case 6 - overview of obesity Flashcards
what is healthy BMI
18.5-24.9 is healthy weight
what is overweight BMI
25-29.9 is overweight
what is obesity II BMI
30-39.9 is obesity II
what is obesity III BMI
40+ is obesity III
what are the low and high risk waist circumferences and when are they considered
considered in adults with a BMI less than 35
Men <94cm is low risk, 94-102 is high risk and >102cm is very high risk
Women <80cm is low risk, 80-88cm is high risk, >88cm is very high risk
what are centile charts
are used to measure for obesity in children
what are the caveats with BMI
muscular people: overestimated
South Asian population: higher risk
Older people: lower risk
Children have special charts
what did NICE state about BMI
that it is not a direct measurement of adiposity but it is a practical measure of adiposity in adults
what is gynaecoid
lower fat obesity
- pear shaped
- encouraged by oestrogen and progesterone
- less health risk than upper body obesity
however, after menopause, naturally an upper body obesity appears
what is andrioid
upper fat obesity
- apple shaped
- associated with heart disease and type 2 DM
- abdominal fat is released right into the liver
- this kind of fat is encouraged by testosterone and excessive alcohol
what are the key differences in male and female obesity
Obesity of the male (android) type shows a dominant visceral and upper thoracic distribution of adipose tissue, whereas in the feminine (gynecoid) type adipose tissue is found predominantly in the lower part of the body (hips and thighs).
Android obesity is clearly a cardiovascular risk factor, more so than gynecoid obesity. Hereditary factors contribute significantly to the occurrence of this pathology in families, although environmental factors play a role in its development.
Android obesity is associated with metabolic anomalies which also characterize the syndrome X: resistance to insulin, arterial hypertension and dyslipidemia.
what does the predisposition of individuals with android obesity to become diabetic rest on
rests in part on genetic and in part on environmental factors
what are two determining factors for type II diabetes
Hyperinsulinemia and a high flux of free fatty acids act at the level of liver and endocrine pancreas to increase resistance to insulin and to decrease insulin secretion, two determining factors for type II diabetes.
what are the facts of obesity globally
Globally, obesity nearly tripled since 1975
>1.9 billion adults are overweight
13% of the worlds population of adults are obese
38 million children under 5 are overweight or obese
>340 million children and adolescents overweight and obese
what are the statistics on obesity in england 2020
63% UK adults are overweight or obese
67% of men and 60% of women were classed as overweight or obese
Lowest levels in London, highest levels in north east and west midlands
711,000 hospital admissions with obesity as primary or secondary diagnosis in UK
15% increased from 2016/17
what are the physical health consequences of being overweight and obese
raised BMI significantly increases risk of non-communicable diseases
CVD, diabetes, MSK disorders, some cancers, respiratory problems, reproductive function, hypertension
Children who are obese can experience breathing difficulties, hypertension, insulin resistance
as BMI increases, risk increases
what are the psychological consequences of being overweight and obese
weight stigma (including among HCPs)
Anxiety and depression
Shame and guilt
what is tier one in behaviour change
Tier 1: universal interventions
prevention and reinforcement of health eating and physical activity
Population level e.g media, campaigns, sugar tax
what is tier two on behaviour change
Tier 2: behavioural interventions
prevention and reinforcement of health eating and physical activity including behaviour change conversations
Community level e.g primary care, schools
what is tier 3 on behaviour change
Tier 3: specialist services
non-surgical intensive management by MDT for individuals living with obesity and complex needs
Specialist weight management service
what is tier 4 on behaviour change
Tier 4: surgery
surgical and non-surgical bariatric surgery supported for MDT for individuals living with morbid obesity
Bariatric surgery
what skill do we use for conversations about behaviour change
motivational interview skills (OARS)
what is orlistat and what is the MoA
is a lipase inhibitor, reducing the absorption of dietary fat. It works by inhibiting gastric and pancreatic lipase, which break down triglycerides in the intestine
The triglycerides therefore do not break down to fatty acids, to be absorbed into the blood stream
They are then excreted into the faeces
abdominal pain and diarrhoea are common this may be minimised by reduced fat intake
what is liraglutide (Saxenda) and what is its MoA
It is a GLP-1 agonist
GLP-1 hormone has different roles, one being to regulate appetite
GLP-1 is released when food is ingested
The GLP-1 travels to and works at the hypothalamus
Saxenda is a GLP-1 analogue, and works by interacting with neurones involved in the regulation of appetite in the hypothalamus.
This decreases the feeling of hunger, causing patients to eat less and thus lose weight.
when should saxenda be offered
in tier 3 weight management clinics
what complications make you eligible for bariatric surgery
- BMI of 35 and other medical complications makes you eligible for bariatric surgery
- As well as just a BMI of 40
- Asian people with BMI of 30 plus diabetes is eligible
