3.15 Obesity

Question 1

What is obesity?

Answer 1

A condition of abnormal or excessive fat accumulation in adipose tissue, to the extent that health is impaired

Question 2

What BMI is overweight?

Answer 2

25-29.9

Question 3

What BMI is obese?

Answer 3

30+

Question 4

What is linked to obesity?

Answer 4

genetics
access to parks and playgrounds
average car use
poor diet
screen time
education level
poverty

Question 5

What comorbidities is obesity linked to? (12)

Answer 5

depression
stroke
obstructive sleep apnoea
myocardial infection
hypertension
diabetes
bowel cancer
osteoarthritis
peripheral vascular disease
gout
infertility 
gallbladder disease

Question 6

How do we assess and manage obesity in adults?

Answer 6

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

Question 7

How do we decide the treatment for obesity?

Answer 7

intervention based on BMI, waist circumference and presence of co-morbidities

Question 8

When do we consider drugs for treatment of obseity?

Answer 8

Obesity 2 or higher
OR
Co-morbidities present

Question 9

When do we consider surgery for treatment of obesity?

Answer 9

Obesity level 3
OR
Obesity level 2 with comorbidities

Question 10

What do we prescribe for obesity that isn’t drugs or surgery?

Answer 10

diet and physical activity

Question 11

What drugs can we prescribe for treatment of obesity?

Answer 11

Orlistat

Question 12

What is orlistat?

Answer 12

derivative of endogenous lipstatin produced by Streptomyces toxytrincini

Question 13

What does orlistat do?

Answer 13

gastric and pancreatic lipase inhibitor

reduced dietary fat absorption by 30%

Question 14

What are some side effects of orlistat?

Answer 14

fatty stool
faecal urgency
faecal incontinence
possible deficiencies of fat soluble vitamins (A,D,E,K)

Question 15

When is bariatric surgery a first line treatment?

Answer 15

BMI of >50

Question 16

What criteria must a patient meet to be eligible for bariatric surgery?

Answer 16

• 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

Question 17

What are the 3 types of bariatric surgery?

Answer 17

gastric bypass
gastric band
sleeve gastrectomy

Question 18

What is gastric bypass?

Answer 18

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

Question 19

What is gastric band?

Answer 19

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

Question 20

What is sleeve gastrectomy?

Answer 20

some of your stomach is removed so you cannot eat as much as before and you’ll feel fuller sooner

Question 21

What is the most effective bariatric surgery?

Answer 21

gastric bypass

Question 22

What is the problem with prescribing drugs and lifestyle changes to a patient with obesity?

Answer 22

largely ineffective

Question 23

Why does genetics play an important role in obesity with the presence of risk factors?

Answer 23

because genetics increase susceptibility to risk factors of obesity

Question 24

What is the relationship between mortality and BMI?

Answer 24

as BMI increases so does mortality

Question 25

What is the relationship between comorbidities and obesity?

Answer 25

as obesity increases so does comorbidities

Question 26

What % of your chance of being obese is based on your genes?

Answer 26

70%

Question 27

How do genes affect obesity?

Answer 27

Can affects different aspects:

• waist to hip ratio
• BMI
• birth weight
• visceral adiposity

Question 28

Where is leptin released from?

Answer 28

adipose tissue

enterocytes in the small intestine

Question 29

What does leptin do?

Answer 29

Acts on hypothalamus to decrease hunger, and increase fullness

Question 30

What is the main single gene mutation associated with extreme obesity?

Answer 30

Melanocortin 4 receptor mutation affecting the action of leptin