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Pathophysiology of ill-health > Obesity > Flashcards

Obesity Flashcards

1
Q

What is the definition of Obesity?

A

Obesity is the deposition of excess fat in the body and is caused by ingestion of greater amounts of food than can be utilised by the body as energy.

Imbalance between food consumed and exercise taken

High

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2
Q

Where is fat stored?

A

Adipose tissue / fat tissue

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3
Q

What happens to excess carbohydrates?

A

Stored as glycogen in the liver and muscle

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4
Q

Effects of obseity (2 x)

A

Physical changes due to increased mass of fatty tissue

Changes at cellular and metabolic level due to increased production of various products by enlarged fat cells, e.g. inflammatory mediators, cytokines

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5
Q

Anthropometry

A

Used t assess and predict performance, health and survival of individuals and reflect the economic and social well being of populations

Widely used, inexpensive, non-invasive measure of the general nutritional status of an individual or population group

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6
Q

Commonly used anthropometry assess:

A

Height/weight chart

BMI

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7
Q

Key

A

Weight for age
Weight for height
Height for age
Mid upper arm circumference

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8
Q

Definition of obesity (Ref)

A

A disorder of excess body fatness that is associated with an increased risk of disease (WHO, 2000)

Based on BMI score

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9
Q

BMI score - how calculated?

A

weight in kilograms divided by height in meters squared

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10
Q

Classification of underweight, normal weight, overweight

A 
<18.5
18.5-24.9
>25
25-29.9 Pre obese
30-34.9 Class 1 Obese
35.0-39.9 class 2 Obesity
>40 Class 3
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11
Q

Relevance - stats - worldwide

A

> 300 million adults worldwide
Assoc with reduced qual of life and health issues
Enormous public health issue with serious physical, psychological and social effects on the population

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12
Q

Relevance - stats - UK

A

In 2015, 58% of women and 68% of men were overweight or obese

Obesity prevalence increased from 15% in 1993 to 27% in 2015

In 2015/16, over 1 in 5 children in reception and over 1 in 3 children in year 6 were measured as obese or overweight

In 2015/16 there were 525,000 admissions where obesity was recorded as a factor

Bariatric surgery - 3/4 patients were 35-54, 3/4 were female

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13
Q

Aetiology of Obesity

A

Energy imbalance - increased food/ calorie intake and reduced physical activity

Medications - steroids, antipsychotics, some antidepressants, contraceptives, valproate

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14
Q

3 x metabolic factors predictive of weight gain:

A

Low adjusted sedentary energy expenditure

High respiratory quotient (carbohydrate to fat oxidation ratio)

Low levels of spontaneous physical activity

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15
Q

Relevance - obstetric perspective

A

Prevalence of maternal obesity carries significant maternal risk to child and mother

Practical difficulties with examination can cause knock on problems

Make ventilation and intubation difficult - failed intubation is the leading cause of maternal death in relation to anasthesia

++ so much info in lectures

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16
Q

Health consequences

A

Increased risk
Reduced quality of life
Chronic inflammation
Presence and clustering of cardiovascular and metablic risk factors
Fatty liver
Asthma exaccerbations
Long term persistence
Poor long term educational and economic attainment
Increased risk of poor psychosocial health

17
Q

MH Relevance?

A

Those diagnosed with severe and enduring mental illnesses such as schizophrenia and bipolar disorders are at increased risk for a range of physical illnesses and conditions including coronary heart disease, infections, respiratory disease and obesity

2 x likely to die from coronary heart disease
4x more likely to die from respiratory disease

/in many cases, weight gain is a clear side effect from

18
Q

LD Relevance?

A

Obesity is unusually high, increased risk of heart diease, t2 diabetes etc…

Genetic - Down’s syndrome and Prader-Willi syndrome

19
Q

prevalnce of obesity amoung adults (reference)

A

Health Survey for England 2012-2014:

Overweight:

Almost 7/10 men are overweight or obese (66.4%)

Almost 6/10 women are overweight or obese (57.5%)

Obese:

One in 4 men is obese (24.9%)

One in 4 women is obese (25.2%)

Trend - obesity is increasing in the population

20
Q

It is widely recognised that obesity increases the risk of…?

A
  • All causes of death at any given age
  • Coronary heart disease, stroke, hypertension hyperlipidemia, and type 2 diabetes
  • High LDL cholesterol or low HDL cholesterol
  • Sleep apnoea
  • Breast, endometrial, ovarian, liver and colon cancer
  • Gallbladder disease
  • Musculoskeletal disorders / osteoarthiritis
  • Infertility
  • Non alcoholic liver disease
  • Pain and difficulty with physical functioning

Indirectly related to MH - low SE, anxiety, clinical depe

21
Q

Impact of Obesity on Major Body Systems…

Circulatory System!

  1. Blood Pressure
A

. More fatty tissues mean more circulatory blood is required to perfuse tissues. This increases the workload of the heart and puts more pressure on the artery walls.

Obesity can therefore raise heart rate and reduce ability to transport blood through the vessels.

Strong relationship between Obesity -> Hypertension

Hypertension is a risk factor for CHD, stroke and renal failure

High BP damaged nephrons

Cardiovascular lecture - artherosclerosis

Risk of deep vein thrombosis and pulmonary embolisms also increased

**HIGH BLOOD PRESSURE ** shear stress damages inner lining of arteries - narrows and hardens.

If arteries narrow - red cells bump into lumen, break up RBC fragments (schistocytes)…can travel and cause damage

Heart Disease - ARTHEROSCHLEROSIS is present 10 x more often in obese people compared to non obese

CORONARY HEART DISEASE due to more fatty deposits in arteries that supply the heart.

Narrowed arteries and reduced blood flow to the heart can cause chest pain (stable or non-stable angina) or an myocardial infarction (ST elevation or non-ST elevation)

Subsequent blood clots can cause stroke or pulmonary embolism

22
Q

Impact of Obesity on Major Body Systems…

Circulatory System!

  1. Diabetes
A

DIABETES - obesity as major cause

Occurring more in children

Causes insulin resistance (pancreas doesn’t produce enough or body reacts unusually to insulin) blood sugar levels become elevated

Even moderate obesity dramatically increases the risk of diabetes

Sugary environment - good for bacteria, increases infection

How? Abdominal fat causes fat cells to release ‘pro-inflammatory’ chemicals, which disrupts function of insulin responsive cells.

Normal health - glucose via glucose transporters, these transport glucose by diffusion down concentration gradients

Glut4 receptor - allows glucose to enter cells, activated by insulin

Insulin resistance in fat cells is associated with decrease glut4 transporter number and activity.

Acanthosis Nigricans - dark patches caused by poor perfusion due to elevated glucose in bloodstream

23
Q

Impact of Obesity on Major Body Systems…

Joints

A

Including osteoarthrosis

Non-inflammatory joint disease characterised by degeneration of the joint cartilage

Obseity can affect kneews and hips because of the stress placed on the joints by extra weight

Joint replacement surgery, while commonly performed on damaged joints, may not be an advisable option because artificial joint has a higher risk of causing further damage.

24
Q

Impact of Obesity on Major Body Systems:

Gastro

Asthma - Inflammatory mediators

Independent reading? Relationship between obesity & service user outcomes…?

A

Obesity assoc. with increased risk of gastro-oesophageal reflux

Due to direct abdominal pressure on diaphragm

Acid in trachea

Aspiration luminitis/?

25
Q

Impact of Obesity on Major Body Systems:

Repsiratory

A

Sleep apnoea and respiratory problems

Stop breathing for brief periods causing tiredness during the day. Also causes heavy snoring.

Added weight of chest wall squeezes the lungs and causes restricted breathing.

26
Q

Impact of Obesity - Cancer

A

CVD causes 37% (200,000) of deaths each year in the UK

Cancers cause 27% (156,000) of deaths

At least part of the cause of these diseases are due to weight and obesity

18,000 develop cancer because they are overweight. This is set to treble in the next 2 x decades.By 2035, 56,000 will develop obesity related cancer

27
Q

Impact of Obesity - Cancer

A

CVD causes 37% (200,000) of deaths each year in the UK

Cancers cause 27% (156,000) of deaths

At least part of the cause of these diseases are due to weight and obesity

18,000 develop cancer because they are overweight. This is set to treble in the next 2 x decades.By 2035, 56,000 will develop obesity related cancer

Cancer in overweight men - esp. colon and prostate
Cancer in overweight women - esp. breast, colon, gallbladder, liver and uterus

28
Q

International Agency for Research on Cancer (IARC)

A

Reviewed ++ data, concluded that excess body fatness causes….
Colon and Rectal Cancer
Liver, gallbladder, pancreas, kidney, thyroid, breast (post menopause), endometrium, ovary, oesophagus (adenocarcinoma) and gastric cardia, as well as meningioma and multiple myeloma

This makes body fat the second most modifiable cancer risk factor after tobacco use.

29
Q

How does Obesity cause cancer…?

A

Fat cells attract immune cells to body tissues

These immune cells release chemicals that cause long-lasting inflammation which raise the risk of cancer

Excess fat changes levels of sex hormones oestrogen, testosterone. This can increase cancer risk.

Insulin (hormone) is very important part of how the body uses energy from food - in overweight people there is much more insulin in the body.

Its unclear how this could lead to cancer, but one mechanism could be insulin affecting levels of growth factors available to cells which tell them to divide.

30
Q

Non-alcoholic Fatty Liver Disease

A

Range of conditions resulting from the accumulation of fat (steatosis) in cells inside the liver

One of the commonest forms of liver disease in the UK

If left untreated, it may progress to severe forms such as cirrhosis (scar tissue, making inflexible, less spongey and ineffective)

Fatty liver disease linked to liver cancer

31
Q

Spectrum of NAFLD

A

Fatty liver (fat accumulates in liver)

Non-alcoholic steatohepatitis (fat plus inflammation and scarring)

Cirrhosis (Scar tissue replacing liver cells)

32
Q

Normal functions of the liver

A
  • Produces bile and bile salts
  • Storage of minerals, vitamins A, D, E, K, B12, copper and iron
  • Role in metabolism
  • Glucose converson, storage and release
  • Storage of glucagon
  • Amino acid conversion into glucose with deamination of amino acid to urea
  • Lipid metabolism
  • Synthesis of carbohydrates
  • Excretion of steroid hormones
  • Production of clotting factors
  • Production of plasma proteins
  • Production of cholesterol
  • Heat Generator
  • Destroys red blood cells
  • Excretory organ detoxifying poisons
  • Immune system - phagocytosis
  • Lactate processing

ANY of these functions can therefore be impaired by obesity

33
Q

Oesophogeal Varicies

A

Consequence of liver cirrohisis
Scarred liver, poor elasticity
blood supply to liver impaired, back pressure on

Pathophysiology of ill-health (16 decks)

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