Obesity Flashcards
What is the purpose of BMI?
Surrogate for excess adiposity
What are the pros/cons of BMI use in diagnosing obesity?
Easily measured
Very useful at higher BMIS
Overdiagnosis at higher BMI
Underdiagnosis at lower BMI as harmful excess adiposity within the normal range.
Define overweight and obesity by BMI
Overweight = equal to or more than 25
Obestiy stage 1 = 30
Stage 2 = equal to or greater than 35
Stage 3 = equal to or greater than 40
What other measures are used to measure obesity?
Waist circumference
Waist/hip ratio
Waist/height individual
Impedence - uses electrical resistance of body
What is the obesity paradox?
Excess of fat or obesity can be beneficial for health in certain circumstances = protective
Danger of imminent famine or major ill health
What tends to be the first line treatment for tackling individual obesity?
Healthy eating
Exercises
Behavioural Modification
What pharmacotherapy can be used to treat obesity?
Orlistat
Liraglutide
Semaglutide
Tirzapeptide
Retratrutide
How does semaglutide treat obesity?
GLP-1 receptor agonist
How does tirzapeptide treat obesity?
GLP-1 and glucose-dependent insulin trophic polypeptide (GIP) receptor co-agonist
How does retatrutide treat obesity?
Triple receptor agonist
GLP-1, GIP and Glucafon
How does orlistat work to treat obesity?
Gastric and pancreatic lipase inhibitor
Decreases fat absoprtion
What is the indication for orlistat?
BMI of 30 or more
BMI or 28 or more with associated risk factors
Not recommend to use with other weight reduction drugs
Continue beyond 3 months only if lost as least 5% initial body weight
What is the relevant guidance for use of semaglutide for weight loss?
use for 2yrs max - within specialist weight management
Have at least 1-weight related co-morbidity and BMI of 35 or BMI of 30 (and referall for specialist weight management services)
Lower BMI thresholds (by 2.5) for south asian, chinese, asian etc
Stop if not more than 5% lost in 6 months
What are the general guidelines regarding treating obesity?
Adults BMI of 30 or 27 with weight related conditions
Counselling every 4 weeks to adhere to reduced-calorie diet and increased physical activity.
What are some adverse events from weight loss drugs?
Nausea
Vomitting
Diarrhea
Constipation
Nasopharyngitis
Headache
Dyspepsia
Abdominap pain
URTI
What is the guidelines for the use of tirazepatide for weight loss?
Alongside reduced calorie diet and increase PA only if:
BMI of 35
At least 1 weight related co-morbidity
Lower BMI threshold (2.5) for high risk |South asian, Black African
Stop if less than 5% weight loss in first 6 months.
What is the NICE criteria for Bariatric surgery?
BMI >40
BMI >35 with significant health condition what would improve with weight loss
BMI 30-35 with recent onset T2DM
BMI threshold down 2.5 for south asian, chineses etc
When does the National institute of health recommended major Bariatric surgery
BMI > or equal to 35
BMI > 30 with metabolic disease
Asian population BMI 27.5
Appropriately selected children and adolescents
What co-morbidities are recognised to benefit from weight loss surgery?
Cardiovascular disease
HTN
Idiopathic intracranial HTN
NAFLD
Obstructive sleep apnoea
T2DM
This list is examples not exhaustive
What are the complications of bariatric surgery?
1/1000 30 day mortality (1:250 with lap chole)
5% complications
0.5% major complications
What are the key benefits of bariatric surgery?
Improves health
Co-morbidity reduction (T2DM, HTN)
Reduces cancers (particularly in women)
INcrease quality and quantitiy of life
Pays back within 24 months
How long do different bariatric surgeries take?
Sleeve gastrectomy 45-50 minutes to perform
Bypass 80-90 minutes
What are the different types of bariatric surgery?
Roux en Y gastric bypass
Sleeve gastrectomy
Gastric band
OAGB/MGB
What ethnic groups have a lower BMI threshold for weight loss treatment?
Asian
Chinese
Middle Eastern
Black African
African-Caribbean
What are the benefits of sleeve gastrectomy?
75% working length in short term and 50% long term
Less supplement need compared to bypass
Hospital stay = 1 day
What are the complications of a sleeve gastrectomy?
Irreversible
short term:
30 day 1:1000 mortality
GI leaks and bleeding
DVT and PE
Long term:
Acid reflux
Sleeve twist and kinks
Weight regain
What are the benefits of a one anastomosis gastric bypass?
80% working short term, 60% long term
Weight loss similar to RYGB but better for DM
Hospital stay 1 day
What are the short term complications of a one anastomosis gastric bypass?
30 day mortality 1:1000
GI leaks and bleeding
DVT and PE
What are the long term complications of a one anastomosis gastric bypass?
Acid bile reflux (More than RYBG)
Marginal ulceration
Abdominal pain
Internal hernia, dumping, reactive hypoglycaemia
What are the beneficts of a roux-en-Y gastric bypass?
80% effective in short term and 60% in long term
Hospital stay of 1 day
What are the relevant complications of roux-en-Y gastric bypass?
Short term: 30 day mortality 1:500. GI leaks, bleeding. obstruction, DVT and PE
Long term: Dumping, Reactive hypoglycaemia, internal hernia, marginal ulceration, abdominal pain
What is the success/complications of gastric banding?
Hospital post op stay = 24 hrs
Mortality < 1 in 1000
Major complication rate is rare
Late complication/failure/explant
EWL of 50% 12 months
EWL > 40% after 5 years
What are the benefits/complications of a gastric balloon?
Posteroperative hospital stay of 24hrs
Mortality is rare
Major complication rate is rare
Bowel obstruction, GORD, Intolerance
EWL = 13-15kg at 6 months
Temporary procedure
What is the mechanism of action of orlistat?
Pancreatic lipase inhibitor, reduces absorption of dietary fat
Causes weight loss
What is the mechanism of action of leraglutide/semaglutide?
binds to and activates GLP-1 receptor to increase insulin secretion, suppress glucagon secretion, slows gastric emptying, may also act on hypothalamus to induce satiety = prolonged fullness to reduce dietary intake, inhibit lipase release
Causes weight loss
What is the mechanism of action of Tirzapeptide?
Long acting GIP (glucagon-dependent insulinotropic polypeptide) receptor and GLP-1 receptor agonist - increases insuline secretion, suppresses glucagon and slows gastric emptying. inhibit lipase release
Causes weight loss
What is the mechanism of action of Retatrutide?
GLP-1, GIP and glucagon agonist
Causes weight loss
