ENDOCRINOLOGY - OBESITY Flashcards
What is obesity?
An abnormal or excessive accumulation of fat which may impair health
Outline how we use BMI to classify obesity?
Normal weight 18.5-24.9
Overweight 25-29.9
Class 1 obesity - 30-34.9
Class 2 obesity - 35-39.9
Class 3 obesity - >40
What are the pros and cons of using BMI to classify obesity?
Advantages - easy low cost
Disadvantages - does not account for muscle, cut off points don’t distinguish between male/female nor race
What percentage of the Uk are overweight or obese?
Over 63%
What is an obesogenic environment?
offers ready access to high-calorie foods but limits opportunities for physical activity.
Whats the most commonly implicated gene in obesity?
MC4R and leptin gene
What medications most commonly cause weight gain?
Oral hypoglycaemic agents - sulfonylureas and glitazones
Antidepressants - tricyclics, mirtazapine, MAO inhibition, SSRI inhibitors
Antipsychotics
Anticonvulsants - siduym valproate, gabapentin and vigabatrin
Corticosteroids
Beta blockers
What medical conditions can cause weight gain?
Hypothyroidism
Cushing syndrome
GH deficiency
Polycystic ovary syndrome
Hypothalamic damage
Menopause
What are the consequences of obesity?
type 2 diabetes
high blood pressure
high cholesterol and atherosclerosis which can lead to coronary heart disease and stroke
asthma
metabolic syndrome - a combination of diabetes, high blood pressure and obesity
several types of cancer, including bowel cancer, breast cancer and womb cancer
gastro-oesophageal reflux disease (GORD)
gallstones
reduced fertility
osteoarthritis
sleep apnoea
liver disease and kidney disease
pregnancy complications
Whats a realistic target for weight loss?
0.5-1kg per week
Who should you offer drug treatment for managing obesity to?
those overweight with comorbidities
those obese with comobidities
obese stage 2 without comorbidities
Who should you offer surgery to for treating obesity?
anyone stage 2 obesity with comorbidities or obese stage 3 without comorbidities.
How much exercise should be encouraged for those overweight/with obesity?
Adults should be encouraged to do 30 minutes of moderate intensity activity on at least 5 days a week. (45-60 of moderate intestinty every day if they do not want yo reduce their energy intake)
For those who have been obese and lost weight, 60-90 minutes per day are advised to avoid relapse.
What pharmacotherapy can you offer for obesity?
Orlistat
Liraglutide
What is orlistat moa?
lipase inhibitor which acts by reducing the absorption of dietary fat, preventing absorption of around 30% of dietary fat
What are the side effects of orlistat?
GI side efefcts
Anxiety
Who should you give orlistat to?
adults who have a BMI of 28 or more with associated risk factors or a BMI of over 30
Continue orlistat therapy beyond 3 months only if the person has lost at least 5% of their initial body weight since starting
What are the contraindications of orlistat?
cholestasis, chronic malabsorption syndrome
Whats the moa of Liraglutide?
‣ A GLP-1 receptor agonist which increases insulin secretion, suppresses glucagon secretin, and slows gastric emptying.
What are the contraindications of Liraglutide?
diabetic gastroparesis, IBD
Whats the inclusion criteria for bariatric surgery?
hose with a BMI over 40 or a BMI 30-35 with other significant disease. All appropriate non-surgical measures have to have been tried without sufficient effect. The person has to be deemed fit for anaesthesia and surgery, have to be under intensive management of a specialist service and they need to commit to the need for long-term follow up (at least 2 years)
◦ It can also be used for adults with a BMI of more than 50 when other interventions have not been effective
What are the main types of bariatric surgery?
Adjustable gastric band
Vertical sleeve gastrectomy
Roux-en Y gastric bypass
Intra-gastric balloon
Biliopancreatic diversion
Primary obesity surgery endolumena
What is an intra-gastric balloon?
a soft balloon filled with air or salt water that’s placed into your stomach using a thin tube passed down your throat (known as a gastroscopy).
This means you will not need or be able to eat as much before you feel full. But it’s only a temporary measure and the balloon is usually left in for a maximum of 6 months.
What is a primary obesity surgery endolumena?
surgeon then passes tiny tools through the endoscope, which are used to gather your stomach into folds to make it smaller.
Primary obesity surgery endolumena is not currently available on the NHS so you will have to pay for this treatment.
