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Life Maintenance > Consequences of obesity > Flashcards

Consequences of obesity Flashcards

1
Q

What are the main ways of assessing obesity?

A 
BMI
WHR
WHH (waist: height)
waist circumference
hydrodensitometry 
dual energy x-ray absorptiometry
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2
Q

What are the benefits of using BMI to assess obesity?

A

correlates significantly with body fat, morbidity and mortality

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3
Q

What are the main categories of weight classification by BMI?

A

Underweight < 18.5

Normal 18.5 – 24.9

Overweight 25.0– 29.9
Obesity_1 30.0- 34.9
Severely obese 35.0-29.9
Morbidly obese >40

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4
Q

What is defined as being SUPER OBESE?

A

BMI >50

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5
Q

What are the complications associated with being super obese?

A
  • osteoarthritis
  • cardiopulmonary failure
  • metabolic syndrome (DM, NASH, HTN, hyperlipidaemia)
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6
Q

Are there specific Rx to combat the complications of superobesity?

A

No

Metabolic syndrome improves with 5-10% weight loss

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7
Q

What are the main causes of obesity?

A
  • nutrient and energy imbalance
  • genetics
  • behavioural and culture factors
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8
Q

What are the main contributors to weight gain?

A
  • socio-economic status
  • smoking cessation
  • hormonal
  • inactivity
  • psychosocial/emotions
  • medications
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9
Q

What can the increasing prevalence of obesity over past 20-30 years be attributed to?

A 
Reduced resting metabolic rate
Reduced muscle mass
Increased fat mass
Increased accumulation of abdominal
adipose tissue
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10
Q

What 3 process are dysregulated in obesity?

A

energy intake
adipose tissue formation
energy expenditure

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11
Q

What are the main complications of obesity?

A 
Hypertension
Stroke
Diabetes mellitus, Type 2
Metabolic syndrome
CV mortality
Cancer – endometrium, breast, prostate, and colon.
Gallbladder disease
Osteoarthritis
Respiratory diseases and sleep-apnea
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12
Q

What are the 2 main types of body patterns observed in obesity?

A

APPLE SHAPED

  • intra-abdominal or visceral
  • visceral fat deposition

PEAR SHAPED

  • lower body or external type
  • subcutaneous fat deposition

both are linked to elevated levels of FFAs

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13
Q

What is the nature of adipocytes found in the visceral depots?

A
  • large insulin-resistant adipocytes
  • increased adrenergic receptors
  • catecholamine mediated lipolysis

inverse correlation between visceral fat % and insulin sensitivity

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14
Q

What is the nature of adipocytes found in the subcutaneous depots?

A
  • small insulin-sensitive adipocytes

- reduced adrenergic receptors

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15
Q

What is the insulin resistance syndrome?

A

= physiologic response is inadequate for the amount of insulin secreted

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16
Q

What are other names for metabolic syndrome?

A
  • syndrome X
  • dysmetabolic syndrome
  • insulin resistance syndrome
17
Q

What are the main components of insulin resistance?

A
  • complex dyslipidaemia
  • endothelial dysfunction
  • systemic inflammation
  • atherosclerosis
  • disordered fibrinolysis
  • hypertension
  • T2DM
  • visceral obesity
18
Q

When is dysmetabolic syndrome thought to occur?

A

When insulin resistance results in atherosclerosis

19
Q

What are clinical manifestations of insulin resistance syndrome?

A 
Central obesity
Glucose intolerance
Atherosclerosis
Hypertension
Polycystic ovary syndrome
20
Q

What are the biochemical abnormalities of insulin resistance?

A

Insulin resistance
Hyperinsulinemia

High TG
Low HDL-C
Small, dense LDL

Increased PAI-1

21
Q

How does hyperglycaemia and hyperinsulinaemia result in hypertension?

A

Activation of the sympathetic nervous system
Increase of arterial tone
Na+ reabsorption

22
Q

How does hyperglycaemia and hyperinsulinaemia result in T2DM?

A

Overstimulation of pancreatic -cell function

Reduction of insulin secretion

23
Q

What is the correlation between high BMI and BP?

A

70% in men
60% women

association between excess adiposity and hypertension

24
Q

What 3 metabolic mechanisms promote hypertension in obesity?

A

INCREASED

  • vasconstriction
  • cardiac output
  • sodium reabsorption
25
Q

What are the mechanisms by which obesity influences cancer risk?

A
  • sex steroid hormone synthesis (oestrogen, androgen)
  • reduced insulin sensitivity and increased production of IGFs
  • action of leptin + adiponectin on adipose tissue
  • increased oxidative stress
  • increased chronic low-grade inflammation
26
Q

Which cancers are obese people most at risk of?

A

MALES: oesophageal adenocarcinoma, thyroid, colon, renal

FEMALES: endometrium, gallbladder, oesophageal adenocarcinoma, renal

27
Q

Which cancers do obesity reduce the survival from?

A
  • breast
  • colon
  • endometrium
  • ovary
  • prostate
28
Q

What are the main risk factors for sleep apnoea?

A 
Family history
Obesity: 80 % of sleep apnea patients
Increasing age
Male gender
Large tonsils / adenoids
Small mandible, large neck
Smoking, alcohol, sedatives
29
Q

What are the consequences of sleep apnoea?

A 
Social / Psychological: work, family
Personal: fatigue, tired, depression, irritability, impotence, memory
More accidents: work home motor vehicle
Higher death rates with severe apnea
Hypertension, Congestive Heart Failure
Heart Attacks, Strokes, A Fib
Promotes obesity and diabetes
30
Q

What is NAFLD?

A

Non-Alcoholic fatty liver disease

spectrum of pathology
- ranging from fatty liver to cirrhosis

31
Q

When is drug therapy for obesity considered?

A

consider when
BMI > 30
or
BMI > 27 with comorbid illness

32
Q

What drugs can be used to treat obesity?

A
  • sibutramine (appetite suppressant)
  • orlistat (lipase inhibitor)
  • Rimonabant
  • Incretins (slows gastric emptying)
33
Q

What are the benefits of using orlistat?

A
  • useful as adjunct in weight loss
  • improved glycaemic control
  • reduced serum lipid levels
  • reduced BP

used in conjunction with metformin for T2DM

34
Q

What are the incretins?

A

GI hormones released post-prandially, that stimulate GSIS

GLP1: effective
GIP: not effective in GSIS

35
Q

What are the physiological effects of GLP-1?

A
  • GSIS
  • reduced gluconeogenesis
  • cardioprotective
  • increased satiety
  • reduced gastric emptying
  • improves insulin sensitivity
36
Q

What is an example of SGLT2i?

A

dapafliflozin

inhibits SGLT2 in the PCT

37
Q

How does amylin in the exocrine pancreas aid insulin?

A
  • effectively slowing doen intestinal absorption of glucose

- suppresses GCG

38
Q

What is the goal of gastric bypass surgery?

A

achieve and maintain a healthier body weight

most weight loss occurs in first 6 months post-surgery

then gradual loss in 18-24 months

Data suggest that if weight loss has been maintained for 5 years, there is a > 95% likelihood that the patient will keep the weight off over the long term.

Life Maintenance (25 decks)

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