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Endo > 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 BMI classification is given for obesity?

A

BMI > 30

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3
Q

What is the problem with BMI?

A

BMI does not account for muscle mass

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4
Q

What is a GWAS and what has it shown for obesity?

A

Genome Wide Association Study - shows there are multiple genes involved in BMI, Waist:Hip Ratio, Body Fat, Birthweight, Satiety upon Food Intake (Leptin and GLP-1)

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5
Q

What are some of the driving factors of obesity?

A

Food intake (cheap, high calorie high fat high salt&sugar food widely available), Sedentary lifestyle (cars, fewer playgrounds, screen time), Income, Education

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6
Q

What are some comorbidities associated with obesity?

A

T2DM,
CVD,
Stroke,
Cancer,
Hypertension,
Osteoarthritis,
Sleep Apnoea,
Depression

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7
Q

Describe the relationship between mortality and BMI

A

Lowest risk of mortality is in a healthy BMI, there is a slightly higher risk at lower BMIs, but there is an exponential increase as BMI reaches overweight and obese levels

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8
Q

How would you assess the patient for a management plan for obesity?

A

Assess the patient’s current lifestyle, comorbidities and willingness to cooperate, from there you can suggest lifestyle changes, drugs or surgery

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9
Q

At what stage would you consider drugs for obesity control?

A

At any stage where comorbidities are present, always when severe or morbidly obese

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10
Q

When would you consider surgery for obesity control?

A

Morbidly obese or severely obese with comorbidities

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11
Q

Obesity and the hypothalamus

A

Responds to signals from the periphery e.g. the gut
Causes appetite suppression via short term signals
long term signals from adipose tissue indicate levels of fat stores

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12
Q

Where is leptin produced and where does it act?

A

Adipose tissue, acts on the brain

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13
Q

What is the general function of leptin?

A

Induces satiety feeling to stop eating -> anti-starvation hormone by telling the brain it has enough fat to survive

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14
Q

How can leptin deficiency present?

A

Infertility,
stunted linear growth,
obesity,
decrease body temperature and energy expenditure, decreased immune function,
Hyperphagia (really hungry)

mode of starvation

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15
Q

What are 6 physiological functions of leptin?

A

Regulation of appetite,
increases blood pressure,
regulates thyroid hormone synthesis,
decreases insulin secretion,
increases heart rate,
regulates menstrual cycle

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16
Q

How can you treat leptin deficiency and what does this do?

A

Administer recombinant leptin therapy - reduces weight and restores FSH & LH pulsatility

17
Q

Where else can leptin administration be used?

A

Restoring LH pulsatility in women with amenorrhea

18
Q

Can you use leptin to treat T2DM

A

Leptin resistance
High leptin has little effect as it signals to the CNS that the system has sufficient fat reserves

19
Q

Medication for obesity

A

derivatives of endogenous lipostatin
gastric and pancreatic lipase inhibitor
reduces dietary fat absorption by around 30%

20
Q

Orlistat

A

lipase inhibitor
3% weight reduction
GI problems, steatorrhea

21
Q

What are the effects of GLP-1?

A

Low appetite, high satiety, high insulin, more sodium excretion

22
Q

What is a long acting GLP-1, and how effective is it?

A

Liraglutide, daily injection, 4-5% weight loss
GI side effects

23
Q

When can bariatric surgery be recommended?

A

BMI > 40 or > 35 with comorbidities
Non-surgical measures have failed, fit for surgery, will commit to follow-up plan

24
Q

What are the three types of bariatric surgery?

A

Gastric bypass (top of stomach joined to small intestine - do not absorb as much),
Gastric band (band around stomach constricting, less food needed to feel full),
Sleeve gastrectomy (some stomach is removed vertically, cannot eat as much to feel full)

25
Q

Semaglutide

A

Long acting GLP1 receptor agonist

26
Q

Tirzepatide

A

Long acting GLP1 receptor agonist
Glucose dependent insulinotropic polypeptide (GIP) receptor co-agonist

27
Q

Cagrilinitide

A

Long acting amylin analogue given together with semaglutide

28
Q

Retratrutide

A

Triple agonist of GIP, GLP1 and glucagon receptors

29
Q

How do you treat obesity

A

Lifestyle - largely ineffective
Drugs - new gen seems promising despite high price point and side effects incl nausea
Surgery - effective but impractical for large numbers

30
Q

Main two drivers of obesity

A

Genetic predisposition
Obesogenic environment
combo of each is critical

Endo (13 decks)

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