Endo - Obesity Flashcards
What is obesity?
condition of abnormal or excessive fat accumulation in adipose tissue, to the extent that health is impaired
What BMI is considered obese?
> 30 kg/m^2
Why is BMI inaccurate?
doesn’t factor in:
→ ethnicity
→ muscle : fat ratio
→ gender
How can you drive down obesity / BMI?
more exercise and/or less food
What can influence risk of obesity?
genetics
→ identical twins + non-identical twins put in a study to see if different lifestyles affects their BMI
→ 60-70% of chances of being obese based on genetics
education
→ high education + academic success = more likely to be
→ obese
→ poverty
→ social deprivation
What comorbidities is obesity associated with?
→ depression → stroke → sleep apnoea → myocardial infarctions → hypertension → diabetes → bowel cancer → osteoarthritis → peripheral vascular disease → gout → aggravated arthritis → infertility →
How do you assess + manage adults?
→ determine degree of overweight or obesity
→ assess lifestyle, comorbidities + willingness to change
→ management involves lifestyle changes + drug treatments
What factors are considered when deciding treatment for obesity?
→ BMI classification
→ waist circumference
→ presence of co-morbidities
What is the treatment for those overweight with a low waist circumference?
general advice about healthy weight + lifestyle
What is the advice for those who are overweight and have a high / very high waist circumference?
diet + physical activity
What is the advice for those who are Obese I and with any waist circumference?
diet + physical activity
What is the advice for those who are Obese II and with any waist circumference?
→ diet + physical activity
→ consider drugs
What is the advice for those who are Obese III and with any waist circumference?
→ diet + physical activity
→ consider drugs
→ consider surgery
What is the advice for those who are overweight / Obese I with co-morbidities present?
→ diet + physical activity
→ consider drugs
What is the advice for those who are Obese II / Obese III with co-morbidities present?
→ diet + physical activity
→ consider drugs
→ consider surgery
What drugs can be used to treat obesity?
Orlistat
How does Orlistat help with obesity?
→ Derivative of an endogenous lipstatin produced by Streptomyces toxytricini
→ Gastric and pancreatic lipase inhibitor
→ Reduces dietary fat absorption by around 30%
What are the stats behind orlistat?
→ Meta-analysis of 11 placebo-controlled trials of 1 year in 6021 overweight or obese patients, orlistat reduced weight by 2·9%.
→ Attrition rates were high ~33%.
→ Fatty and oily stool, faecal urgency, oily spotting, faecal incontinence in 7%
→ Possible deficiencies of fat-soluble vitamins
→ No long-term data on orlistat on obesity-related morbidity and mortality
What surgery is considered for obesity?
bariatric surgery
Who is surgery considered for?
→ first line for BMI >50
→ BMI of 40 kg/m2 or more
→ BMI of 35-40 kg/m2 and other co-morbidities
→ BMI of 30-34.9 kg/m2 for newly diagnosed T2DM
non-surgical measures have failed to achieve or maintain adequate clinically beneficial weight loss for at least 6 months
→ receiving or will receive intensive specialist management
→ generally fit for anaesthesia and surgery
→ commit to the need for long-term follow-up
What are the different types of bariatric surgery?
→ gastric bypass
→ gastric band
→ sleeve gastrectomy
What is a gastric bypass?
→ top part of your stomach is joined to the small intestine so → feel fullersooner + do not absorb as many calories
What is a gastric band?
→ band is placed around your stomach
→ do not need to eat as much to feel full
What is a sleeve gastrectomy?
→ some of your stomach is removed
→ you cannot eat as much as you could before and you’ll feelfull sooner
