Obesity Flashcards
What is obesity
A condition of abnormal or excessive fat accumulation in adipose tissue, to the extent that health is impaired
Obesity constraints
Healthy = 18.5-24.9
Overweight=25-29.9
Obese=30-34.9
Obese II/ Extremely obese = 35-39.9
Obesity III=40+
What drives obesity?
Sedentary lifestyle
Food intake - sugar, salt and fat + cheap
No access to parks
Car use
Screen time
Educational level
Educational achievement
Poverty
Social deprivation
What are the comorbidities associated with obesity?
Depression
Sleep apnoea
Bowel cancer
Osteoarthritis
Gout
Peripheral vascular disease
Diabetes
Hypertension
Myocardial infarction
Stroke
What diseases is obesity a risk factor for?
Type II diabetes
Cardiovascular diseases
Cancer
Gallbladder disease
Obstructive sleep apnoea
Aggravated arthritis
Gout
Infertility
How to assess and manage obesity in adults
Determine degree of
overweight or obesity
Assess lifestyle,
comorbidities and
willingness to change
Management:
lifestyle changes;
drug treatment
OR
Consider referral
to specialist care
Specialist assessment
and management;
surgery and follow up
Leptin is released from fat
A way that the adipose tissue tells the brain what kind of energy stores you have
What does leptin deficiency result in
Infertility.
Stunted linear growth.
Decreased body temperature.
Decreased energy expenditure.
Decreased immune function
Same as starvation
Why is leptin necessary for normal physiological function
Leptin receptors that manage food intake, endocrine systems and reproduction
Helps regulate the synthesis of thyroid hormones
Decreases glucose stimulated insulin secretion
Increases heart rate
Regulates bone mass
Regulating the menstrual cycle
Regular appetite, control of metabolism and energy homeostasis
Activation of immune cells
Increases blood pressure
What does leptin administration in children do
Reduces appetite and body weight
Restores LH pulsatility
What does leptin administration do in women
Restores LH pulsatility in women with amenorrh
What drug to use for obesity?
Orlistat
Derivative of an endogenous lipstatin produced by Streptomyces toxytricini.
Gastric and pancreatic lipase inhibitor
Reduces dietary fat absorption by around 30%.
What does GLP-1 do
Decrease body weight, blood pressure, plasma glucose and lipids
Reduces appetite and increases satiety
Increases insulin and decreases glucagon
Decreases liver fat, inflammation and insulin resistance
Increases sodium excretion and diuresis
Increase endothelial function and decreases arterial stiffness and inflammation
Increases myocardial contractility, reduces glucose uptake and increases ischaemic preconditioning
What does Liraglutide/Saxenda do
Long-acting glucagon-like peptide-1 receptor agonist from Novo Nordisk.
Daily injection.
Double the dose used for T2DM.
4-5% weight loss.
-Causes GI problems sometimes
Who should bariatric surgery be considered for?
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.
– 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.
Consider surgery as a first-line option for adults with a BMI >50 kg/m2.
