Aspects of obesity

Question 1

Why is it important/worrying that obesity is so prevalent ?

Answer 1

• It is associated with increased risk for lots of health problems
• These co-morbidities put a huge burden on the NHS

Question 2

What does leptin do ?

Answer 2

• Tells your body how fat you are. If you don’t have leptin or leptin receptors then your brain thinks you are starving and acts accordingly.
• BUT if you have plentiful fat stored, leptin doesn’t do the opposite, once fat stores reach a certain level leptin affects level out

Question 3

What is the only drug avaliable in the UK to treat obesity ?

Answer 3

Orlistat

Question 4

What is the overall idea of dietary strategies in obesity treatment ?

Answer 4

'’Hypocaloric’’ meaning that the number of calories you eat must be less than the number you use up

Question 5

Describe the action of orlistat

Answer 5

• Inhibits lipases which blocks absorption of dietary fats.
• Resulting in up to 1/3rd of ingested fat to be excreted into faeces

Question 6

What are the bariatric surgery options to treat obesity ?

Answer 6

Procedure is considered either restrictive or malabsorptive, or both

1. Adjustable gastric band - purely restrictive
2. Gastric bypass - restrictive and malabsorptive
3. Verticle sleeve gastroectomy - restrictive

Question 7

What is the most effective long-term solution for obesity ?

Answer 7

Bariatric surgery - but this is very invasive

Question 8

Define resting metabolic rate (RMR)

Answer 8

It is the amount of energy expended at rest i.e. the minimum energy expenditure

Question 9

Why is it difficult to maintain weight loss ?

Answer 9

Because your RMR is higher in obesity but as you loose weight your RMR falls therefore using up less energy, making it harder to lose weight and easier to put it back on

Question 10

What is it called when RMR decreases with weight loss ?

Answer 10

Adaptive thermogenesis

Question 11

Describe the treatment pathway of obesity

Answer 11

1st line - diet plus physical activity

2nd line - If they are showing weight loss but not meeting target weight and BMI is ≥ 28 with associated risk factors or BMI is ≥ 30 then can give orlistat

3rd line - if 1st and 2nd line don’t work and BMI ≥ 40 or BMI ≥ 35 with associated risk factors then can do bariatic surgery (need to demonstrate 5% weight loss in the past 6-12 months to get it)