obesity

Question 1

people with severe obesity over 40-45 BMI are likely to develop what two things

Answer 1

T2DM

Obstructive sleep apnea occurs when the muscles that support the soft tissues in your throat, such as your tongue and soft palate, temporarily relax. When these muscles relax, your airway is narrowed or closed, and breathing is momentarily cut off

Question 2

do cancers link with obesity if so what ones

Answer 2

yes 13 cancers

bowel, kidney, ovarian and liver

Question 3

what cancers linked to brca1 gene

Answer 3

breast cancer and ovarian cancer. They also increase a man’s chance of developing male breast cancer and prostate cancer.

Question 4

for sustainable weight loss what is the recommended calorie deficit

Answer 4

5-600kcal

Question 5

what is orlistat

Answer 5

lipase inhibitor

Question 6

Moa of orlistat

Answer 6

reduces absorption of calories from fat
but also fat bound vitamin D,A,E,K

other liscensend treatment is GLP-1 agonist

Question 7

what tier is drug therapy commenced

Answer 7

tier 3

Question 8

side effects of orlistat

Answer 8

flatulence 
oily discharge from the rectum 
oily, fatty or liquid stools 
passing stools more often than usual 
Stomach pain and discomfort 
sudden urge to pass stools 
distension of the stomach 
faecal incontinence 
Rectal pain and discomfort
 lower blood sugar

Question 9

referral criteria for bariatric surgery

Answer 9

BMI over 40
BMI over 35 with co-morbities icnluding hypertension, T2DM , sleep apnoea, cardio disease, OA and dyslipidemia ( abnormal fat)

Question 10

what is an adjustable gastric band
adv
dis

Answer 10

its reversible and less invasive as round stomach creating two portions

needs more aftercare and less weight loss, band slippage and erosion and need to be replaced after year

Question 11

gastric sleeve

Answer 11

requires massive surgery to remove part of the stomach

Question 12

gastric balloon

Answer 12

inflates in the stomach and least invasive and makes you feel full - only used for 6 months

Question 13

gastric bypass is the gold standard what is it

RYGB vs SLGB

Answer 13

causes malabsorption and restriction

loads of weight loss
more effective than diabetes remission

not reversible and more vitamin deficiencies and higher operative risk with sepsis and anatomic leaks

basically cuts out the lower stomach and liver and bile addition and part of intestines

Question 14

Name the 2 major types of bariatric surgery that are available in the UK, and list any other available procedures.

Answer 14

Gastric Sleeve
Gastric Bypass
Others: gastric band now more likely done privately, on exceptional need balloon (can only be used for 6 months

Question 15

Which type of Bariatric Surgery is classed as the “Gold

Standard”?

Answer 15

Gastric Bypass (specifically Roux-En-Y Gastric Bypass)

Question 16

Which hormones and metabolic markers are affected by weight loss surgery directly or indirectly by weight loss?

Answer 16

Appetite hormones (GLP-1, PYY, inflammatory cytokines, lipid levels, glucose levels, liver hormones)

Question 17

Do ghrelin levels change post bariatric surgery?

Answer 17

Increases in adjusted gastric banding but may be reduced after gastric bypass

Question 18

What is the effect of PYY and its changes with surgery?

Answer 18

Stimulates satiety (anorexigenic)
Gastric Bypass surgery via the hindgut hypothesis may affect PYY by faster transit of nutrients to the ileum/ colon which causes increased release of PYY
Inducing satiety.

Question 19

can leptin be used as a marker of weight loss

Answer 19

Yes, Leptin levels decrease over-time dependent on loss of adipose tissue but is less sensitive to dieting/ short term changes
Leptin resistance may continue

Question 20

What is the influence of GLP-1 on the pancreas?

Answer 20

stimulates insulin secretion by the pancreas, increases the insulin
sensitivity of pancreatic cells, inhibition of glucagon secretion. GLP-1
has also been shown to influence β cell mass by stimulating β cell
proliferation. GLP-1 analogues are used in the treatment of diabetes and obesity (together, e.g. ‘diabesity’ and separately for obesity- see both NICE guidelines)

Question 21

Why does RYGB increase GLP-1 levels?

Answer 21

RYGB may allow faster arrival of nutrients into the hindgut, which then

Question 22

Does hepatic or peripheral insulin sensitivity improve first and
why?

Answer 22

This is the confusing part! Hepatic insulin sensitivity improves first;
Seen at 48hours post surgery – this is brought about by relative caloric
restriction due to a negative energy balance immediately post surgery.
The mechanisms are still not understood. However, the increased hepatic sensitivity in relation to hyperinsulinaemia (brought on by peripheral insulin
resistance seen in T2DM) causes reduced gluconeogenesis and
glycogenolysis within the liver. Equally peripheral insulin resistance reduces with time, in part due to reduced adipose tissue inflammation

Question 23

How long after surgery does an improvement in peripheral

insulin sensitivity occur?

Answer 23

Demand in insulin reduce immediately after surgery (in part due to calorie restriction) and usually continue till nadir or weight loss seen at 12-18 months post-surgery. Antihyperglycamic medication/insulin treatment may need to be gradually re-introduced after being closely monitored after surgery