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Metabolic and Endocrine > Obesity > Flashcards

Obesity Flashcards

1
Q

what do you need to know when undertaking a dietary intake assessment?

A

Assess average day/weeks intake, weekends, frequency of eating out, alcohol intake
Structure and timing of meals
Nutritional balance and adequacy of dietary intake
Portion sizes
Snacking-what foods and what time of day
Any relationship between mood and food

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2
Q

what is the definition of obesity?

A

condition characterized by increased fat accumulation with associated risk to health. Weight is in excess of reference values or standard criteria. BMI is the universally used and acceptable criteria for screening obesity (BMI >25 threshold for overweight and >30 indicates obesity

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3
Q

how can obesity be measured?

A

BMI, Percent body fat and wait circumference

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4
Q

what are the advantages of using BMI?

A

Good correlation with metabolic disease
Easy and low cost
Adequate first screening
Adequate for epidemiological and population studies

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5
Q

what are the disadvantages of using BMI?

A

Doesn’t account for muscle, fat free mass
Cut off points don’t distinguish between male/female or racial features
Be used only as part of evaluation and more accurate when used in association with other methods

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6
Q

what are the advantages of using percentage body fat?

A

Takes fat free mass into consideration

More reliable for athletes, elderly etc

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7
Q

what are the disadvantages of using percentage body fat?

A

Single site skinfold is not accurate or reproducible
Electronic machines expensive
Does not correlate with metabolic syndrome as well as WC

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8
Q

what are the advantages of using waist circumference?

A

Good correlation with metabolic syndrome especially when BMI <35
Direct anatomical measure that clearly reflects dysfunction adipocytes
Easy low cost

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9
Q

what are the disadvantages of using waist circumference?

A

Sometimes measurement is not reproducible
Ethnicdifferences
Not superior to BMI to predict metabolic dysfunction if BMI>35

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10
Q

describe the prevelance of obesity in adults

A

2014 – 13% of worlds population (11% M / 15% F were obese
Adult obesity
Highest in US (35.9%) and lowest in japan (3.5%).
24.8% in England

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11
Q

describe the prevalence of obesity in children?

A

2010 – 6.7% children overweight and obese globally
highest in Greece (B=44.4% G=37.7%
Lowest in turkey (B=11.3% G=10%
England B=21.8% G=26.1%

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12
Q

when is bariatric surgery an option for adults with obesity?

A

BMI or more than 50 when no other interventions effective or is used if the following criteria is fulfilled
BMI of 40 or more, or between 35 and 40 with other significant disease such as type 2 diabetes or high blood pressure
All appropriate non surgical measures have been tried but they haven’t achieved or maintained adequate weight loss
They have been receiving or will receive intensive management in tier 2 service
Generally fit for anaesthesia and surgery
They commit to the need for long term follow up

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13
Q

what are the options for medical treatment of obesity?

A

orlistat

liraglutide (saxenda)

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14
Q

when can orlistat be used in obese patients?

A

BMI 28 with associated risk factors
BMI >30
Continue orlistat beyond 3 months if lost 5% of initial weight

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15
Q

when can liraglutide (saxenda) be used in obesity treatment?

A

Obese overweight with risk factors
BMI of 30
BMI 27 upto 30 with presence of at least one weight related comorbidiy such as dysglycamia, hypertension, dysliidaemia or obstructive sleep apnoea
Treatmend discontinued after 12 weeks on 3mg

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16
Q

describe the features of adjustable gastric band (lap band)?

A
  • inserted laparoscopically
  • fewer dietary deficiencies
  • less weight loss
  • adjustable
  • relatively easy surgical procedure
  • adjustable band placed around stomach and a port placed under the skin
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17
Q

describe the features of vertical sleeve gastrectomy?

A
  • portion of stomach removed, gastric sleeve is the new stomach
  • good weight loss
  • fewer dietary deficiency
  • hunger producing hormones are lowered
  • no foreign body used
  • no long term data
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18
Q

describe the features of roux-en-Y gastric bypass (RNY)?

A
  • most of stomach completely bypassed
  • long term, sustained weight loss
  • little protein calorie malabsorption
  • few vitamins or mineral deficiencies
  • technically difficult procedure
19
Q

describe the NHS diabetes prevention programme?

A
  • Recruits patients at high risk of developing type 2 diabetes and refers them to behavior change programe
  • Joint commitment from NHS England, public health England, diabetes UK started in 2016 covering half the population and aim for whole nation improvement by 2020.
20
Q

what are the aims of the NHS diabetes prevention programme?

A

Reduce incidence of type 2 diabetes
Reduce incidenceof complications associated with type 2 diabetes
Over long term, reduce inequlities associated with incidence of diabetes

21
Q

what is the eligibility of the NHS diabetes prevention programme?

A

Age >18
HbA1c 42-47mmol/mol
Fasting glucose 5.5-6.9mmol/L

22
Q

what are the 3 goals for individuals taking part in the NHS diabetes prevention programme?

A

Achieve healthy weight
Achieve dietary recommendations
Achieve physical activity recommendations

23
Q

what conditions is obesity associated with?

A

genetic syndromes associated with hypogonadism, hypothyrodisim, cushings syndrome, stein-Leventhal syndrome, drug induced, hypothalamic damage

24
Q

what are the factors related to food intake?

A

factors related to home environment, finance and availability of sweets and snacks affect this some people eat more during periods of heavy exercise or during pregnancy and are unable to get back to old habits

25
Q

describe normal control of appetite?

A

following a meal satiation occurs which depends on gastric and duodenal distension and release of substances peripherally and centrally
After a meal CC, bombesin, GLP-1, enterostatin and somatostatin are released from small intestine and glucagon and insulin from the pancreas. Centrally the hypothalamus plays a role in integrating signals involved in appetite and bodyweight regulation

26
Q

what are the 2 main appetite pathways in the arcuate nucleus?

A
  • central appetite stimulating (orexigenic) pathway
  • central appetite suppressing (anorexigenic pathway or leptin melanocortin pathway)
  • These pathways interact with each other and feed into lateral hypothalamus which influences ANS and ingestive behavior. The central pathways are influenced by a variety of peripheral signals
27
Q

describe the Central appetite stimulating (orexigenic) pathway?

A

In ventromedial part of arcuate nucleus which expresses NPY and AgRP. This pathway decreases energy expenditure

28
Q

describe the Central appetite suppressing (anorexigenic pathway or leptin-melanocortin pathway)?

A

Dorsolateral part of arcuate nucleus which expresses POMC/CART. In this pathway alpha-MSH, formed by cleavage of POMC by PC1, exerts appetitie suppressing affect via Mc4R in areas of brain that regulate food intake and autonomic activity. Increases energy expenditure

29
Q

what is the edmonton obesity staging system?

A
  • stages 0-4
  • each stage has obesity related risk factors
  • each stage has different level of physical symptoms, functional limitations etc
30
Q

describe stage 0 on the edmonton obesity staging system?

A
  • no obesity related risk factors

- no physical symptoms

31
Q

describe stage 1 on the edmonton obesity staging system?

A
  • subclinical obesity related risk factors (borderline hypertension, impaired fasting glucose, elevated liver enzymes)
  • mild physical symptoms
32
Q

describe stage 2 on the edmonton obesity staging system?

A
  • established obesity related risk factors (hypertension, T2DM, sleep apnoa, osteoarthritis, reflux, pcos, anxiety
  • moderate physical symptoms
33
Q

describe stage 3 on the edmonton obesity staging system?

A
  • established obesity related risk factors of end organ damage (MI, HF, diabetic complications)
  • significant physical symptoms
34
Q

describe stage 4 on the edmonton obesity staging system?

A
  • severe disabilities of obesity related risk facotrs (end stage)
  • severe physical symptoms
35
Q

what are the causes of weight gain in western society?

A 
Fatty acid deficiency 
Stress and adrenal fatigue
Hormonal imbalances
Dehydration and mineral imbalances
Brain chemistry deficiency
Unstable blood sugar
Digestive problems
Food sensitivities 
Yeast overgrowth 
Toxin overload
Genetics
Junk food
Food addiction
Western diet promotes insulin resistance 
Medications
sugar
36
Q

what BMI is healthy, overweight, obese?

A 
healthy weight: 18.5–24.9kg/m2
overweight: 25–29.9kg/m2
obesity I: 30–34.9kg/m2
obesity II: 35–39.9kg/m2
obesity III: 40kg/m2or more
37
Q

when should referral to tier 3 service be considered in obese patients?

A

the underlying causes of being overweight or obese need to be assessed
the person has complex disease states or needs that cannot be managed adequately in tier2 (for example, the additional support needs of people with learning disabilities)
conventional treatment has been unsuccessful
drug treatment is being considered for a person with a BMI of more than 50kg/m2
specialist interventions (such as a very-low-calorie diet) may be needed
surgery is being considered

38
Q

what behavioural interventions are useful in obese patients?

A

self-monitoring of behaviour and progress
stimulus control
goal setting
slowing rate of eating
ensuring social support
problem solving
assertiveness
cognitive restructuring (modifying thoughts)
reinforcement of changes
relapse prevention
strategies for dealing with weight regain.

39
Q

what dietary changes should be suggested in obese patients?

A

Tailor dietary changes to food preferences and allow for a flexible and individual approach to reducing calorie intake.
Do not use unduly restrictive and nutritionally unbalanced diets, because they are ineffective in the long term and can be harmful.
Encourage people to improve their diet even if they do not lose weight, because there can be other health benefits.

40
Q

when should drug treatment be considered for obese pateints?

A

Consider pharmacological treatment only after dietary, exercise and behavioural approaches have been started and evaluated.
Consider drug treatment for people who have not reached their target weight loss or have reached a plateau on dietary, activity and behavioural changes.

41
Q

when should bariatric surgery be considered for obese patients?

A

They have a BMI of 40kg/m2or more, or between 35kg/m2and 40kg/m2and other significant disease (for example, type2 diabetes or high blood pressure) that could be improved if they lost weight.
All appropriate non-surgical measures have been tried but the person has not achieved or maintained adequate, clinically beneficial weight loss.
The person has been receiving or will receive intensive management in a tier 3service[10].
The person is generally fit for anaesthesia and surgery.
The person commits to the need for long-term follow-up

42
Q

how does obesity cause insulin suppresion?

A

In obese persons, cells of fat tissues have to process more nutrients than they can manage. The stress in these cells triggers an inflammation that releases a protein known as cytokines. Cytokines then block the signals of insulin receptors, thus gradually causing the cells to become resistant to insulin.
Insulin allows your cells to use glucose (sugar) for energy. When you are resistant to insulin, your body is unable to convert the glucose into energy and you end up with a persistently high blood glucose level.
Besides suppressing normal responses to insulin, the stress also triggers inflammation in cells that can lead to heart disease

43
Q

what conditions and complications associated with obesity?

A 
psychological
osteoarthritis
varicose veins
hiatus hernia
gallstones
postoperative proplems
back strain
accident proneness
obstructive sleep apnoea 
hypertension
breathlessness
ischaeic heart disease
stroke
T2DM
hyperlipidaeia
menstrual abnormalities 
morbidity and mortality 
cancer risk
heart failure

Metabolic and Endocrine (12 decks)

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