Obesity

Question 1

What is obesity?

Answer 1

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

Question 2

What BMI is considered clinically obese?

Answer 2

> 30

Question 3

Is obesity genetic?

Answer 3

• around 60-70%
• Identical twins tend to have similar BMIs, irrelevant of environment
• polygenomic

Question 4

Mechanism of appetite?

Answer 4

• leptin (body fat)
• insulin (pancreas)
• hypothalamus

Question 5

What is the most common gene associated with obesity?

Answer 5

MC4R

Question 6

What social/environmental factors affect the risk of obesity?

Answer 6

• ability to play outside
• car use
• screen time
• education level / achievement
• poverty
• social deprivation

Question 7

What drives obesity?

Answer 7

The environment either heightens or reduces the impact of genetics on the risk of obesity

Question 8

What co-morbidities are associated with obesity?

Answer 8

• depression
• sleep apnoea
• stroke
• myocardial infarction
• hypertension
• diabetes
• peripheral vascular disease
• gout
• osteoarthritis
• bowel cancer
• infertility
• gallbladder disease

Question 9

Impact of obesity of cancer?

Answer 9

Incidence of cancers increases in those with obesity

Question 10

What does an BMI above 35 mean for your life expectancy?

Answer 10

2 x the risk of death of those of a healthy BMI

Question 11

Only effective example of reduction in obesity at a national level?

Answer 11

• economy collapse, fuel and food shortages

Question 12

How do we treat obesity?

Answer 12

• determine degree of obesity
• assess lifestyle, co-morbidities and willingness to change
• management, lifestyle changes, drug treatment
• consider referral to specialist
• possibly: bariatric surgery

Question 13

Why do weight rebounds happen?

Answer 13

Hypothalamus thinks: starvation, therefore encourages you to regain +more (increases appetite)

Question 14

What does leptin deficient mean?

Answer 14

• insatiable hunger
• body is in survival mode, irrelevant of what is seen in the mirror
• almost impossible to lose weight
• infertility
• stunted linear growth
• decreased body temperature
• decreased energy expenditure
• decreased immune function

Question 15

How to address health issues caused by diabetes?

Answer 15

• identify how difficult losing weight is

Question 16

What is the impact of visceral fat?

Answer 16

• Visceral fat (fat at the waist), feeds the most into co-morbidities
• worse in men

Question 17

What dietary recommendations should be made?

Answer 17

• 3 portions of fruit+veg (minimum)
• more fruit+veg the better

Question 18

What drugs are used to treat obesity?

Answer 18

• Orlistat
• Gastric and pancreatic lipase inhibitor
• prevents fat absorption by 30%
• less than 3% change in weight
• low adherence (due to uncomfortable side effects)
  (have to be safe, because used as a preventative measure)
  -GLP1 agonists

Question 19

What about Bariatric surgery?

criteria

Answer 19

BMI>40
BMI35-40 and other comorbidities
BMI30-34.9 (T2DM)
BMI>50 : first line option
- non-surgical failed to achieve/maintain clinically beneficial weight-loss (at least 6 months) 
- receive intensive specialist treatment
- fit for anaesthesia and surgery
- commit to long-term follow up

Question 20

What are the 3 types of Bariatric surgery?

Answer 20

• Gastric Bypass
• Gastric Band
• Sleeve Gastrectomy

Question 21

What is the effectiveness of Bariatric surgery?

Answer 21

• most effective: Gastric Bypass (25% body weight - long term)
• least effective: Gastric Band

Question 22

Impact of treatment of leptin deficiency?

Answer 22

• puberty
• increased educational treatment
• lose weight

Question 23

Risks of bariatric surgery?

Answer 23

• risk of gambling
• risk of risky sex

Question 24

What is the process of a Gastric Bypass surgery?

Answer 24

the top part of the stomach is joined to the small intestine, feel fuller faster, less calories consumed

Question 25

What is the process involved in a Gastric Band?

Answer 25

band is placed around the stomach, therefore less food is required to feel hungry

Question 26

What is the process involved in a Sleeve Gastrectomy?

Answer 26

removal of some of the stomach, therefore unable to eat as much as you could before - feel full sooner

Question 27

What can leptin administration restore in deficient children?

Answer 27

FSH and LH pulsatility

Question 28

What can leptin administration restore in deficient women?

Answer 28

Periods (due to LH pulsatility being resotred)

Question 29

What is leptin?

Answer 29

An anti-starvation hormone NOT an anti-obesity hormone

Question 30

What is semaglutide?

Answer 30

Long-acting glucagon-like peptide-1 (GLP-1) receptor agonist.

Question 31

What is liraglutide/saxenda?

Answer 31

• Long-acting glucagon-like peptide-1 receptor agonist
• Daily injection.
• Double the dose used for T2DM.
• 4-5% weight loss

Question 32

What is tirzepatide?

Answer 32

Long-acting glucagon-like peptide-1 (GLP-1) receptor and glucose-dependent insulinotropic Polypeptide (GIP) receptor co-agonist.

Question 33

What is cagrilinitide?

Answer 33

Long-acting amylin analogue given in combination with semaglutide.