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Endocrinology > Obesity > Flashcards

Obesity Flashcards

1
Q

What is obesity?

A

“A condition of abnormal or excessive fat accumulation in adipose tissue, to the extent that health is impaired.”

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2
Q

What is a normal BMI vs Obese BMI?

A

18.5-24.9= NORMAL
30-34.9= OBESE

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3
Q

What are some issues with using BMI to diagnose obesity?

A
  • Does not deal with/ consider muscle
  • Very rough estimate
  • Does not paint the whole picture: context is important (not just BMI alone)
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4
Q

What causes obesity?

A
  • Obesity is genetic (genes contribute 60/80% of the cause)
  • Leptin resistance (makes us feel hungry) can cause uncontrolled eating (which can lead to an increase in weight)
  • Increased food intake
  • Lack of physical activity
  • Sleep disturbance
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5
Q

Describe the prevalence of obesity

A
  • Incidence has increased rapidly
  • In 2016:
    >1.9 billion adults were overweight. Of these, >650 million were obese.
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6
Q

What drives obesity?

A
  • Increased fast food chains
  • Decreased ability to play outside
  • Increased car use
  • Screen time
  • Lower education leveks
  • Poverty
  • Social deprivation
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7
Q

What comorbidities are associated with obesity?

A
  • Depression
  • Stroke
  • Sleep apnoea
  • Bowel cancer
  • Osteroarthritis
  • Gout
  • Peripheral vascular disease
  • Diabetes
  • Hypertension
  • Myocardial infarction
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8
Q

In which diseases, in obesity a risk factor?

A
  1. Type II
  2. Cardiovascular diseases
  3. Cancer
  4. Gallbladder disease
  5. Obstructive sleep apnoea
  6. Aggravated arthritis
  7. Gout
  8. Infertility
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9
Q

What affect does BMI have on mortality?

A

Mortality increases with increased BMI

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10
Q

How is obesity assessed/ managed?

A
  1. Determine degree of overweight or obesity
  2. Assess lifestyle, comorbidities and willingness to change
  3. Management: lifestyle changes; drug treatment AND/ OR consider referral to specialist care
  4. Specialist assessment and management; surgery and follow up
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11
Q

What are the consequences of a Leptin deficiency?

A

Infertility. (decreases LH/FSH levels, amenorrhea)
Stunted linear growth.
Decreased body temperature.
Decreased energy expenditure.
Decreased immune function.

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12
Q

Why does a leptin deficiency have a negative impact ?

A
  • Brain is no longer stimulated; brain thinks you have no fat
  • Switches off menstrual cycle (can’t support pregnancy if body is starved)
  • Preserves energy; retains fat
  • More prone to eating “dry” food, e.g. frozen food
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13
Q

How is obesity treated?

A
  • Diet changes (can be difficult to maintain: sometimes dieting can make the hypothalamus think it is being “starved”; retains more weight)
  • Recombinant Leptin therapy (increase leptin to reduce appetite and body weight)
  • Orlistat (drug)- not very effective; too many side effects usually affect GI, no evidence of long- term effects
  • GLP-1 (can decrease apetite, increase insulin, decreases plasma glucose/ lipids)
  • Liraglutide/ Saxenda (drugs)- again GI side effects
  • Surgery- effectibe but impractical for large numbers
  • Semaglutide (drug)
  • Tirzepatide
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14
Q

Why does a leptin deficiency have a negative impact ?

A
  • Brain is no longer stimulated; brain thinks you have no fat
  • Switches off menstrual cycle (can’t support pregnancy if body is starved)
  • Preserves energy; retains fat
  • More prone to eating “dry” food, e.g. frozen food
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15
Q

What is Liraglutide/Saxenda?

A
  • Drug used to 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.
  • not very effective, has GI side effects
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16
Q

What are common types of bariatric surgery used to treat obesity?

A

Gastric bypass– 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

Gastric band– a band is placed around your stomach, so you do not need to eat as much to feel full

Sleeve gastrectomy–some of your stomach is removed,soyou cannot eat as much as you could before and you’ll feelfull sooner.

17
Q

What qualifies an individual for bariatric surgery?

A
  1. Consider surgery for patients with:
    - 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
  2. Consider surgery as a first-line option for adults with a BMI >50 kg/m2
  3. If:
    – 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.
18
Q

How effective is surgery in the treatment of obesity?

A
  • Effective but impractical for large numbers

Endocrinology (14 decks)

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