Obesity ☺️

Question 1

Description

Answer 1

A condition that arises when one has excess body fat that may impact on health

Question 2

Epidemiology

Answer 2

Worldwide obesity has tripled since 1975

According to PHE, 7 out of 10 men and 6 out of 10 women are overweight or obese.
3 out of 10 men and 3 out of 10 women are obese

Question 3

Aetiology

Answer 3

Imbalance between energy intake and expenditure influenced by modifiable factors like
Lifestyle factors
-poor diet high in fat, salt, calories, alcohol
-lack of physical activity
-smoking cessation
-stress

Medical

• hypothyroidism
• Cushings, steroids
• hypothalamic damage

Genetics
-Prader Willi

Question 4

Pathophysiology

Answer 4

Leptin -

• produced by adipose => acts on hypothalamus, decreases apetite
• stimulates MSH, CRH release

Ghrelin -

• produced by P/D1 cells on stomach fundus and epsilon cells of pancreas
• increases before meals and decreases after meals

However, these outputs can be overriden by many mechanism including higher cortical inputs or the development of leptin resistance

Question 5

Symptoms

Answer 5

Increased fat around waist and abdomen
May feel tired, sweaty or breathless after any physical activity
Increased back, joint pain

Question 6

Differential diagnoses

Answer 6

Iatrogenic/idiopathic
-Corticosteroid use

Endocrine

• hypothyroidism => fatigue, depression, cold intolerance, dry hair and skin, muscle cramps
• Cushings => central obesity, striae, proximal muscle wasting, hirsuitism, moon faced

Question 7

Signs

Answer 7

High BMI when weight and height measured

Question 8

Diagnostic criteria

Answer 8

BMI = kg/m2
-Healthy = 19.5-24.9
-Overweight = 25-29.9
-Obesity I = 30-34.9
-Obesity II = 35-39.9
-Obesity III - 40+
Be wary that you might get a high BMI with very muscular patients

If BMI is less than 35, consider also measuring waist circumference

• 94cm+ in men or 80cm+ in women => increased risk of obesity related problems
• 102cm+ in men or 88cm+ in women => very high risk of obesity related health problems

Question 9

Investigations

Answer 9

Rule out other causes

• TFTs => hypothyroidism
• Cortisol => dexamethasone suppression test to test for Cushing’s

Question 10

Management - conservative

Answer 10

Increase energy use, reduce intake

• low fat, salt, alcohol
• high fibre, starchy foods, moderate protein
• aim to do at least 30mins of moderate intensity exercise 5 days a week

Question 11

Complications

Answer 11

T2DM
IHD
Dyslipidemia
HTN
OA
Breast, bowel cancer

Question 12

Management - medical and surgical

Answer 12

In addition to conservative
Orlistat  
-low fat diet
-SE, hepatitis, steattorhea
Liraglutide
-GLP agonist => weight loss for 1+ weight related comorbidity

Medical + surgery if
-BMI 40+ OR BMI 35+ diabetes/other comorbidities + other measures have failed
=> gastric bypass, sleeve