Diabesity Flashcards
What is the equation for BMI- you must know it!! ?
BMI= weight in Kg / height in meters squared
What causes obesity?
It occurs when energy intake from food and drink consumption is greater than energy expenditure through the body’s metabolism and physical activity over a prolonged period of time. This results in accumulation of excess body fat.
Leads to obesity!!
What’s the main disadvantage of using BMI?
People with a high muscle mass will not receive an accurate BMI measure
This is because muscle is heavier than fat. So weight will be bigger= high BMI (but not necessarily obese!)
It is also not accurate for elderly and pregnant people
What four things is a high waist circumference associated with an increased risk for?
Type 2 diabetes
Dyslipideamia
Hypertension
Cardiovascular disease
Phentermine, fenfluramine and rimonabant are all examples of what?
Drugs used in the past to try and aid waste loss
They are now all withdrawn due to various effects they caused such as addiction, heart problems and psychiatric disorders
Sibutramine
A more recent drug that WAS licensed for treating obesity along with diet and exercise
It’s now been withdrawn from the market due to it being associated with increased cardiovascular events
What’s the main drug used now for weight loss?
Orlistat
Also licensed as an OTC medication (Alli)
How does orlistat work?
It acts peripherally where it inhibits the breakdown of fat
This causes fat to be excreted rather than digested
What are the main two side effects of orlistat?
Steatorrhea (fat in poo)
Impaired absorption of fat-soluble vitamins
Orlistat is now being investigated regarding fears involving _________.
Involving Liver failure
Pharmacological treatment doesn’t seem to work for most people trying to loose weight.
To prevent and treat obesity we must develop approaches to modulate the ways in which the brain controls metabolism, body weight and composition.
Ways we can do this: Diet Exercise Healthy living pharmacies Bariatric surgery
What is leptin?
A circulatory factor involving the control of appetite
It’s a signalling molecule secreted from the adipocyte cell
Where the leptin receptor activity is deficient, it demonstrates that obesity and diabetes (T2) are very closely linked
What type of diabetes is obesity linked to?
Type 2
This is where a person can become diabetic in later life due to poor diet throughout life
Recent studies have identified links between obesity and T2 diabetes involving?
Pro-inflammatory cytokines
Insulin resistance
Deranged fatty acid metabolism
Cellular processes such as mitochondrial dysfunction and endoplasmic reticulum stress
What is type 2 diabetes summed up in a sentence?
A metabolic disorder characterised by high blood glucose in the context of insulin resistance and relative insulin deficiency.
Can you think of some classic symptoms of diabetes?
Polyuria (increased urine)
Polydipsia (increased thirst)
Polyphagia (increased hunger)
Fatigue and weight loss
Type 2 diabetes is where insulin resistance develops so the body cells don’t respond even in the presence of insulin.
Type 1 diabetes is where there is an actual lack of insulin itself, the cells that produce insulin are depleted.
Which is more complex?
Which is easier to treat?
Type 2 is more complex
But type 2 is actually easier to treat, especially in the early years when insulin is often still being produced
Liraglutide is a drug recommended as a third line therapy by NICE for type 2 diabetes.
It is a GLP-1 agonist
What unique effect does it have compared to things like insulin?
It actually causes weight LOSS rather than weight gain
Therefore it’s under trials as an anti-obesity treatment for non diabetics!
What ethnicities does diabetes effect more frequently?
Those of an Asian or African-Caribbean descent
What is dyslipideamia?
Abnormal amount of lipid in the blood
Often due too diet and lifestyle
What Is orlistats trade name OTC?
What about as a POM?
OTC= Alli
POM (given on prescription) = Xenical
What is the dosing of Alli (OTC Orlistat) as this is not in the BNF?
Chewable 27mg tablets TDS
OR 60mg hard capsules TDS (more common)
What is bariatric surgery?
Bariatric surgery (weight loss surgery) includes a variety of procedures performed on people who are obese. Weight loss is achieved by reducing the size of the stomach with a gastric band or through removal of a portion of the stomach
Some benefits of bariatric surgery?
Weight loss after surgery (most patient loose weight rapidly for 18-24 months after)
Obesity related conditions improve
What are the risks of bariatric surgery?
gastric band could burst- causes a lot of pain
Complications eg infections
Gall stones
Absorption of tablets now different as person lost weight, decrease BSA- need to consider different doses
Nerve damage
Decrease in vitamin absorption- watch out for supplements
Dumping syndrome- diahorrea and bloating
What form of tablets should be avoided after bariatric surgery?
Avoid effervescence tablets
To diagnose diabetes, plasma glucose will be over ____ mmol/L, 2 hours after a 75g oral glucose load.
How do we achieve this oral glucose load?
Over 11.1 mmol/L
Can give polycal (liquid sugar) to achieve oral glucose load
To diagnose diabetes, the fasting plasma glucose will be over ___mmol/L
The glycosylated heamoglobin will be over ___%
Over 7 mmol/L
Over 6.5%
Impaired glucose tolerance shows a blood glucose of ____-____ mmol/L
7.9-11mmol/ L
ACR (Albumin creatinine ratio) when to add an ACE inhibitor? Hint: diff for men and women
ACR over 3.5% in females
ACR over 2.5% in males
Add ACEi to reduce pressure on kidneys
BP should be controlled to reduce risk of renal deterioration
Monitor eGFR- if manage to reduce it by 20% the do a benefit vs risk (as ACEi can cause renal damage) of patient being on ACEi- may take them back off it!!
Who can have Bariatric surgery (Hint : BMIs)?
BMI over 40, or over 35+ comorbidities eg diabetes
First line for people with BMI over 50
What are the comorbidities of obesity?
Diabetes Hypertension CV risk High cholesterol Non alcoholic fatty disease MuscoSkeletal problems- can't walk, bed bound
When can Alli be given?
BMI over 28 , 18-75 years old
When can Xenical be given?
BMI 28+ fat related medical condition or BMI over 30, for 18-75 year olds
Need to achieve weight loss of over 5% in three months to keep them on it!!
