Obesity

Question 1

What is obesity?

Answer 1

Obesity is a disease caused by abnormal weight gain carrying risk for further disease

Question 2

What are 3 components of metabolism?

Answer 2

adaptive thermogenesis
(e.g. shivering)

physical activity

obligatory energy expenditure

Question 3

How does the BMI scale vary for asian populations?

Answer 3

starts earlier

no clear reason

Question 4

What affects the trend in obsity levels in females in England and Scotland?

Answer 4

not driven by genetic factors

N and S divide

Question 5

How does obesity change with age?

Answer 5

obesity is a disease of ageing - with increasing age, number of overweight/obese people increases, as does the associated disease risks

Question 6

How does obesity affect countries worldwide?

Answer 6

it is a global problem

rise in T2DM associated with obesity

Question 7

How does obesity vary with social class?

Answer 7

• those in poorest societies have a greater risk of obesity

- depends on environment (food availability)

Question 8

Which age group has the highest BMI?

Answer 8

55-64

Question 9

What ethnic group has highest BMI?

Answer 9

highest in Caucasian and Bangladeshi

Question 10

How does BMI vary regionally?

Answer 10

Scotland and North England highest

Question 11

What is the trend for BMI in smokers?

Answer 11

lower BMI but greater central obesity

Question 12

How do genes influence obesity?

Answer 12

60% is inheritable but explain only 5% of obesity

Question 13

What important genes in CNS regulate body weight?

Answer 13

Anabolic/orexigenic molecules

• Neuropeptide Y
• MCH
• dopamine

Catabolic/anorectic molecules

• leptin receptor
• POMC
• CRH
• GLP-1R

Question 14

What is the average caloric intake per year?

Answer 14

900,000kcal

Question 15

What is the projected cost of obesity per year by 2022?

Answer 15

£30 billion / year

Question 16

How does obesity affect the rest of the body?

Answer 16

hypertension
diabetes - insulin resistance 
arthritis
depression
sleep apnoea
stroke
gallstone
cancer
infertility 
IHD

Question 17

What disease has the strongest influence from obesity?

Answer 17

T2DM - steep rise in relative risk of T2DM with rising BMI
Obesity –> insulin resistance –> more fat stored in liver and pancreas which is toxic –> greatly increases risk of T2DM

Question 18

How does location of fat affect risk?

Answer 18

Where you store fat changes risk of disease - subcutaneous of internally (omentum or fat associated with intestines/ around liver or heart)
Fat dictates metabolism as blood supply connects fat supply from gut to liver
Immune cells trapped in fat are inflamed when increase body fat
Greatly affects liver metabolism

android - apple
gynoid - pear

Question 19

How does insulin need change with increasing waist circumference?

Answer 19

increases with greater waist circumference

pancreas must work harder to control the same blood glucose []

Question 20

How can you monitor risk of T2DM?

Answer 20

monitor insulin sensitivity by assessing waist circumference

Question 21

What is 10% weight los associated with?

Answer 21

fall in LDL, TGs, total cholesterol, FBS
rise in HDL
improvement of BP

reduction in mortality risk by 20-25%
30-40% reduction in diabetes risk
40-50% reduction in some cancers

Question 22

What does NICE recommend for obese individuals?

Answer 22

diet
exercise
behavioural therapy
drugs
surgery

Question 23

Why do people feel more hungry after initial loss of weight?

Answer 23

body avoids loss of weight - tries to boost hunger

Question 24

What is the problem with pharmaceutical management?

Answer 24

body weight increases as soon as drug removed
side effects
- SIBUTRAMIDE (depression, hypertension)

Question 25

What surgical intervention has a significant impact on reducing obesity?

Answer 25

gastric bypass

Question 26

What system is used to manage obesity?

Answer 26

TIER system with appropriate lifestyle advice