Obesity Flashcards
Metabolic syndrome
Coexistence of obesity, insulin resistance and high BP, hyperlipidaemia, sleep apnea etc.
Increase risk of coronary heart disease, stroke and type 2 diabetes.
Hypothalamus
Main centre in CNS, controlling energy homeostasis by regulating appetite and feeding behaviour through complex interaction with nervous/endocrine systems.
What can be used for measurement of obesity?
4-compartment model- costly and takes time
Other options:
1. BMI- weight/height
2. Waist circumference- directly indicative of visceral fat so better than BMI.
3. Waist to hip ratio- ratio of >0.9 in men/>0.85 in women= elevated risk of metabolic complications
4. Skinfold thickness and percentage body fat- use callipers, fat can be measured at various points.
5. Percentage body fat using bioelectrical impedance- electrodes are connected and a current in passed between them.
4 compartment model
combines data from total body water assessment (via dilution of administered deuterium labelled water) , bone mineral (via dual x-ray absorptiometry), and total bone density (via displacement following immersion in fluid.)
Main drug licensed in UK for weight loss
Orlistat
Available as:
1. 120mg (Xenical) POM
2. 60mg (Alli, Orlos) P capsules
When is the 120mg POM dose taken?
Taken immediately before, during or upto one hour after each main meal. If the meal is skipped/ contains no fat, the dose is excluded
When is weight medication prescribed?
Only prescribed to those with BMI≥30 (obese), or BMI≥28 (overweight) if the pt has comorbidities related to obesity (T2 diabetes, hypertension etc.)
How long is Orlistat prescribed for?
For a 3 month period
If ≥ 5% of the initial body weight is lost, the prescription may continue up to 12 months till review.
Side effects of Orlistat
Fatty/oily stools
Increased defecation frequency and urgency
Oily rectal discharge
Farting
Dicomfort
What should be consumed alongside Orlistat medication
Multivitamins A, D , E and K as decreased triglyceride absorption causes malabsoprtion of fat soluble vitamins
What can Orlistat interfere with?
Gi uptake of certain fat soluble meds like ciclosporin
What medication is now included for obesity treatment?
Antidiabetic drugs like liraglutide and semaglutide
What is bariatric surgery?
Surgery to induce weight loss
Only for those with BMI>40 (class 3 morbidly obese) or BMI>35 (class 2 morbidly obese) in those with comorbidities relating to obesity
Two forms of bariatric surgery
Gastric band surgery
Gastric bypass surgery
Gastric band surgery
Adjustable band partially occludes top part of the stomach, allowing lower volumes of food to enter small upper pouch. Triggers stretch receptors, earlier feeling of satiety.
GP controls level of occlusion, band can be removed later.
Pt required to take multivitamins
Gastric bypass surgery
Lower part of stomach and upper part of small intestine are surgically bypassed, providing a permanent smaller stomach and lower SA for nutrient absorptions
Pt required to take multivitamins
