3.15 Obesity Flashcards
What is obesity?
A condition of abnormal or excessive fat accumulation in adipose tissue, to the extent that health is impaired
What BMI is overweight?
25-29.9
What BMI is obese?
30+
What is linked to obesity?
genetics access to parks and playgrounds average car use poor diet screen time education level poverty
What comorbidities is obesity linked to? (12)
depression stroke obstructive sleep apnoea myocardial infection hypertension diabetes bowel cancer osteoarthritis peripheral vascular disease gout infertility gallbladder disease
How do we assess and manage obesity in adults?
determine degree of overweight or obesity
assess lifestyle comorbidities and willingness to change
manage lifestyle changes and drug treatments
consider referral to specialist care
specialist assessment and management; surgery and follow up
How do we decide the treatment for obesity?
intervention based on BMI, waist circumference and presence of co-morbidities
When do we consider drugs for treatment of obseity?
Obesity 2 or higher
OR
Co-morbidities present
When do we consider surgery for treatment of obesity?
Obesity level 3
OR
Obesity level 2 with comorbidities
What do we prescribe for obesity that isn’t drugs or surgery?
diet and physical activity
What drugs can we prescribe for treatment of obesity?
Orlistat
What is orlistat?
derivative of endogenous lipstatin produced by Streptomyces toxytrincini
What does orlistat do?
gastric and pancreatic lipase inhibitor
reduced dietary fat absorption by 30%
What are some side effects of orlistat?
fatty stool
faecal urgency
faecal incontinence
possible deficiencies of fat soluble vitamins (A,D,E,K)
When is bariatric surgery a first line treatment?
BMI of >50
What criteria must a patient meet to be eligible for bariatric surgery?
- non-surgical measures have failed to achieve or maintain adequate clinically beneficial weight loss for at least 6 months
- receiving or will receive intensive specialist management
- generally fit for anesthesia and surgery
- commit to the need for long term follow up
What are the 3 types of bariatric surgery?
gastric bypass
gastric band
sleeve gastrectomy
What is gastric bypass?
the top par of the stomach is joined to the small intestine so you feel fuller sooner and do not absorb as many calories from food
What is gastric band?
a band is placed around your stomach so you do not need to eat as much to feel full
under skin pot for adjusting band tightness
What is sleeve gastrectomy?
some of your stomach is removed so you cannot eat as much as before and you’ll feel fuller sooner
What is the most effective bariatric surgery?
gastric bypass
What is the problem with prescribing drugs and lifestyle changes to a patient with obesity?
largely ineffective
Why does genetics play an important role in obesity with the presence of risk factors?
because genetics increase susceptibility to risk factors of obesity
What is the relationship between mortality and BMI?
as BMI increases so does mortality
What is the relationship between comorbidities and obesity?
as obesity increases so does comorbidities
What % of your chance of being obese is based on your genes?
70%
How do genes affect obesity?
Can affects different aspects:
- waist to hip ratio
- BMI
- birth weight
- visceral adiposity
Where is leptin released from?
adipose tissue
enterocytes in the small intestine
What does leptin do?
Acts on hypothalamus to decrease hunger, and increase fullness
What is the main single gene mutation associated with extreme obesity?
Melanocortin 4 receptor mutation affecting the action of leptin
