Obesity & Eating Disorders Flashcards
What are the thresholds for being underweight, healthy and overweight/obese?
Underweight BMI <18.5 kg/m2
Healthy 18.5- 25
Overweight 25-30
Obese 30 or above
How is BMI calculated?
Weight in kg / height in m2
Why might BMI not be the most accurate tool?
It does not consider muscle density, overall body composition, race and sex differences
What are the causes of obesity
Society - cheap, palatable food with advertisement - availability.
- lifestyle choices
- busier lifestyles, lack of exercise
- Genetics, thyroid problems
- Hormones e.g Leptin and Grehlin that may affect energy balance
What are the health hazards of obesity?
- Type 2 diabetes due to glucose intolerance/insulin resistance
- Hypertension - due to increased angiotensinogen
- Increased cancer risk due to inflammation
- Sleep apnoea /respiratory due to excess visceral fat
- Fatty liver disease due to increased visceral adipose tissues
- Thrombosis/stroke/CVD - hyperlipidaemia, cholesterol
- Skin problems - inflammation, skin folds, hygeine
(In addition to osteoarthritis/mental health)
What is a better diagnostic marker for excess visceral fat and what are the parameters?
Waist circumference cm
LOW: men <94cm, Women <80cm
HIGH: men 94-102 cm, women 80-88cm
What does waist circumference correlate with?
Risk of type II diabetes in men e.g 96.4cm and above
What is an advantage of waist circumference measurement?
Recognise ethnic origin e.g European, asian ,chinese
What are the benefits of weight loss?
- reduced mortality - improved risk profile if 5-10% WL
- Reduced mortality by 20% if have an obesity related disease
- Reduced risk of all CVD
- Hypertension - BP reduces 1mmhg for every1kg loss
- Type 2 diabetes - 4g loss, 58% reduced risk
What is the role of the Pharmacist in obesity?
Support & empowerment - helping them recognise the problem and associated risks, providing advice on:
- physical activity
- diet
- behaviour and lifestyle changes
- Also advising on OTC products for e.g joint pain
- Advising on requests for OTC Alli or prescriptions for Orlistat
- managing expectations e.g that it is progressive, only 5-10% WL, lifelong dieting
- Setting goals e.g reducing co-morbidities, increasing metabolic health
What dietary advice could be given?
Total energy intake determines the effectiveness of weight loss with diet. Low caloric meal replacements e.g break relationship with food?
Eating behaviour - reducing portion sizes, smaller plates? identifying any emotional eating and reasons/patterns
What exercise advice could be given?
In combination with diet - maintains WL better than dieting alone.
If overweight - moderate increase in activity provides greatest benefit. Min 3 days/week, 300 kcal / session
But must be aware that energy in = energy out so if eat loads but don’t exercise = overweight
What does exercise do?
Enhances fat mobilisation from adipose depots and fat breakdown
Protects against protein loss, improves insulin sensitivity
What is Orlistat and what is the licensing ?
In conjunction with a mildly hypocaloric diet in individuals with a BMI of 30kg / m2 or more
(or BMI of 28 or more with another risk factor e.g type 2 diabetes)
What is the MoA of orlistat and dose?
Dose - 120mg up to TDS - immediately before,during or 1 hour after each main meal - but if meal is missed or contains no fat then omit dose
MoA: inhibits pancreatic lipase enzyme that breaks down triglycerides in ingested fat - increases excretion of fats
