Appetite

Question 1

Obesity is…

Answer 1

BMI > 30

Question 2

In the UK/USA prevalence of obesity has…

Answer 2

tripled in the past two decades

>60% of adult population

Question 3

Worldwide prevalence…

Answer 3

400million obese and 1.6 billion overweight

>40 million children

Question 4

Problems with obesity are…

Answer 4

increased risk of type 2 diabetes
cardiovascular disease
certain cancers
Alzheimer's disease 
premature mortality

Question 5

Economic costs of obesity are…

Answer 5

2-3% total NHS spend = £47 billion p.a.

Question 6

Morbid obesity is…

Answer 6

BMI of 40-50

Question 7

Super obesity is…

Answer 7

BMI 50+

Question 8

Why do we defend well against weight loss but not weight gain?

Answer 8

Ancestors had scarce food sources and active lifestyles, opposite of us today

Question 9

Prophylaxis (prevention)

Answer 9

education, earlier the better

Question 10

What are the treatments?

Adan (2013)

Answer 10

Diet and exercise
CBT
Bariatric surgery
pharmacology

Question 11

What are the issues with diet and exercise?

Answer 11

Compliance or efficacy issues

Question 12

What are the issues with CBT?

Answer 12

Mass delivery problems

Question 13

What are the issues with Bariatric surgery?

Answer 13

Has complications but remains effective

Question 14

What psychostimulants were used in the 40s/60s?

Answer 14

amphetamines, phentermine, diethylpropion and mazindol

Question 15

When was MDMA presented as an appetite suppressant?

Answer 15

1914

Question 16

What were the problems with amphetamines as a treatment?

Answer 16

sleep problems, cardiovascular problems and abuse potential

Question 17

What serotonin releasers were used as treatment in 70s/80s?

Answer 17

dl-fenfluramine, d-fenfluramine

Question 18

What problems were associated with serotonin releasers as treatment?

Answer 18

pulmonary hypertension and cardiovascular toxicity

Question 19

What combination of psychostimulant and serotonin releaser was used in the 1990s?

Answer 19

phentermine and fenfluramine (phen-fen)

Question 20

What problems were associated with the use of phen-fen?

Answer 20

valvulopathy

Question 21

What are the three treatments licensed for long term obesity?

Answer 21

Orlistat (Xenical)
Sibutramine (Reductil)
Rimonabant (Acomplia)

Question 22

Orlistat is…

Answer 22

a pancreatic lipase inibitor reducing fat absorption through the gut

Question 23

Problems with Orlistat are…

Answer 23

only cause 5-10% weight loss
unpleasant GI side effects
only effective in high fat diets

Question 24

Sibutramine is…

Answer 24

a dual NA and 5-HT reuptake inhibitor

Question 25

Sibutramine works by...

Answer 25

appetite suppression increasing thermogenesis enhancing efficacy of dieting/exercise

Question 26

Sibutramine's side effects are...

Answer 26

``` insomnia nausea constipation tachycardia hypertension stroke ```

Question 27

Rimonabant is the new kid on the block and...

Answer 27

Is a cannabinid CB1 receptor antagonist/inverse agonist

Question 28

Rimonabant works by...

Answer 28

suppressing appetite and weight gain

Question 29

RImonabant's side effects are...

Answer 29

increased anxiety depression suicidal ideation

Question 30

in 2008 the European Medicines Evaluations Agency withdrew the license for...

Answer 30

Rimonabant for psychiatric risk concerns

Question 31

in 2010 EMEA suspended the licence for...

Answer 31

Sibutramine after cardiovascular risks

Question 32

What is a nutrient-regulated appetite?

Answer 32

feeding initiated by nutrient depletion and terminated by replenishment

Question 33

What are the origins of nutrient-regulated appetite?

Answer 33

``` Ancient Greece (one nutrient hypothesis) C19 - 3 primary nutrients ```

Question 34

What were the 3 primary nutrients in the 19C?

Answer 34

saccharine (carbs) oleosa (triglycerides) albuminosa (protein)

Question 35

What are the components of set point theories from the 1950s?

Answer 35

All operate on the negative feedback principle, comprising; set point mechanism detector mechanism effector mehanism

Question 36

What are the four set point theories?

Answer 36

``` Thermostatic theory (Brobeck, 1948) Adipostatic theory (Kennedy, 1953) Glucostatic theory (Mayer, 1955) Aminostatic theory (Mellinkoff, 1956) ```

Question 37

What are the flaws of set point theories?

Answer 37

Should avoid deficits not respond to them no role for sociocultural factors location of three components? CNS must be important

Question 38

What does Stellar's (1950) dual centre theory state?

Answer 38

Lateral hypothalamus is the hunger centre ventromedial hypothalamus is the satiety centre activity is activated by circulating glucose and lipids

Question 39

What elements of the hypothalamus do we know are important?

Answer 39

PVN, DMN and arcuate (ARC) nuclei, all form connections with LH and VMH to regulate homeostasis

Question 40

What is the role of the ARC?

Answer 40

regulate hypothalamic and extra-hypothalamic areas by a host of peripheral feedback signals

Question 41

What neuropeptide systems are involved in appetite regulation?

Answer 41

``` Neuropeptide Y system (NPY) (stimulation) Melanocortin systen (αMSH) (inhibition) ```

Question 42

Where do NPY and αMSH originate from?

Answer 42

arcuate nucleus

Question 43

NPY acts mainly via...

Answer 43

Y1 and Y5 receptors

Question 44

αMSH acts mainly via...

Answer 44

MC3R and MC4R receptors

Question 45

What follows feeding behaviour?

Answer 45

metabolic and body temperature changes (Secor, 2009) cardiovascular function renal function HPA activity

Question 46

The changes following feeding behaviour are known as...

Answer 46

the behavioural satiety sequence

Question 47

In mammals feeding is a discontinuous process so drugs may work by...

Answer 47

increasing non feeing behaviours