Obesity

Question 1

BMI = []

greater than [] = obese.

greater than [] = morbidly obese.

Good corelation between body fat and BMI accept for a few outliers - eg. []

Answer 1

BMI = weight / height2

greater than 30 = obese.

greater than 40 = morbidly obese.

Good corelation between body fat and BMI accept for a few outliers - eg. weightlifters / preganant

Question 2

How do excess lipids cause intracellular lipotoxicity? [2]

Answer 2

Lipotoxicity - lipids and their metabolites create oxidant stress to the endoplasmic reticulum and mitochondria.

Question 3

Normal state: fatty acids are stored as [] within [] to protect against toxicity (would otherwise circulate freely leading to [])

Answer 3

Normal state – fatty acids are stored as triaclyglycerol within adipocytes to protect against toxicity (would otherwise circulate freely leading to oxidative stress)

Question 4

Explain MoA of how obesity causes harm via inflammation?

Answer 4

Obesity is state of chronic low-level inflammation in response to excess nutrients

In liver, brain, pancreas and adipose tissue

Immune cells are abundant in adipose tissue and obesity-induced activation of their inflammatory response causes changes in their number and activity = inflammation and dysregulated immune system

Why you get cancers and ID

Question 5

Explain MoA of Obesity and impact of gut microbiome

Answer 5

obesity is associated with profound microbial changes

Studies transplanting lean faecal microbiota into obese individuals have demonstrated improved insulin sensitivity and microbial diversity

Question 6

Name 4 diseases that increased risk of mortality bc of obesity [4]

Answer 6

CVD
Cancers
CKDs
DM

Question 7

The organs affected by obesity can be broadly grouped into three classes:[]

Answer 7

The organs affected by obesity can be broadly grouped into three classes: metabolic, mechanical, and mental

Question 8

Obesity and comorbidities:

Name 4 impacts of metabolic & CV diseases because of obesity

Answer 8

T2DM
HTN
Lipids (adverse lipid profiling: high LDLs)
Heart failure

Question 9

Obesity and comorbidities:

Name 4 impacts of immunity because of obesity

Answer 9

Obesity induces a dysregulated immune system which can be seen from childhood.

Increased susceptibility to range of infections:
* surgical-site
* urinary tract
* nosocomial
* skin

Impaired response to vaccines

Evidence linking obesity with:
* Rheumatoid arthritis
* Multiple Sclerosis
* Psoriasis and Psoriatric Arthritis

Question 10

Obesity and comorbidities:

Name 4 impacts of hepatology because of obesity

Answer 10

Causes:

• Non-alcoholic fatty liver disease (NAFLD) -commonest cause of CLD (25-30%)
• One-third progress to NASH - liver inflammation and injury, which can lead to cirrhosis and hepatocellular carcinoma.
• NAFLD =hepatic manifestation of metabolic syndrome

Question 11

Obesity and comorbidities:

Name 5 impacts of GI because of obesity

Answer 11

Gall bladder disease –even moderate weight gain increases risk

Rapid weight loss increases the risk of gallstone formation

Pancreatitis –poor prognostic factor

GORD

Barrett’s oesophagus

Oesophageal adenocarcinoma

Question 12

Increased BMI has what impact on risk of cancer? [1]

Answer 12

Increases!

Question 13

What is the impact of obesity on COVID ptx? [1]

Name 2 proposal for how could cause ^? [2]

Answer 13

Obesity increases the risk of worse outcome from COVID-19

Proposed to be a consequence of metabolic impairment of organ functioning, leading to insulin resistance

Central fat accumulation could contribute to the increased risk

Question 14

Pathophysiology of Visceral Fat

Question 15

Visceral Fat Measurement in Practice:

healthy central adiposity: waist-to-height ratio [] to [], indicating no increased health risks

increased central adiposity: waist-to-height ratio [] to [], indicating increased health risks

high central adiposity: waist-to-height ratio [] or more, indicating further increased health risks.

Answer 15

Visceral Fat Measurement in Practice:

healthy central adiposity: waist-to-height ratio 0.4 to 0.49, indicating no increased health risks

increased central adiposity: waist-to-height ratio 0.5 to 0.59 indicating increased health risks

high central adiposity: waist-to-height ratio 0.6 or more, indicating further increased health risks

Question 16

FYI

Answer 16

Weight gain increases severity of obstructive sleep apnoea

Question 17

What are treatments for obesity? [3]

Answer 17

• Build foundation of diet and exercise
• Drug treatment: orlistat
• Bariatric surgery: for individuals BMI greater than 40 kg / m2. When all else has failed

Question 18

What needs to be identified if having surgery treat obesity? [1]

Answer 18

If have sleep apnea

Question 19

The physiological responses to weight loss promote weight gain.

Explain why

Answer 19

The physiological responses to weight loss promote weight regain

After losing weight, the body responds with a variety of compensatory mechanisms, including changes in the secretion of hormones from the gut, pancreas, and adipose tissue which results in an increase in hunger and desire to eat