Diabesity

Question 0

What is the equation for BMI- you must know it!! ?

Answer 0

BMI= weight in Kg / height in meters squared

Question 1

What causes obesity?

Answer 1

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!!

Question 2

What’s the main disadvantage of using BMI?

Answer 2

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

Question 3

What four things is a high waist circumference associated with an increased risk for?

Answer 3

Type 2 diabetes
Dyslipideamia
Hypertension
Cardiovascular disease

Question 4

Phentermine, fenfluramine and rimonabant are all examples of what?

Answer 4

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They are now all withdrawn due to various effects they caused such as addiction, heart problems and psychiatric disorders

Question 5

Sibutramine

Answer 5

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It’s now been withdrawn from the market due to it being associated with increased cardiovascular events

Question 6

What’s the main drug used now for weight loss?

Answer 6

Orlistat

Also licensed as an OTC medication (Alli)

Question 7

How does orlistat work?

Answer 7

It acts peripherally where it inhibits the breakdown of fat

This causes fat to be excreted rather than digested

Question 8

What are the main two side effects of orlistat?

Answer 8

Steatorrhea (fat in poo)

Impaired absorption of fat-soluble vitamins

Question 9

Orlistat is now being investigated regarding fears involving _________.

Answer 9

Involving Liver failure

Question 10

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.

Answer 10

Ways we can do this:
Diet 
Exercise
Healthy living pharmacies 
Bariatric surgery

Question 11

What is leptin?

Answer 11

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

Question 12

What type of diabetes is obesity linked to?

Answer 12

Type 2

This is where a person can become diabetic in later life due to poor diet throughout life

Question 13

Recent studies have identified links between obesity and T2 diabetes involving?

Answer 13

Pro-inflammatory cytokines
Insulin resistance
Deranged fatty acid metabolism
Cellular processes such as mitochondrial dysfunction and endoplasmic reticulum stress

Question 14

What is type 2 diabetes summed up in a sentence?

Answer 14

A metabolic disorder characterised by high blood glucose in the context of insulin resistance and relative insulin deficiency.

Question 15

Can you think of some classic symptoms of diabetes?

Answer 15

Polyuria (increased urine)
Polydipsia (increased thirst)
Polyphagia (increased hunger)
Fatigue and weight loss

Question 16

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?

Answer 16

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

Question 17

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?

Answer 17

It actually causes weight LOSS rather than weight gain

Therefore it’s under trials as an anti-obesity treatment for non diabetics!

Question 18

What ethnicities does diabetes effect more frequently?

Answer 18

Those of an Asian or African-Caribbean descent

Question 19

What is dyslipideamia?

Answer 19

Abnormal amount of lipid in the blood

Often due too diet and lifestyle

Question 20

What Is orlistats trade name OTC?

What about as a POM?

Answer 20

OTC= Alli

POM (given on prescription) = Xenical

Question 21

What is the dosing of Alli (OTC Orlistat) as this is not in the BNF?

Answer 21

Chewable 27mg tablets TDS

OR 60mg hard capsules TDS (more common)

Question 22

What is bariatric surgery?

Answer 22

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

Question 23

Some benefits of bariatric surgery?

Answer 23

Weight loss after surgery (most patient loose weight rapidly for 18-24 months after)
Obesity related conditions improve

Question 24

What are the risks of bariatric surgery?

Answer 24

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

Question 25

What form of tablets should be avoided after bariatric surgery?

Answer 25

Avoid effervescence tablets

Question 26

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?

Answer 26

Over 11.1 mmol/L

Can give polycal (liquid sugar) to achieve oral glucose load

Question 27

To diagnose diabetes, the fasting plasma glucose will be over ___mmol/L
The glycosylated heamoglobin will be over ___%

Answer 27

Over 7 mmol/L

Over 6.5%

Question 28

Impaired glucose tolerance shows a blood glucose of ____-____ mmol/L

Answer 28

7.9-11mmol/ L

Question 29

ACR (Albumin creatinine ratio) when to add an ACE inhibitor? Hint: diff for men and women 

Answer 29

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!!

Question 30

Who can have Bariatric surgery (Hint : BMIs)?

Answer 30

BMI over 40, or over 35+ comorbidities eg diabetes

First line for people with BMI over 50

Question 31

What are the comorbidities of obesity?

Answer 31

Diabetes
Hypertension
CV risk
High cholesterol 
Non alcoholic fatty disease
MuscoSkeletal problems- can't walk, bed bound

Question 32

When can Alli be given?

Answer 32

BMI over 28 , 18-75 years old

Question 33

When can Xenical be given?

Answer 33

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!!