CEP WK10 - OBESITY

Question 1

WHY PEOPLE DEVELOP OBESITY

Answer 1

• In order to accumulate fat, energy intake > expenditure. Therefore, a lot of treatment options are about eat less, move more (not amazing & just saying eat less move more doesn’t always work as energy intake & energy expenditure aren’t two factors that are always independent so reducing one can reduce the other)
• Increased hunger hormones & reduction in resting energy expenditure so patient gains weight

Question 2

WHAT WE SHOULD DO ABOUT OBESITY

Answer 2

societal change (food environment, addressing stigma), individual treatment (lifestyle & behaviour, drugs, surgery)

Question 3

BMI

Answer 3

• strengths - cheap, quick, no special equipment

- weaknesses - doesn’t differentiate between body fat & muscle (bodybuilders have huge BMI but aren’t obese)

Question 4

INSULIN RESISTANCE

Answer 4

• body must release larger amounts of insulin to achieve same level of glycaemic control
• More insulin resistance = higher risk of hypertension, heart disease, type 2 diabetes

Question 5

REGULATION OF ADIPOSE TISSUE (ROLE OF INSULIN)

Answer 5

pluripotent converted to preadipocyte which needs insulin to differentiate to adipocyte

Question 6

TREATING OBESITY

Answer 6

WEIGHT LOSS - only 5-10% weight loss -> lower risk of type 2, improved BP, improved quality of life (patient picks the weight loss method not us)

Question 7

UNDERLYING CAUSES OF OBESITY

Answer 7

• Genetic – Prader-Willi, convertase-1 deficiency, MC4R deficiency, POMC deficiency
• Hypothalamic – post-radiation therapy, post-surgery, hypothalamic tumour
• Endocrine – Cushing, hypothyroidism, GH deficiency, menopause, hypogonadism
• Medication – antidepressants, antipsychotics, anti-epileptics, B-blockers, insulin
• Mental disorders – depression, binge-eating disorder, bulimia nervosa
• Lifestyle – hypocaloric intake, lack of exercise, alcohol abuse

Question 8

BARRIERS TO ACHIEVE PATIENT AIMS

Answer 8

• Mental – knowledge, expectations, self-image, mood, anxiety, attention, sleep, personality, addiction
• Mechanical – osteoarthritis, pain, hypoventilation, oesophageal reflex
• Metabolic – nutritional deficiencies, insulin resistance, type 2, hypertension
• Monetary – education, employment, low income, disability, surgery

Question 9

EDMONTON OBESITY STAGING SYSTEM

Answer 9

• using it to plan treatment > tracking BMI
• focuses on medical, mental & functional aspects
• has 4 stages which each have descriptions

Question 10

KING’S CRITERIA TO MEASURE SUCCESS IN TREATMENT

Answer 10

staging system which has stages and definitions for each stage & takes into account several criteria (airways, BMI, cardiovascular, diabetes, economic, functional, gonadal)

Question 11

DIETARY INTERVENTIONS

Answer 11

main requirement is total energy intake < expenditure

Question 12

PHYSICAL ACTIVITY

Answer 12

• isn’t important for weight loss but reduces vascular risk

- lower cardiovascular fitness = higher risk of all-cause mortality

Question 13

TYPES OF BARIATRIC SURGEY

Answer 13

• most successful weight loss method in long-term
• increases diabetes remission (drop in severity)
• decreases risk of metabolic diseases e.g. cholesterol, diabetes, hypertension, hypercalcaemia
• bariatric surgery leads to less need for medical treatments