Obesity (E&M) Flashcards
Define obesity.
- chronic adverse condition due to an excess amount of body fat
- defined as BMI >=30kg/m2 (can be grouped into classes 1-3)
What are the classes of obesity? (3)
- class I: 30-34.9kg/m2
- class II: 35-39.9kg/m2
- class III: >=40kg/m2
How prevalent is obesity in adults and adolescents?
40% of adults and 20% of adolescents (12-19 years)
What are the categories of causes of obesity? (4)
- genetic - monogenic forms include leptin deficiency, Prader-Willi Syndrome
- behavioural - larger portion sizes, sedentary lifestyle, poor dietary habits
- environmental - low socioeconomic level
- hormonal - hypothyroidism, hypercortisolism, insulinoma
What is the main clinical feature of obesity?
High waist circumference and BMI>=30kg/m2
What comorbid conditions may you see with obesity? (15)
- T2DM
- CVD
- hypertension
- hyperlipidaemia
- GORD
- asthma
- OSA
- stroke
- gout
- cancer
- gallbladder disease
- arthritis
- depression
- urinary incontinence
- NASH
What are some risk factors for obesity? (4)
- hypothyroidism
- hypercortisolism
- corticosteroid therapy
- peri- and post-menopause
What is the first-line investigation for obesity?
Clinical exam - BMI measurement (weight in kg/height in m2)
When is BMI not accurate? (2)
- pregnant women
- people with large muscle mass e.g. athletes
What other investigations can we do for obesity? (4)
- FBC - may show anaemia
- serum transaminases - elevated if liver dysfunction
- TFTs - hypothyroidism can cause obesity
- ECG - may show heart abnormality
What are some differential diagnoses for obesity? (2)
- primary/central hypothyroidism
- Cushing’s syndrome
What are the different weight categories according to BMI (kg/m2)?
- underweight: <18.5
- normal: 18.5-24.9
- overweight: 25-29.9
- obese: 30-39.9 (class I/II obesity)
- extremely obese: >/=40 (class III obesity)
What is first-line management for class I obesity (30-35kg/m2) or BMI>27 with obesity-related comorbidity?
- dietary changes - women 1000-1200kcal/day, men 1200-1500kcal/day (produces 500-1000 calorie deficit/day + low carb/high protein)
- increase in physical activity (moderate physical exercise)
What medications can we consider for obesity? (3)
- orlistat - inhibits gastric and pancreatic lipases
- liraglutide - GLP-1 agonist = induces incretin effect, use if:
- BMI>/=35
- prediabetic hyperglycaemia (e.g. HbA1c 42-47mmol/mol)
- naltrexone - opiate antagonist
How do we manage obesity with BMI>/=35 with or without comorbidities (or BMI>30 with lifestyle/medications not working)?
Bariatric surgery - sleeve gastrectomy, gastric banding, gastric bypass, intragastric balloon pump
