obesity Flashcards
people with severe obesity over 40-45 BMI are likely to develop what two things
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
do cancers link with obesity if so what ones
yes 13 cancers
bowel, kidney, ovarian and liver
what cancers linked to brca1 gene
breast cancer and ovarian cancer. They also increase a man’s chance of developing male breast cancer and prostate cancer.
for sustainable weight loss what is the recommended calorie deficit
5-600kcal
what is orlistat
lipase inhibitor
Moa of orlistat
reduces absorption of calories from fat
but also fat bound vitamin D,A,E,K
other liscensend treatment is GLP-1 agonist
what tier is drug therapy commenced
tier 3
side effects of orlistat
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
referral criteria for bariatric surgery
BMI over 40
BMI over 35 with co-morbities icnluding hypertension, T2DM , sleep apnoea, cardio disease, OA and dyslipidemia ( abnormal fat)
what is an adjustable gastric band
adv
dis
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
gastric sleeve
requires massive surgery to remove part of the stomach
gastric balloon
inflates in the stomach and least invasive and makes you feel full - only used for 6 months
gastric bypass is the gold standard what is it
RYGB vs SLGB
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
Name the 2 major types of bariatric surgery that are available in the UK, and list any other available procedures.
Gastric Sleeve
Gastric Bypass
Others: gastric band now more likely done privately, on exceptional need balloon (can only be used for 6 months
Which type of Bariatric Surgery is classed as the “Gold
Standard”?
Gastric Bypass (specifically Roux-En-Y Gastric Bypass)
Which hormones and metabolic markers are affected by weight loss surgery directly or indirectly by weight loss?
Appetite hormones (GLP-1, PYY, inflammatory cytokines, lipid levels, glucose levels, liver hormones)
Do ghrelin levels change post bariatric surgery?
Increases in adjusted gastric banding but may be reduced after gastric bypass
What is the effect of PYY and its changes with surgery?
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.
can leptin be used as a marker of weight loss
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
What is the influence of GLP-1 on the pancreas?
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)
Why does RYGB increase GLP-1 levels?
RYGB may allow faster arrival of nutrients into the hindgut, which then
Does hepatic or peripheral insulin sensitivity improve first and
why?
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
How long after surgery does an improvement in peripheral
insulin sensitivity occur?
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
