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RB Y2 Endocrine - 1 Diabetes > Aspects of Obesity > Flashcards

Aspects of Obesity Flashcards

1
Q

basal metabolism

A

the obligatory consumption of energy to keep the body functioning at rest

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2
Q

thrifty genotype

A

one that is evolved to live in an evironment where food was not plentiful

enables individuals to efficiently collect and process food to deposit fat during periods of food abundance in order to provide for periods of food shortage

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3
Q

what co-morbidities are there in obesity that are simply related to inreased fat mass

A

OA, back pain, asthma, sleep apnoea

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4
Q

describe the link between diabetes and obesity

A

obese people are resistant to the actions of insulin (more is produced as more is eaten), this causes a compensatory rise in insulin as the pancreas tries to overcome the resistance

eventually the pancreas can no longer keep up, and the patient becomes hyperglycaemic and develops diabetes

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5
Q

obesity and inflammation

A
  • Obesity is a proinflammatory condition in which hypertrophied adipocytes and adipose tissue-resident immune cells both contribute to increased circulating levels of proinflammatory cytokines
  • There is an obesity associated state of chronic low-grade systemic inflammation.
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6
Q

what is the primary function of adipose tissue

A
  • store excess nutrients and release FFA during fasting through ß oxidation
  • also contain various immune cells
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7
Q

what are proteins and peptides secreted by adipocytes called

A

adipokines

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8
Q

name some adipokines

A

leptin, adiponectin, inflammatory mediators

oestrogen, cortisol and FFA

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9
Q

the functions of adipocytes and macrophages in obesity

A

share several overlapping functions (eg secrete cytokines and store fat), although some are quite distinct

in obesity, adipocytes secrete cytokines and macropahges accumulate fat becoming foam cells (found in atheroscerotic plaques)

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10
Q

what happens to the adipokines in obesity

A
  • Adipose tissue from lean individuals preferentially secretes anti-inflammatory adipokines e.g. adiponectin. These mediate physiological functions.
  • In contrast, obese adipose tissue mainly releases proinflammatory cytokines e.g. TNF alpha, angiotensin II. These modulate insulin resistance.
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11
Q

adiponectin

A
  • anti inflammatory cytokine
  • secretion reduced in obestiy
  • It is a protein hormone involved in regulating glucose levels and fatty acid breakdown
  • Reduction of adiponectin is associated with atherosclerosis and dyslipidaemia.
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12
Q

cellular stress in adipocytes

A

the ER in adipocytes cannot cope with the increased metabolic demands due to an expanding fat mass - activates pathways that in the short term cause inflammation

these same pathways in the longer term can lead to insulin resistance (diabetes) and hyperlipidaemia (atherosclerosis)

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13
Q

leptin

A
  • one of the main secretions of adipose tissue
  • Secreted from adipocytes proportionally to fat cell mass
  • Acts on the brain to decrease food intake, increase energy expenditure and influence glucose and lipid metabolism.
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14
Q

leptin in obesity

A

In obese subjects, leptin levels are increased, with little or no impact to regulate energy homeostasis – leptin resistance.

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15
Q

what are the features of high and low leptin

A

high - decreased appetite and increased thermogenesis

low - increased appetite and decreased thermogenesis

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16
Q

why can leptin not be used as an anti obesity drug

A

if one has plenty of fat stores, leptin has a flat dose response curve

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17
Q

what is the mainstay of every weight loss programme

A

diet

many morbidly obese patients have little capacity to exercise

18
Q

hypocaloric diet

A

calories consumed < calories used

19
Q

what is defined as a very low calorie diet

A

<800 calories/day

20
Q

what is the most important determinant of success with dietary interventions

A

compliance

21
Q

Orlistat

A

inhibits lipases to block absorption of dietary fat over a certain level

up to one third of digested fat is excreted into the faeces - steatorrhoea

22
Q

what must Orlistat always be prescribed in the context of

A

hypocaloric diet

23
Q

bariatric definition

A

deals with the causes, treatment and prevention of obesity

24
Q

who is eligible for bariatric surgery

A

BMI >40

BMI >35 with co-morbidities

25
Q

gastric banding

A

purely restrictive

means that the stomach holds less food, one eats less and feels full quicker

it is the simplest surgical operation, but is the most prone to complications eg band slipping, especially when patients lose a lot of weight

26
Q

sleeve gastrectomy

A

also restrictive

significantly reduces capacity in terms of eating

27
Q

gastric bypass

A

both restrictive and malabsorptive

28
Q

what must always be performed post bariatric surgery

A

nutritional assessments

29
Q

what causes more weight loss - conservative treatment or bariatric surgery

A

bariatric surgery

also huge improvements in post op hyperglycaemia

30
Q

resting metabolic rate

A
  • amount of energy expended at rest - minimum energy consumption
  • eg amount of energy required to perform basal functions
31
Q

what contributes to RMR

A

fat and fat free (eg muscle) mass

32
Q

describe the relationship between RMR and weight loss

A
  • RMR is higher in obesity and falls with weight loss - it is the amount of energy required to perform basal functions
  • however, it falls more than one would expect with the weight loss
  • it is as if the body perceives the weight loss as a threat to survival
  • = adaptive thermogenesis acts as a brake on further weight loss
33
Q

with reference to RMR, why is bariatric surgery more effective

A

less adaptive thermogenesis

34
Q

with reference to RMR, why is it harder for some people to lose weight

A

essentially, the lower the RMR, the harder it is to lose weight

people have different RMR

35
Q

define adaptive thermogenesis

A

Adaptive thermogenesis is defined as the decrease in energy expenditure beyond what could be predicted from body weight or its components (fat-free mass and fat mass) under conditions of standardized physical activity in response to a decrease in energy intake.

36
Q

BMI thresholds

A

Underweight: <18.5

Increased risk: 23-27.5

High risk: ≥27.5

37
Q

waist circumference thresholds

A

men≥ 94

women ≥80

38
Q

what are thresholds values for BMI and waist circumference in asian populations

A

lower

39
Q

risk with relative BMI

A
40
Q

definition of weight status in children - centile cut offs

A

RB Y2 Endocrine - 1 Diabetes (16 decks)

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