Obesity Flashcards

1
Q

Obesity

A

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

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2
Q

BMI benchmarks

A

18.5 or less underweight

18.5 - 25 normal

25 - 30 overweight

30 - 35 obese

35+ severely obese

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3
Q

Issue with bmi

A

Doesn’t take into account body composition

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4
Q

What causes obesity

A

Mix of genetic and environmental/behavxioiral factors

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5
Q

examples of driving environmental factors?

A

less access to outdoor space, car use, screen time, lower education, poverty, social deprivation = positive correlation with obesity

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6
Q

global incidence patterns?

A

occurs worldwide, almost 2 billion adults worldwide overweight and 650 million + obese

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7
Q

what comorbidities is obesity associated with?

A

depression, stroke, MI, hypertension, diabetes, bowel cancer, osteoarthritis, peripheral vascular disease etc

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8
Q

BMI affect on mortality

A

Higher bmi correlated with higher mortality

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9
Q

how is obesity treated?

A

diet and lifestyle changes, consider drugs or surgery with increasing degrees of severity

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10
Q

what should diet aim for?

A

enough portions of fruit and veg, good balance between nutrient types

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11
Q

what does leptin deficiency cause?

A

infertility, stunted growth, decreased {body temp, immune function, energy expenditure}

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12
Q

what does leptin do?

A

Regulates appetite
Regulates synthesis of thyroid hormones,insulin secretions,bone mass,menstrual cycle,increases heart rate and activates immune cells

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13
Q

Effect of leptin administration in deficient children

A

Weight goes down and LH pulsatility restored

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14
Q

who else can leptin be administered to for a therapeutic effect?

A

restores LH pulsatility in women with amenorrhea

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15
Q

what is the principle of leptin resistance?

A

high leptin doesn’t have more effect (inhibit appetite) than lower presence of leptin as it is an anti starvation hormone not anti obesity so presence shows CNS that system has sufficient fat reserves
Ibsen E2 can cause hyperphagia,lowered energy expenditure and sterility

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16
Q

what is orlistat?

A

gastric and pancreatic lipase inhibitor → reduces dietary fat absorption
Produced by streptomyces toxytricini

17
Q

Side effects of orlistat

A

Fatty stools,faecal urgency and incontinece
Fat soluble vitamin deficiency

18
Q

Effects of GLP-1

A
  • generalbody weight down, BP down, plasma glucose down, plasma lipids down
  • pancreaticinsulin up, glucagon down
  • brainappetite down, satiety up
  • heartcontractility up, glucose uptake down
  • vesselsendothelial function up, stiffness and inflammation down
  • kidneyssodium excretion and diuresis up
  • liverliver fat down, inflammation down, insulin resistance down
  • GLP-1 receptor agonist
19
Q

What is liraglutide/saxenda

A

GLP-1 agonist which is long acting
Daily injection
Double dose used for type 2 diabetes

20
Q

when should bariatric surgery be considered?

A

40+ BMI / 35+ with comorbidities / 30-35 with newly diagnosed type II DM

21
Q

Common types of bariatric surgery

A
  • gastric bypasstop part of stomach connected to small intestine
  • gastric bandadjustable tightness band to restrict stomach
  • sleeve gastrectomyremove portion of stomach
22
Q

how effective is bariatric surgery?

A

requires commitment to long term follow up, maybe some reduction in mortality and weight loss long term but questionable

23
Q

other examples of long-acting GLP-1 receptor agonists?

A

tirzepatide, semaglutide

24
Q

what is given in combination with semaglutide

A

cagrilintide
Long acting amylin analogue

25
Q

what is retatrutide?

A

triple agonist → glucose-dependent insulinotropic polypeptide, GLP-1, glucagon receptors

26
Q

how effective are drugs against obesity?

A

Previously ineffective new gen might be effective

27
Q

Tirzepatide

A

Long acting GLP1 receptor and glucose dependant insulinotrophic polypeptide receptor co agonist causes 20-22 body weight loss

28
Q

Cagrilintide

A

Long acting amylin analogue given with semaglutide
Causes nausea but significant weight loss