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Year 2 - BRS > 3.18 - Obesity > Flashcards

3.18 - Obesity Flashcards

1
Q

What is obesity?

A

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

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2
Q

What BMI range is classed as underweight?

A

<18.5 kg/m2

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3
Q

What BMI range is classed as healthy weight?

A

18.5-24.9 kg/m2

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4
Q

What BMI range is classed as overweight?

A

25-29.9 kg/m2

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5
Q

What BMI range is classed as obesity I?

A

30-34.9 kg/m2

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6
Q

What BMI range is classed as obesity II (extremely obese)?

A

35-39.9 kg/m2

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7
Q

What BMI range is classed as obesity III (extremely obese)?

A

40+ kg/m2

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8
Q

What are some issues with using BMI to measure obesity?

A
  • poor for those with high muscle mass
  • set up for white Europeans (healthy BMI may vary between populations)
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9
Q

How much of our chance of being obese is dictated by genes?

And what is an example of a mutation seen?

A

70-80% (obesity can be inherited) e.g. mutation in MC4R gene

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10
Q

Where are the genes that dictate BMI and what do they respond to?

e.g. MC4R mutation

A
  • many genes in hypothalamus
  • regulate food intake
  • respond to signals from periphery (GI hormones)
  • longer term signals from adipose tissue
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11
Q

How has the incidence of obesity changed overall?

A

Obesity has increased rapidly

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12
Q

What drives obesity? (8)

A
  • diet and food industry
  • not living near parks/playgrounds
  • using cars instead of walking
  • increased screen time
  • lower education level and educational achievement
  • poverty
  • social deprivation
  • sedentary lifestyle
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13
Q

What are some obesity and overweight stats (2016)?

A
  • > 1.9 billion adults were overweight
  • of these, >650 million obese
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14
Q

How do genetics and the environment come together in obesity?

A
  • tendency to become obese is heritable but dependent on environment you are in
  • obesogenic environment - people with genetic predisposition are at increased risk of obesity
  • over years, genetic tendency has not changed but the environment has
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15
Q

What comorbidities are associated with obesity? (11)

A
  • depression
  • sleep apnoea
  • stroke
  • MI
  • hypertension
  • diabetes
  • bowel cancer
  • osteoarthritis
  • peripheral vascular disease
  • gout
  • infertility
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16
Q

What do we do if someone comes into the GP with obesity?

A
  • determine degree of overweight/obesity
  • assess lifestyle, comorbidities and willingness to change
  • management - lifestyle changes; drug treatment
  • consider referral to specialist care
  • specialist assessment and management - surgery and follow up
17
Q

What is leptin?

A
  • necessary for normal physiological function
  • acts in feedback loop to brain from adipose tissue
  • signals to brain that we are not starving
18
Q

What does leptin do? (8)

A
  • regulate appetite, control of metabolism and energy homeostasis
  • helps regulate thyroid hormone synthesis
  • decreases glucose-stimulated insulin secretion
  • increased heart rate
  • regulate bone mass
  • regulate menstrual cycle
  • activation of immune cells
  • high BP
19
Q

What happens in leptin deficiency? (5)

A
  • infertility
  • stunted linear growth
  • decreased body temperature
  • decreased energy expenditure
  • decreased immune function
  • (hyperphagia: increased appetite)
20
Q

How do you treat leptin deficiency in children?

A
  • leptin administration
  • reduces appetite and body weight in leptin deficient children
  • restores LH pulsatility - puberty and fertility
21
Q

How can leptin be used in women with amenorrhoea?

A

Restores LH pulsatility in women with amenorrhoea - tells brain that there is increased fat to restore menstruation

22
Q

What is leptin resistance?

And what kind of hormone is leptin?

A
  • absence of leptin –> hyperphagia, lowered energy expenditure, sterility etc
  • leptin is an anti-starvation hormone rather than an anti-obesity hormone
  • presence of leptin is signal to CNS that system has sufficient fat reserves for normal functioning but high leptin has little effect
23
Q

What is the main drug we give to obesity patients?

A
  • Orlistat - derivative of endogenous lipstatin produced by Streptomyces toxytricini
  • gastric and pancreatic lipase inhibitor
  • reduces dietary fat absorption by 30%
24
Q

What is the efficacy, side effects and attrition level of Orlistat?

A
  • reduces weight by 3%
  • side effects - fatty and oily stool, faecal urgency, oily spotting, faecal incontinence in 7%
  • possible deficiencies of fat-soluble vitamins
  • no long-term data on Orlistat on obesity-related morbidity and mortality
  • attrition rates (no. who stop) high - 33%
25
Q

What are the effects of GLP-1?

A
  • reduced appetite, increased satiety
  • increased insulin, decreased glucagon
  • reduced liver fat, inflammation, insulin resistance
  • increased sodium excretion and diuresis
  • increased endothelial function, decreased arterial stiffness and inflammation
  • increased myocardial contractility and ischaemic preconditioning, decreased glucose uptake

Body weight, BP, plasma glucose and plasma lipids decreased

26
Q

What is Liraglutide/Saxenda?

A
  • long-acting glucagon-like peptide-1 receptor agonist
  • daily injection
  • double the dose used for T2DM
  • 4-5% weight loss
27
Q

What levels of BMI do we consider bariatric surgery? (4)

A
  • first line for BMI >50 kg/m2
  • BMI 40 kg/m2 or more
  • BMI 35-40 kg/m2 and other comorbidities
  • BMI 30-35 kg/m2 for newly diagnosed T2DM
28
Q

What are other requirements for bariatric surgery? (4)

A
  • non-surgical measures have failed to achieve/maintain adequate clinically beneficial weight loss for at least 6 months
  • receiving/will receive intense specialist management
  • generally fit for anaesthesia and surgery
  • commit to the need for long-term follow-up
29
Q

What are the three types of bariatric surgery?

A
  • gastric bypass
  • gastric band
  • sleeve gastrectomy
30
Q

What is gastric bypass surgery?

A

Top part of stomach is joined to small intestine, so you feel fuller and do not absorb as many calories from food

31
Q

What is a gastric band?

A

A band is placed around your stomach so you do not need to eat as much to feel full (less effective)

32
Q

What is a sleeve gastrectomy?

A

Some of your stomach is removed, so you cannot eat as much as you could before and you feel full sooner

33
Q

How effective is bariatric surgery?

A

Very effective - you can lose up to 1/4 of body weight through it

34
Q

What is Semaglutide?

A

Long-acting GLP-1 receptor agonist

35
Q

What is Tirzepatide?

A

Long-acting GLP-1 receptor and GIP (glucose-dependent insulinotropic polypeptide) receptor co-agonist

36
Q

What is Cagrilintide?

A

Long-acting amylin analogue given in combination with semaglutide

Semaglutide = long acting GLP-1 agonist

37
Q

What is Retatrutide?

A

Triple agonist of GIP, GLP-1 and glucagon receptors

38
Q

Summary of drugs given for obesity. (4)

A
  • semaglutide (and liraglutide) - long acting GLP-1 receptor agonist
  • tirzepatide - long-acting GLP-1 receptor and GIP agonist
  • cagrilintide - long-acting amylin analogue given in combination with semaglutide
  • retatrutide - triple agonist of GLP-1, GIP and glucagon receptors

Year 2 - BRS (84 decks)

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