Obesity Flashcards

1
Q

Describe the energy balance.

A

There is a balance between energy input and energy expenditure. Obese and overweight people have net energy input.

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2
Q

What makes up the majority of energy expenditure?

A

REE - resting energy expenditure - AKA basal metabolic rate

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3
Q

How does REE change with weight loss?

A

As you lose weight, REE decreases so it becomes more and more difficult to lose more weight

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4
Q

How can obesity be defined?

A

Based on weight

BMI (weight/height^2) - this varies depending on ethnicity

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5
Q

What is another measure of obesity that can be used to determine risk of metabolic syndrome?

A

Waist: hip circumference

A high value indicates increased risk of metabolic syndrome

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6
Q

What are the five components of metabolic syndrome?

A
Waist: hip circumference
Hypertension
Fasting blood glucose
Microalbumin + insulin resistance
Low HDL
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7
Q

What waist circumferences give a major risk of CHD in men and women?

A

Men - >102

Women - >88

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8
Q

What polymorphism is associated with increased risk of obesity?

A

FTO

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9
Q

Describe the effect of leptin on regulating energy intake.

A

Leptin is produced in the adipocytes and communicates with the hypothalamus and lets it know how much fat is stored in the adipocytes thus controlling feeding.

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10
Q

Describe the effect of insulin on adipocytes.

A

Promotes the storage of fatty acids in the adipocytes.

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11
Q

What is Ghrelin?

A

Hunger hormone - when you’re hungry, the Ghrelin levels increase and tell the hypothalamus that you need to eat
Energy expenditure and satiety will DECREASE

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12
Q

What is PYY?

A

Fullness hormone - this is released after a big meal

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13
Q

State some complications of obesity.

A
Hypertension
T2DM
Osteoarthritis 
Cancer
Cardiovascular disease 
CIRRHOSIS
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14
Q

What is the only licenced obesity medication in the UK?

A

Orlistat

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15
Q

How does orlistat affect diabetes risk?

A

It decreases diabetes risk

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16
Q

What new medications have been put forward for obesity?

A

GLP-1 supplements (iraglutide and saxenda)
Belviq - serotonin agonist
Contrave - suppress appetite

17
Q

State the three forms of bariatric surgery.

A

The stomach is made into the size of a thumb and the second part of the small intestine is joined to the top of the stomach.
The first part of the duodenum no longer sees food and only sees bile.
Food enters the second part of the small intestine much faster than usual.
Vagal nerves are cut by the surgeon so there are changes in perception of food and appetite regulation.

18
Q

Describe gastric bypass.

A

The stomach is made into the size of a thumb and the second part of the small intestine is joined to the top of the stomach.
The first part of the duodenum no longer sees food and only sees bile.
Food enters the second part of the small intestine much faster than usual.
Vagal nerves are cut by the surgeon so there are changes in perception of food and appetite regulation.

19
Q

What effect does bariatric surgery have on glycaemic control? What are possible mechanisms for this effect?

A

Bariatric surgery improves glycaemic control
Could be due to decrease in insulin resistance, changes in insulin secretion, changes in gut microbiota, changes in bile salt secretion

20
Q

What are the criteria for bariatric surgery?

A

BMI 30-35 with short spell of T2DM
BMI 35-40 with comorbidities
BMI > 40 with no comorbidities

21
Q

State another surgical technique used to treat obesity.

A

Duodeno-jejunal sleeve

22
Q

What are the benefits of bariatric surgery?

A

Decreased risk of cardiovascular disease
Decreased risk of T2DM
Improvement in hypertension
Reduced cancer related deaths