expenditure
Decreased immune function
The body thinks it is in a starving state, and therefore does not waste energy on other body functions as listed above
Describe the physiological functions of leptin?
Helps regulate thyroid hormone synthesis
Increases heart rate
Decreases glucose-stimulated insulin release
regulates bone mass
regulates the menstrual cycle
Activates immune cells
INcreases blood pressure
Regulates appetite and controls metabolism
Describe the effects seen when children with leptin deficiency receive recombinant leptin therapy?
Body weight reduction
Describe the effects of leptin therapy on LH and FSH secretion?
Restores the pulsatile secretion patterns
What is leptin?
An anti-starvation hormone
What does the presence of leptin suggest to the brain?
Signal that the system has sufficient fat reserves for normal functioning but HIGH LEPTIN HAS LITTLE EFFECT
What drug can you use as a treatment for obesity?
ORLISTAT
What is Orlistat?
Derivative of an endogenous lipstatin produced by Streptomyces toxytricini
Gastric and pancreatic lipase inhibitor therefore it stops fat digestion directly in turn reducing absorption
What type of drug is Liraglutide / Saxenda?
Long acting glucagon like peptide-1 receptor agonist - daily injection
What other gut hormone can be targetted in the treatment of diabetes?
GLP-1
What are the three conditions in which you should consider Bariatric Surgery?
- BMI of 40>
- BMI of 35-50 and other co-morbidities
- BMI or 30-35 for newly diagnosed T2DM
What are the three types of Bariatric Surgery?
- Gastric Bypass
- Gastric Band
- Sleeve gastrectomy
What does a gastric bypass involve?
Top part of the stomach is joined to the small intestine so you feel fuller sooner and do not absorb as many calories
What is a gastric band surgery?
Band placed around the stomach so you do not need to eat as much to feel full
What is a sleeve gastrectomy?
Some of the stomach is removed so cannot eat as much
What is Tirzepatide?
Long acting glucagon like peptide 1 receptor and glucose dependant insulinotrophic polypeptide receptor co-agonist
Which type of bariatric surgery has the most effect on weight change?
Gastric Bypass - long term as well
List the things you need to check before a patient can have bariatric surgery.
Non-surgical measures have failed to achieve or maintainadequate clinically beneficial weight loss for at least 6 months
Receiving or will receive intensive specialist management
Generally fit for anaesthesia and surgery
Commit to the need for long-term follow-up.
