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.
Which bariatric surgery has the quickest results?
Gastric bypass or sleeve gastrectomy
Which bariatric surgeries have the highest risks?
Gastric bypass or sleev gastrectomy
Which bariatric surgeries are reversible?
Gastric bands
Whats the function of leptin?
Produced by adipose tissue and acts on satiety centres in the hypothalamus to decrease appetite
Leptin stimulates the release of melanocyte-stimulating hormone and CRH
Whats the function of ghrelin?
Produced by P/D1 cells lining the fungus of the stomach and epsilon cells of the pancreas
It stimulates hunger
What is metabolic syndrome?
Any 3 of…
Waist circumference >102cm men and >88cm women
HDL cholesterol <1 in men and <1.3 in women
Triglycerides >= 17
Bp >= 130/85
Fasting plasma glucose >=6.6
What is sleep apnea?
Irregular breathing patterns, shallow breathing and snoring during sleep
What are the risk factors for sleep apnea?
More common in males
Incidence increases with age
Having one of the following: obesity or overweight, treatment-resistant hypertension, type 2 diabetes, cardiac arrythmia, stroke or TIA, chronic heart failure, asthma, polycystic ovary syndrome, Down’s syndrome, non-arteritic anterior ischaemic optic neuropathy, hypothyroidism, acromegaly.
What is central sleep apnoea?
A sudden failure of the brain’s respiratory centres generation of spontaneous breathing efforts
The damage to brain respiratory centres increases the respiratory drive which causes hyperventilation which leads to hypocapnoea. This causes a period of apnoea in an effort to increase CO2 and this becomes hypercapnia which increases respiratory drive, causing hyperventilation again
What is obstructive sleep apnoea?
Intermittent airway obstruction which wakes the individual from sleep
What can cause obstructive sleep apnoea?
Obesity
Hypertrophic adenoid glands/palatine tonsils
Micrognathia (underbite)
Sedatives (alcohol or sleeping pills)
Allergies
Hypothyroidism
What are the signs and symptoms of sleep apnea?
Sleep deprivation
Headache
Difficulty concentration
Morning headaches
Nocturia, stress-induced insomnia and nocturnal angina chest pain - central sleep apnoea
Loud snoring, hypoapnoea, repeated arousals from sleep and decreased libido - obstructive sleep apnoea
How can you diagnose sleep apnoea?
Polysomnography - monitoring sleep brain movement, oxygen and carbon dioxide levels, vital signs, snoring and movement
How do you treat sleep apnoea?
Medications to stimulate resp drive e.g. acetazolamide and theophylline
Surgery for obstructive sleep apnea e.g. removing tonsils
Continuous positive airway pressure
Supplemental oxygen during sleep
Weight loss
Custom mouth pieces
What are the DVLA rules for driving if you have sleep apnoea?
You need to notify the DVLA and stop driving if you have mild obstructive sleep apnoea syndrome (i.e. you have excessive sleepiness)
