**_🧪Endocrinology🧪 - Obesity

Question 1

What is the definition of obesity?

Answer 1

A condition of abnormal or excessive fat accumulation in adipose tissue, to the extent that health is impaired
BMI>30

Question 2

What are the BMI classifications?

Answer 2

Question 3

How stigmatised is obesity?
(not required knowledge, just for context)

Answer 3

Extremely
Esquire magazine polls 1000 women aged 18-25. More than half said they would rather be run over by a truck than be extremely fat. Two-thirds said they would rather be mean or stupid than fat.
15-30% said they would rather walk away from their marriage, give up the possibility of having children, be depressed, or become alcoholic rather than be obese.
Five percent and four percent, respectively, said they would rather lose a limb or be blind than be overweight.

Question 4

What overall factors contribute to obesity?

Answer 4

Genes and environment

Question 5

Which factors where demonstrated to have real life correlations to obesity?

Answer 5

Ability to play outside sees reduced obesity rates
Strong correlations between car usage and obesity
Strong correlation between increasing screen time and obesity
Higher degree of education shows reduced obesity rates
Higher income shows reduced obesity rates
Correlation between deprivation and childhood obesity

Question 6

What are the comorbidities commonly associated with obesity?

Answer 6

Depression, stroke
Sleep apnoea
Myocardial infarction, hypertension, peripheral vascular disease
Diabetes
Bowel cancer
Osteoarthritis, gout

Question 7

What is the pathway for assessing and managing diabetes in adults?

Answer 7

Question 8

How do we treat obesity?

Answer 8

Question 9

What are the signs/symptoms of leptin deficiency?

Answer 9

Infertility
Stunted linear growth
Decreased body temperature
Decreased energy expenditure
Decreased immune function

Question 10

What is leptin?

Answer 10

Leptin regulates appetite and energy balance by signalling the brain to reduce food intake and increase energy expenditure, but in obesity and T2DM, leptin resistance impairs this function.

Question 11

What is the effect of leptin administration in leptin deficient children?

Answer 11

Body weight decreases in leptin deficient children receiving recombinant leptin therapy
Also restores LH pulsatility

Question 12

How can leptin help women with amenorrhoea?

Answer 12

Leptin administration restores LH pulsatility in women with amenorrhea

Question 13

What effects does leptin resistance/deficiency have?

Answer 13

Hyperphagia
Lowered energy expenditure
Sterility

Question 14

How does orlistat help treat obesity?

Answer 14

Gastric and pancreatic lipase inhibitor
Reduces dietary fat absorption by around 30%

Question 15

How does GLP-1 treat obesity?

Answer 15

Decreases body weight and blood pressure, as well as plasma glucose/lipids
Increases satiety/decreases appetite

Question 16

How does Liraglutide/Saxenda help treat obesity?

Answer 16

Long-acting glucagon-like peptide-1 receptor agonist from Novo Nordisk.
Daily injection.
Double the dose used for T2DM.
4-5% weight loss

Question 17

When should bariatric surgery be used to aid with obesity?

Answer 17

BMI of 40 kg/m2 or more
BMI of 35-40 kg/m2 and other co-morbidities
BMI of 30-34.9 kg/m2 for newly diagnosed T2DM
(assuming: – 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 anaesthesia and surgery
– commit to the need for long-term follow-up)
Consider surgery as a first-line option for adults with a BMI >50 kg/m2

Question 18

What are the common types of bariatric surgery?

Answer 18

Gastric bypass
Gastric band
Sleeve gastrectomy

Question 19

What is gastric bypass surgery?

Answer 19

The top part of your stomach is joined to the small intestine, so you feel fullersooner and do not absorb as many calories from food

Question 20

What is gastric band surgery?

Answer 20

A band is placed around your stomach, so you do not need to eat as much to feel full

Question 21

What is a sleeve gastrectomy?

Answer 21

Some of your stomach is removed,soyou cannot eat as much as you could before and you’ll feelfull sooner

Question 22

How effective is bariatric surgery?

Answer 22

All highly effective
Gastric bypass most effective, followed by sleeve gastrectomy and then banding

Question 23

What is semaglutide?

Answer 23

Long-acting glucagon-like peptide-1 (GLP-1) receptor agonist

Question 24

What is tirzepatide?

Answer 24

Long-acting glucagon-like peptide-1 (GLP-1) receptor and glucose-dependent insulinotropic Polypeptide (GIP) receptor co-agonist

Question 25

What is cagrilintide?

Answer 25

Long-acting amylin analogue given in combination with semaglutide

Question 26

What is retatrutide?

Answer 26

Triple agonist of the glucose-dependent insulinotropic polypeptide, glucagon-like peptide 1, and glucagon receptors