obesity Flashcards
name some conditions that obesity increases the risk of developing
- T2D
- hypertension
- CVD
- dyslipidaemia
- fatty liver disease
- gallstones
- some types of cancer
- reproductive problems
- respitatory and MSK conditions
- GORD
BMI is a measure of ..
obesity
Waist to height ratio is a measure of …
central adiposity
Why should BMI alone be interpreted with caution , and in which individuals in particular
not a direct measure of central adiposity, esp in people who are very muscular or have muscle weakness or atrophy, and in those 65 and over
In patients with BMI below 35 including in the healthy range, what else should be measured
waist to height ratio
define healthy, overweight and obese in patients from a white background (BMI scale)
Healthy 18.5-24.9
Overweight 25-29.9
Obesity class 1 30-34.9
Obesity class 2 35-39.9
Obesity class 3 40 or more
BA, AC, SA, Chinese, other Asian, or ME family background - these pt are at increased risk of chronic health conditions at lower BMI thresholds.
Overweight or obese in these individuals is defined as:
Overweight 23-27.4
Obesity 27.5 or above
Class 2 and 3 are usually identified by reducing the thresholds above 2.5
In all individuals with a BMI <35, central adiposity based on waist to height ratio is defined as
- Increased central adiposity: W-t-H ratio 0.5-0.9
- High central adiposity: W-t-H ratio 0.6 or more
true or false - Individuals with a BMI of 35 or more are at v high risk of obesity related-health problems, regardless of W-t-H ratio
true
name one potential underlying cause of overweight
hypothyroidism
name some medications that are known to cause weight gain
atypical antipsychotics
beta blockers
insulin when used for T2D
lithium
SV
SUs
thiazolidinediones
TCAs
true or false - you can use drug treatment as the sole element of treatment of obesity in some patients
false
NEVER use as the sole element of treatment
Must be used as part of an overall weight management plan
When can you consider orlistat
BMI ≥ 30 kg/m2 in whom diet, exercise and behavioural changes failed to achieve an adequate reduction in weight, or in pt with BMI ≥28 in the presence of associated risk factors e.g. diabetes, high cholesterol, hypertension
These two drugs can be considered for certain patients under specialist care only
(hint GLP1 agon)
liraglutide OD, semaglutide once weekly
true or false - drug treatment may be used to maintain weight loss rather than to continue to lose weight
true
true or false - wright loss may be slower in pt with T2D
true
who can you consider treatment with SETMELANOTIDE in
expert supervision in pt with specific genetic conditions
what does satiety mean
feeling of being full
name some drugs that produce a feeling of satiety which have been used (unlicensed) in an attempt to control appetite, but there is little evidence for their efficacy
hint - bulk forming
- methylcellulose
- sterculia
when can you consider bariatric surgery for pt
BMI ≥ 40 kg/m2, or between 35-39.9 and a significant disease (e.g. CVD, NAFLD, obstructive sleep apnea, T2D, hypertension) which could be improved with weight loss
may also be considered for patients with a BMI of 30 to 34.9 who have recent onset T2D
orlistat MOA
lipase inhibitor, reduces the absorption of dietary fat.
dose of orlistat & how long to continue it for
120mg up to TDS, dose to be taken immediately before, or during, or up to 1 hour after each pain meal
continue treatment beyond 12 weeks only if weight loss since start of treatment exceeds 5% (target for initial weight loss may be lower in pt with T2D)
If a meal if missed or contains no fat, should you still take dose of orlistat
No, miss dose
2 contraindications for orlistat
cholestasis
chronic malabsorption syndrome
Can orlistat affect absorption of vitamins?
Yes it can impair absorption of fat soluble vitamins
Vitamin supplementation (especially of vitamin D) may be considered if there is concern about deficiency of fat-soluble vitamins.
4 SE of orlistat
abdominal pain - can reduce by reducing fat intake
anxiety
diarrhoea
GI disorders
What is the brand name for OTC orlistat and what strength is it
Alli 60mg
What should a persons diet be like if they are on orlistat
nutritionally balanced, mildly hypocaloric diet that contains approximately 30 % of calories from fat. It is recommended that the diet should be rich in fruit and vegetables. The daily intake of fat, carbohydrate and protein should be distributed over three main meals.
MOA setmetalonide
centrally-acting selective melanocortin-4 receptor agonist that regulates hunger, satiety, and energy expenditure, thereby promoting weight loss.
Indication & route - setmelanotide
Obesity with underlying genetic aetiology (under expert supervision)
Via SC injection
Orlistat indication
Adjunct in obesity (in conjunction with a mildly hypocaloric diet in individuals with a body mass index (BMI) of 30 kg/m2 or more or in individuals with a BMI of 28 kg/m2 or more in the presence of other risk factors such as type 2 diabetes, hypertension, or hypercholesterolaemia)
for orlistat
Naltrexone & bupropion indication
Adjunct in obesity (in conjunction with dietary measures and increased physical activity in individuals with a body mass index (BMI) of 30 kg/m2 or more or in individuals with a BMI of 27 kg/m2 or more in the presence of one or more weight related co-morbidity)
MHRA advice - naltrexone/bupropion - risk of adverse reactions that could affect ability to drive
- commonly associated with dizziness or somnolence
- rarely with loss of consciousness or seizure
Naltrexone/bupropion is contraindicated in
uncontrolled hypertension
Alli OTC or POM orlistat - can it be used in children
no adults only
dose of Alli 60mg (OTC orlistat) and how long to continue treatment for
60mg TDS
max 180mg in 24hours
treatment should not exceed 6 months.
if unable to lose weight after 12 weeks, see GP or pharmacist; may need to discontinue treatment
when taking orlistat, pt should be on nutritionally balanced, mildly hypocaloric diet that contains approximately …..% of calories from fat
30%
treatment with orlistat may potentially impair the absorption of fat soluble vitamins
name the 4 fat soluble vits
a, d, e, k
