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Endocrinology > Obesity > Flashcards

Obesity Flashcards

1
Q

Define obesity

A

BMI > 30

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2
Q

Define obesity

A

BMI > 30

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3
Q

Genetic factors that affect ‘energy out’?

A

Muscle mass

Mitochondrial function

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4
Q

What are some important weight Hx questions?

A
  • When did weight gain begin?
  • What has been the trajectory of your weight?
  • earlier the onset of obesity, the less treatable by intervention
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5
Q

What does obesity

A
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6
Q

Genetic factors that affect ‘energy out’?

A

Muscle mass

Mitochondrial function

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7
Q

What are some important weight Hx questions?

A
  • When did weight gain begin?
  • What has been the trajectory of your weight?
  • earlier the onset of obesity, the less treatable by intervention
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8
Q

What does obesity

A
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9
Q

What are some important weight gain Hx questions?

A

A. Cause of weight gain:

  • When did weight gain begin?
  • What has been the trajectory of your weight?
  • earlier the onset of obesity, the less treatable by intervention

B. Consequence of weight gain:

  • T2DM
  • HTN
  • Arterial disease: IHD, stroke
  • Hepatic steatosis
  • Sleep apnoea
  • Lithiasis (kidney stones)
  • Gout (hyperuracaemia) - early onset
  • OA
  • F: PCOS, infertility
  • M: androgen deficiency
  • Mental health: depression,
  • Cancer: due to chronic inflammatory state
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10
Q

What does obesity

A
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11
Q

What are some important weight gain Hx questions?

A

A. Cause of weight gain:

  • When did weight gain begin?
  • What has been the trajectory of your weight?
  • earlier the onset of obesity, the less treatable by intervention

B. Consequence of weight gain:

  • T2DM
  • HTN
  • Arterial disease: IHD, stroke
  • Hepatic steatosis
  • Sleep apnoea
  • Lithiasis (kidney stones)
  • Gout (hyperuracaemia) - early onset
  • OA
  • F: PCOS, infertility
  • M: androgen deficiency
  • Mental health: depression, anxiety
  • Cancer: due to chronic inflammatory state
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12
Q

What does obesity

A
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13
Q

What are some important weight gain Hx questions?

A

A. Cause of weight gain:

  • When did weight gain begin?
  • What has been the trajectory of your weight?
  • earlier the onset of obesity, the less treatable by intervention

B. Consequence of weight gain:

  • T2DM
  • HTN
  • Arterial disease: IHD, stroke
  • Hepatic steatosis
  • Sleep apnoea
  • Lithiasis (kidney stones)
  • Gout (hyperuracaemia) - early onset
  • OA
  • F: PCOS, infertility
  • M: androgen deficiency
  • Mental health: depression, anxiety
  • Cancer: due to chronic inflammatory state
  • GORD
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14
Q

What does obesity

A
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15
Q

Pathophysiology of central adiposity?

A

Visceral and peri-visceral fat

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16
Q

Pathophysiology of central adiposity?

A

Visceral and peri-visceral fat

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17
Q

Normal waist circumference of M

A
18
Q

Normal waist circumference of F

A
19
Q

What is metabolic syndrome?

A

3 or more of:

  1. central (abdominal) obesity
  2. HTN
  3. high blood triglycerides
  4. low levels of high density lipoproteins (HDL)
  5. impaired fasting glucose (IFG) or diabetes
20
Q

Normal waist circumference of F

A
21
Q

What is metabolic syndrome?

A

3 or more of:

  1. central (abdominal) obesity
  2. HTN
  3. high blood triglycerides
  4. low levels of high density lipoproteins (HDL)
  5. impaired fasting glucose (IFG) or diabetes
22
Q

What is the consequence of aggressive weight loss strategy?

A

Must do physical activity to preserve muscle mass when dieting - determines large amount of energy expenditure

If aggressive weight loss without muscle mass preservation, worse off than before

23
Q

Why do males normally have more visceral adiposity than females?

A

On average, females have greater subcutaneous fat stores compared to men.
Therefore less prone to having visceral adiposity even with similar BMI.

24
Q

Why do males normally have more visceral adiposity than females?

A

On average, females have greater subcutaneous fat stores compared to men.
Therefore less prone to having visceral adiposity even with similar BMI.

*indigenous population have less subcutaneous stores - therefore higher T2DM, obesity

25
Q

Why do males normally have more visceral adiposity than females?

Which population group is at risk?

A

On average, females have greater subcutaneous fat stores compared to men.
Therefore less prone to having visceral adiposity even with similar BMI.

*indigenous population have less subcutaneous stores - therefore higher predisposition to T2DM, obesity

26
Q

Rx options for obesity

A

Lifestyle intervention:

a. Diet
b. Exercise

Pharm:

  • Appetite suppressant
  • Orlistat: inhibit fat from diet
  • Phentermine: CNS stimulant
  • Metformin

Pharm + surgery + VL energy diet (very low):
- Replace 2 meals a day with a shake
-

27
Q

Pharm Rx that increase weight?

A

Drugs that increase weight:

B-blockers (reduce thermogenesis), steroids, sulfonylurea, lithium, antipyschotics

28
Q

Rx options for obesity

A

Lifestyle intervention:

a. Diet
b. Exercise

Pharm:

  • Appetite suppressant (topiramate, phentermine)
  • Orlistat: inhibit fat from diet
  • Metformin: especially in PCOS

Pharm + surgery + very low energy diet (VLED):
- Replace 2 meals a day with a shake
-

29
Q

Pharm Rx that increase weight?

A

Drugs that increase weight:

B-blockers (reduce thermogenesis), steroids, sulfonylurea, lithium, antipyschotics

30
Q

Better to lose weight rapidly or slowly?

A

Better to lose weight rapidly than slowly - due to positive reinforcement and continual weight loss after

31
Q

Better to lose weight rapidly or slowly?

A

Possibly better to lose weight rapidly than slowly - due to positive reinforcement and continual weight loss after

32
Q

Better to lose weight rapidly or slowly?

A

Possibly better to lose weight rapidly than slowly - due to positive reinforcement and continual weight loss after

33
Q

Approach to obesity in Hx (terminology)

A

Refer to as ‘fat tissue’
Implications in terms of pathology (visceral fat)
“Waist circumference is up”
Avoid overweight, obese; replace with central adiposity

34
Q

Approach to obesity in Hx (terminology)

A

Refer to as ‘fat tissue’
Implications in terms of pathology (visceral fat)
“Waist circumference is up”
Avoid overweight, obese; replace with central adiposity

35
Q

What are the indications for surgery

A

A. Morbid obesity: > 40kg/m^2 OR
B. BMI > 35kg/m^2 + 2 obesity related comorbidities (e.g. DM, OSA, lipids, HTN, OA)

*all must have shown previous weight loss prior

36
Q

What types of surgery are available?

A

a. Lap gastric band: restrict amount of food one can have
b. Lap sleeve gastrectomy
c. Lap gastric bypass

37
Q

What is a lap gastric band?

A

Band at the top of the stomach, therefore food remains in a little pouch that requires a few peristaltic motions. This sends satiety signal back to brain
* no change in volume

38
Q

What is a lap sleeve gastrectomy?

A

Sleeve: reduction in total volume of stomach via resected stomach, left with gastric sleeve. Effect: less food eaten and food access ileum quicker therefore gut hormones released quicker (GIP and GLP1)

39
Q

What is a lap gastric bypass?

A

Pouch attached to small bowel and reaches ileum more quickly –> GIP and GLP 1 release more quickly

40
Q

What is a lap gastric band?

A

Band at the top of the stomach, therefore food remains in a little pouch that requires a few peristaltic motions. This sends satiety signal back to brain

  • no change in volume
  • safest - if older, more comorbidites
41
Q

What is a lap gastric bypass?

A

Pouch attached to small bowel and reaches ileum more quickly –> GIP and GLP 1 release more quickly
*if younger and resilient

Endocrinology (9 decks)

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