Endo - Obesity

Question 1

What is obesity?

Answer 1

condition of abnormal or excessive fat accumulation in adipose tissue, to the extent that health is impaired

Question 2

What BMI is considered obese?

Answer 2

> 30 kg/m^2

Question 3

Why is BMI inaccurate?

Answer 3

doesn’t factor in:
→ ethnicity
→ muscle : fat ratio
→ gender

Question 4

How can you drive down obesity / BMI?

Answer 4

more exercise and/or less food

Question 5

What can influence risk of obesity?

Answer 5

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

Question 6

What comorbidities is obesity associated with?

Answer 6

→ depression
→ stroke
→ sleep apnoea
→ myocardial infarctions
→ hypertension
→ diabetes
→ bowel cancer
→ osteoarthritis
→ peripheral vascular disease
→ gout
→ aggravated arthritis
→ infertility
→

Question 7

How do you assess + manage adults?

Answer 7

→ determine degree of overweight or obesity
→ assess lifestyle, comorbidities + willingness to change
→ management involves lifestyle changes + drug treatments

Question 8

What factors are considered when deciding treatment for obesity?

Answer 8

→ BMI classification
→ waist circumference
→ presence of co-morbidities

Question 9

What is the treatment for those overweight with a low waist circumference?

Answer 9

general advice about healthy weight + lifestyle

Question 10

What is the advice for those who are overweight and have a high / very high waist circumference?

Answer 10

diet + physical activity

Question 11

What is the advice for those who are Obese I and with any waist circumference?

Answer 11

diet + physical activity

Question 12

What is the advice for those who are Obese II and with any waist circumference?

Answer 12

→ diet + physical activity

→ consider drugs

Question 13

What is the advice for those who are Obese III and with any waist circumference?

Answer 13

→ diet + physical activity
→ consider drugs
→ consider surgery

Question 14

What is the advice for those who are overweight / Obese I with co-morbidities present?

Answer 14

→ diet + physical activity

→ consider drugs

Question 15

What is the advice for those who are Obese II / Obese III with co-morbidities present?

Answer 15

→ diet + physical activity
→ consider drugs
→ consider surgery

Question 16

What drugs can be used to treat obesity?

Answer 16

Orlistat

Question 17

How does Orlistat help with obesity?

Answer 17

→ Derivative of an endogenous lipstatin produced by Streptomyces toxytricini
→ Gastric and pancreatic lipase inhibitor
→ Reduces dietary fat absorption by around 30%

Question 18

What are the stats behind orlistat?

Answer 18

→ 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

Question 19

What surgery is considered for obesity?

Answer 19

bariatric surgery

Question 20

Who is surgery considered for?

Answer 20

→ 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

Question 21

What are the different types of bariatric surgery?

Answer 21

→ gastric bypass
→ gastric band
→ sleeve gastrectomy

Question 22

What is a gastric bypass?

Answer 22

→ top part of your stomach is joined to the small intestine so → feel fullersooner + do not absorb as many calories

Question 23

What is a gastric band?

Answer 23

→ band is placed around your stomach

→ do not need to eat as much to feel full

Question 24

What is a sleeve gastrectomy?

Answer 24

→ some of your stomach is removed

→ you cannot eat as much as you could before and you’ll feelfull sooner