Obesity Flashcards

1
Q

What controls appetite regulation

A

peripheral hormones and neural signals that interact with the CNS appetite circuits

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2
Q

In what ways do messages from the periphery reach the brain

A

circulation: products cross the blood-brain barrier

neural circuits: vagal afferents from GI tract

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3
Q

What produces leptin and what is the function of leptin

A

Adipocytes (fat cells)
It signals to the brain about the quantity of fat stored
It indicates whether fat stores are sufficient for survival and reproduction

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4
Q

Where is ghrelin produced and what does it do

A

peptide produced in the stomach that increases food intake and stimulates GH

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5
Q

What parts of the CNS are important in the regulation of appetite

A

Nucleus of the tracts solitaires
Arcuate nucleus (base of hypothalamus)
Paraventricular nucleus

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6
Q

What does damage to the ventromedial hypothalamus lead to

A

increased food intake and obesity

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7
Q

What does damage to the lateral hypothalamus lead to

A

reduced food intake and lower body weight

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8
Q

What disorders is obesity linked with

A
insulin resistance 
diabetes mellitus 
hypertension
dyslipidaemia 
coronary heart disease
stroke 
sleep apnoea 
cancer
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9
Q

How is obesity defined

A

BMI of 30+

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10
Q

What BMI signals overweight

A

25-29.9

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11
Q

Describe the link between ethnicity and sex

A

White men are more likely to be obese than black men

Black women are more likely to be obese than white women

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12
Q

What are some causes of obesity

A
Lifestyle and social 
Dietary factors
genetic factors
drugs neuroendocrine disorders
prenatal factors
psychological factors
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13
Q

What is the most common monogenic cause of obesity in childhood

A

Heterozygous mutations in the gene encoding the Melanocortin-4 receptor

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14
Q

What gene mutation increases the risk of obesity in the general population

A

A variant in the FTO gene (fat mass and obesity associated) on chromosome 16

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15
Q

What sorts of drugs can cause weight gain

A
atypical antipsychotics
tricyclic antidepressants 
anti epileptic drugs 
insulin 
sulphonylureas 
thiazolidinediones
glucocorticoids
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16
Q

What neuroendocrine disorders may be associated with the development of obesity

A

hypothalamic obesity: rare syndrome in humans
Cushing’s syndrome: stimulation of food intake by excess glucocorticoids contributes to weight gain
Hypothyroidism: the slowing of metabolic activity
PCOS
GH deficiency: increased abdominal and visceral fat

17
Q

What does the clinical evaluation of overweight and obese individuals involve

A

height, weight and BMI

waist circumference in patients with a BMI

18
Q

What should obese patients receive counselling on

A

diet
lifestyle
exercise

19
Q

What are the measurements of an increased waist circumference

A

> 102cm in men

>88cm in women

20
Q

Levels of what increase following a diet induced weight loss

A

Serum ghrelin levels

21
Q

If drug therapy is used for obesity, how much weight should be loss in the first month

A

2kg

22
Q

How does orlistat work

A

It inhibits pancreatic lipase and prevents the hydrolysis of ingested fat to fatty acids and glycerol, resulting ing increased faecal fat excretion

23
Q

How is orlistat to be taken

A

120mg TD before meals

24
Q

What are the main side effects of orlistat

A

intestinal cramps
flatus
faecal incontinence
oily spotting

25
Q

What should be given along side orlistat

A

vitamin A and E

26
Q

Sibutramine is contraindicated in what patients

A

those with a history of any cardiac disease or stolen

27
Q

How does sibutramine work

A

it inhibits food intake but its thermogenic effect in humans is controversial

28
Q

What should patients with T2DM be started don

A

metformin

29
Q

What do glucagon-like peptide-1 agonists do

A

Reduced food intake as well as improving glycemic control

30
Q

Who should be considered for bariatric surgery

A

those with a BMI of 40+who are well informed and motivated
failed previous non-surgical weight loss

Those with a BMI of 35+ and obesity -related comorbidities e.g. hypertension, DM, dyslipidaemia

31
Q

What are some contraindications to bariatric surgery

A

patients with untreated major depression or psychosis
binge eating disorders
drug or alcohol abuse
severe coagulopathy
severe cardiac disease with an excessive anaesthetic risk

32
Q

What is the mean overall percentage of excess weight lost in bariatric procedures

A

60%

33
Q

Surgical therapies are based on what two mechanisms

A

Restrictive procedures: restriction of caloric intake via a small stomach reservoir
Malabsorptive procedures: shortened functional small bowel
Mixed restrict and malabsorptive procedures: roux-en-Y gastric bypass

34
Q

What are the most widely performed procedures for bariatric surgery

A

roux-en-y (RYGB)

Adjustable gastric banding

35
Q

What are some complications of bariatric surgery

A
Blleding
bowel perforation
obstruction 
wound infections 
PE 
MI 
pneumonia 
UTI 
Prolonged vomiting
36
Q

What is dumping syndrome characterised by

A
nausea 
shaking 
sweating 
diarrhoea 
all immediately after eating foods containing high levels of glucose
37
Q

How long should females avoid pregnancy post op

A

12-18 months

38
Q

Patients are at risk of nutritional deficiencies after bariatric surgery. What should they receive daily

A
multivitamin 
calcium
vitamin D 
vitamin B12 
Iron supplements (those at risk of iron deficiency e.g. menstruating females)
39
Q

What should be reviewed at every follow up appointment

A
protein and food intake and patterns of eating 
psychological or eating disorders 
BP and weight 
FBC, U&E, creatinine 
LFT 
glucose 
albumin and serum