L11 - Appetite and weight Flashcards

1
Q

How to measure obesity?

A
BMI 
Waist circumference 
skin-fold thickness 
ethnicity specific cut offs
bioelectrical impedance analysis
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2
Q

Medical consequences of obesity

A
metabolic syndrome/T2D
cardiovascular  disease
respiratory disease
liver disease
cancer
reproductive dysfunction 
joint problems 
more likely to have co morbidities
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3
Q

metabolic syndrome

A
visceral obesity - central 
dyslipidemia 
hyperglycemia
hypertension 
Insulin resistance is the underlying patho mechanism
BMI more than 30
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4
Q

Patho of metabolic syndrome and insulin resistance

A
inc free fatty acids 
lipolysis of visceral fat 
gluconeogenesis 
dyslipidemia 
proinflammatory cytokines 
TNFa and IL6 lead to increase insulin resistance
reduced expression of glut4 
reduced tyrosine kinase activity of insulin receptor
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5
Q

Respiratory problems

A

obstructive sleep apnoea
hypoxia
pulmonary hypertension - right heart failure

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6
Q

effects on GI / Liver

A
non-alcoholic fatty liver 
non-alcoholic steatohepatitis 
may progress to cirrhosis, portal hypertension, hepatocellular cancer 
gallstones 
reflux
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7
Q

cancer and obesity

A

breast, endometrial, oesphagus, colon, gall bladder, renal, thyroid
mechanisms include increased insulin, increased oestrogen, increased free IGF1

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8
Q

reproductive system and obesity

A

Polycystic ovarian syndrome
male hypogonadism
adverse pregnancy outcomes

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9
Q

Joint problems and obesity

A

osteoarthiritis

gout

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10
Q

Psychological problems and obesity

A

eating disorders

depression

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11
Q

Genetic causes

A

Rare; prader-willi syndrome
Bardet-Biedl

Common - polgenic
susceptibility genes

other causes: hypothyroidism
cushings syndrome

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12
Q

Environmental causes of obesity

A
diet - high fat/sugar 
socioeconomic factors 
physical activity 
car ownership 
tv viewing
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13
Q

Fetal programming and obesity

A

Programming’: stimuli / insults at critical periods have persistent biological effects
Mechanism: epigenetic modification of gene expression

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14
Q

Gut microbiome and obesity

A

Differences in gut bacteria
Can be induced by diet e.g. high fat diet
Transplantation of faecal material alters insulin sensitivity

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15
Q

Regulating appetite and weight

A

slow acting hormones that regulate body weight are
LEPTIN
INSULIN
signals % body fat to the hypothalamus to reduce food intake or increase energy expenditure
Rapid acting peptides that regulate meal sizes
Ghrelin encourages eating whilst CCK reduces eating
PYY reduces eating
they are released from GI tract
THESE SIGNAL BACK TO HYPOTHALAMUS WHERE THERE ARE ACCELERATOR NEURONS (NPY/AgRP neurons) WHICH STIMULATE EATING
BRAKE NEURONS - POMC NEURONS INHIBIT EATING

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16
Q

Treatment

A
diet 
exercise 
30 mins moderate - high intensity or 60 mins low intensity 
target 10,000 steps a day
increased 500 step increments 
VLCD

orlistat - binds and inhibits lipases in the lumen of the gut
prevents hydrolysis of dietry fat into absorbable free Fatty acids /glycerol

Metformin
best first line for overweight/obese pts with T2D

17
Q

what are the adverse effects of orlistat?

A

flatulence
oily faecal leakage diarrhoea
reduced absorption fat soluble vitamins
ADEK supplements

18
Q

surgical treatment

A

laparoscopic adjustable banding

19
Q

Roux-en-Y gastric bypass

A

alteration in gut hormones and bile acid flow contributes to weight loss
micronutrient deficiencies - supplement with iron, vit D, B12 folate calcium
Dumping syndrome - GI/Vasomotor symptoms