obesity and cardiometabolic risk Flashcards
what 2 hormones have key roles in obesity
leptin and ghrelin
what is leptin
a hormone released by adipose tissue that regulates hunger by stimulating satiety
what is ghrelin
a multifaceted hormone that stimulates the hunger sensation and thus the drive to eat
6 adverse cardiometabolic effects of products of adipocytes
- hypertension (↑ angiotensinogen)
- atherogenic dyslipidaemia
- type 2 diabetes
- thrombosis
- atherosclerosis
- inflammation (↑ TNFa, ↑IL6 etc.)
how may obesity impact mental health
ma trigger depression, EDs, distorted body image and low self esteem; stigma around being obese may also contribute to the development of these conditions
why might the parent’s opinions causes childhood obesity to persist
many parents don’t recognise obese children =>no motivation for children to lose weight
what is metabolic syndrome
a group of health problems that put you at risk of type 2 diabetes or conditions that affect your heart or blood vessels
4 characteristics of metabolic syndrome
- insulin resistance
- hyperlipidemia
- autonomic dysfunction
- raised BP
metabolic syndrome diagnostic criteria
central obesity (BMI > 20 or high waist circumfrence) + and 2 of:
- high triglyceride (>1.7mmol/L on statin)
- reduced HDL
- raised BP (>130/85)
- raised fasting plasma glucose (5.6mmol/L or diagnoses T2DM)
what is blount’s disease
a growth disorder that affects the bones of the lower leg, causing them to bow outward -> excess weight on growth plates
what are the main resp obesity complications (3)
- hypoventilation
- Obtructive sleep apnoea
- central apnoea
what are the main derm obesity complications (2)
- hirsutism
- sweating
what are the main hepato-billary obesity complications (3)
- gall stones
- non alcoholic fatty liver
- colon cancer
what are the main endocrine obesity complications (3)
- sex hormone disorders
- pituitary hormone abnormalities
- impaired immunity
what are the main cardio obesity complications (3)
- hypertension
- ischaemic heart disease
- thromboembolism
what are the main reproductive obesity complications (3)
- hypogonadism
- infertility
- menorrhagia
what are the main ortho obesity complications (2)
- OA
- gout
how does obestiry lead to heart failure (pathway)
obesity -> expansion of intravascular volume -> increase cadiopulmonary volume/preload -> eccentric left ventricular hypertrophy -> ventricular dysarrythmias and systolic/diastolic heart failure
which cancers are at highest risk of developing due to obesity (8)
- endometrial
- oesophageal
- pancreatic
- kidney
- breast (post menopausal)
- colorectal
- ovarian
- gall bladder
what is key to find out in an obesity history
cause for weight gain -> is this treatable
what is overweight bmi
> 25 is overweight, obese is >30
what is acanthosis nicgrans
areas of dark, thick velvety skin in body folds and creases -> associated with insulin resistance -> often seen in obesity
what 3 visual findings are associated with insulin resistance
- acanthosis nicgrans
- skin tags
- lipoedema
obesity mgx
non surgical:
1. lifestyle changes (regular exercise, healthy eating, alcohol recommendations and smoking cessation etc.)
2. drug treatment (onlyif not responsive to lifestlye change) - orlistat and liraglutide
surgical:
bariatric surgery e.g. Roux-en-Y gastric bypass, sleeve gastrectomy, and gastric bypass
5 As of obesity counselling
- Assess: identify patient at risk
- Ask: “Before you leave could I check your weight today?”
- Advise: “One of the best ways to lose weight is with support and {insert name of weight management service} is available today. I can refer you now if you are willing to give it a go?”
- Assist in establishing interventions and securing goal attainment
- Actions: Make the referral, document the conversation, follow up with the patient
orlistat MOA
preventing the absorption of dietary fat -> side effects of flatulence and loos stools
liraglutide MOA
glucagon-like peptide-1 (GLP-1) analogue and a diabetic drug used to treat weight loss. It works by delaying gastric emptying and inducing early satiety resulting in an overall reduction in calorie intake and weight loss
what is the most cost effective obesity management combination
surgery + lifestyle change -> but surgery is not available everywhere
