🧪Endocrinology🧪 - Obesity Flashcards
What is the definition of obesity?
A condition of abnormal or excessive fat accumulation in adipose tissue, to the extent that health is impaired
BMI>30
What are the BMI classifications?
How stigmatised is obesity?
(not required knowledge, just for context)
Extremely
Esquire magazine polls 1000 women aged 18-25. More than half said they would rather be run over by a truck than be extremely fat. Two-thirds said they would rather be mean or stupid than fat.
15-30% said they would rather walk away from their marriage, give up the possibility of having children, be depressed, or become alcoholic rather than be obese.
Five percent and four percent, respectively, said they would rather lose a limb or be blind than be overweight.
What overall factors contribute to obesity?
Genes and environment
Which factors where demonstrated to have real life correlations to obesity?
Ability to play outside sees reduced obesity rates
Strong correlations between car usage and obesity
Strong correlation between increasing screen time and obesity
Higher degree of education shows reduced obesity rates
Higher income shows reduced obesity rates
Correlation between deprivation and childhood obesity
What are the comorbidities commonly associated with obesity?
Depression, stroke
Sleep apnoea
Myocardial infarction, hypertension, peripheral vascular disease
Diabetes
Bowel cancer
Osteoarthritis, gout
What is the pathway for assessing and managing diabetes in adults?
How do we treat obesity?
What are the signs/symptoms of leptin deficiency?
Infertility
Stunted linear growth
Decreased body temperature
Decreased energy expenditure
Decreased immune function
What is leptin?
Leptin regulates appetite and energy balance by signalling the brain to reduce food intake and increase energy expenditure, but in obesity and T2DM, leptin resistance impairs this function.
What is the effect of leptin administration in leptin deficient children?
Body weight decreases in leptin deficient children receiving recombinant leptin therapy
Also restores LH pulsatility
How can leptin help women with amenorrhoea?
Leptin administration restores LH pulsatility in women with amenorrhea
What effects does leptin resistance/deficiency have?
Hyperphagia
Lowered energy expenditure
Sterility
How does orlistat help treat obesity?
Gastric and pancreatic lipase inhibitor
Reduces dietary fat absorption by around 30%
How does GLP-1 treat obesity?
Decreases body weight and blood pressure, as well as plasma glucose/lipids
Increases satiety/decreases appetite
How does Liraglutide/Saxenda help treat obesity?
Long-acting glucagon-like peptide-1 receptor agonist from Novo Nordisk.
Daily injection.
Double the dose used for T2DM.
4-5% weight loss
When should bariatric surgery be used to aid with obesity?
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
(assuming: – 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)
Consider surgery as a first-line option for adults with a BMI >50 kg/m2
What are the common types of bariatric surgery?
Gastric bypass
Gastric band
Sleeve gastrectomy
What is gastric bypass surgery?
The top part of your stomach is joined to the small intestine, so you feel fullersooner and do not absorb as many calories from food
What is gastric band surgery?
A band is placed around your stomach, so you do not need to eat as much to feel full
What is a sleeve gastrectomy?
Some of your stomach is removed,soyou cannot eat as much as you could before and you’ll feelfull sooner
How effective is bariatric surgery?
All highly effective
Gastric bypass most effective, followed by sleeve gastrectomy and then banding
What is semaglutide?
Long-acting glucagon-like peptide-1 (GLP-1) receptor agonist
What is tirzepatide?
Long-acting glucagon-like peptide-1 (GLP-1) receptor and glucose-dependent insulinotropic Polypeptide (GIP) receptor co-agonist
What is cagrilintide?
Long-acting amylin analogue given in combination with semaglutide
What is retatrutide?
Triple agonist of the glucose-dependent insulinotropic polypeptide, glucagon-like peptide 1, and glucagon receptors
