Obesity Symposium Flashcards
Define obesity
Obesity is a disorder in which excess body fat has accumulated to an extent that health may be adversely affected.
How is an assessment of obesity made?
Most widely used measure is Body Mass Index
BMI=person’s weight in kilograms divided by the square of their height in metres
Which BMI is obese?
At or over 30 kg/m2
How is obesity assessed in children?
Population reference charts using BMI centiles
Children with a BMI at or above the 91st centile will require clinical intervention
State some exceptions to the BMI measurement
Children - use age & gender specific standards
Athletes - particularly those with high muscle mass
People at the extremes of the height distribution
Non-Caucasian populations
(BMI >27.5 in Asian person is associated with comparable morbidities to those in Caucasian with BMI >30)
State some patterns of obesity
General obesity
Central abdominal obesity
Describe general obesity
Fat is distributed over the whole body
Describe central abdominal obesity
Fat is distributed mainly in the chest and abdomen.
What is central abdominal obesity more associated with?
Central abdominal obesity is associated with higher risks of diabetes, raised blood lipids, and greater cardiovascular morbidity and mortality compared to general obesity.
Define metabolic syndrome
A cluster of conditions (body fat, blood lipids, BP, blood sugar associated with increased risk of stroke, heart disease and diabetes).
Increased waist circ. and at least 2 of the following:
Raised blood triglyceride:
Reduced HDL (good) cholesterol:
Raised BP:
Raised fasting glucose:
What is the most common way to define central obesity?
Measurement of the waist circumference
List some individual social factors associated with weight
Gender, age, ethnicity, employment, income, education, marriage status, parenthood, household size, residential density
Is obesity at epidemic levels?
Worldwide increase in prevalence Dramatic accelerated in last decade Dire predictions: Obesity to overtake smoking as cause of preventable death Parents to outlive obese children
Why are health and obesity linked?
Increased mass of fat causes changes at cellular and metabolic levels
Increased weight causes increased wear and tear in joints
Increased fat around the airway – asthma and sleep apnoea (breathing pauses while asleep)
Increased fat in blood alters the insulin response
Associated inactivity has independent effects
Describe the health impact of obesity in children
Type 2 Diabetes Mellitus – former adult disease, increasing in children – 95% of children with Type 2 DM are overweight and 83% obese
Asthma – overweight / obesity increases asthma risk by 40-50%
Sleep apnoea – Obstructive sleep apnoea prevalence estimated at 60% in obese children
Cardiovascular risk – damage in childhood increases risk of hypertension in adults (26% risk vs 6% risk in normal wt.)
Musculoskeletal – Tibia vara (bow legs), slipped femoral epiphysis, knee pain, ankle foot pain / problems
Mental health – Low self esteem, emotional and behavioural problems
Describe the health impact of obesity in adults
Circulatory system– Increased risk of hypertension – co-factor for stroke and coronary heart disease, deep venous thrombosis, pulmonary embolism
Musculoskeletal – weight on the joints – especially the knees with cartilage degeneration. Low back pain.
Metabolic and endocrine systems – Type 2 DM, dyslipidaemias (high cholesterol and triglycerides) with atherosclerosis (fat in lining of arteries), gout
Cancer– Increased risk of breast, colon and endometrial cancers
Reproductive and urological problems – Stress incontinence in women, menstrual abnormalities, polycystic ovarian syndrome, infertility, childbirth risks, erectile dysfunction
Respiratory system – Sleep apnoea and asthma
Liver disease – fatty liver = non-alcoholic fatty liver disease (NAFLD) (steatosis = fat infiltration of liver cells). NAFLD prevalence rising, may require liver transplant at later stages
Gastrointestinal– gastro-oesophageal reflux, gall stones, pancreatitis
Psychological and social – Low self esteem, stress, social disadvantage, depression, reduced libido
List some interventions to address obesogenic behaviour. Give some examples of each
Policy- Legislation, voluntary agreements with industry
Education/communication- media campaigns
Technological changes- Food processing
Treatments of individuals- Motivational interviewing, diets, exercise, drugs, surgery
What are obesogenic environments?
Environments that encourage eating unhealthily and not doing enough exercise
For example: High streets, public spaces dominated by takeaways, coffee shops - calorie dense foods
Describe some brief interventions for behaviour change
Short
Evidence-based
Structured
Non-confrontational
Seeks to motivate to think about behaviour change
Can use motivational interviewing techniques.
Making Every Contact Count (MECC)
What is brief intervention?
A conversation with a patient in a non-confrontational way to motivate and support the individual to think about and/or plan a change in their lifestyle
Brief interventions could be around 30 seconds . They should identify the patients at risk (ASK), explain how best to change behaviour (ADVISE) and refer to obtain help (ASSIST) (PHE 2017. Let’s talk about weight)
Describe the assessment of obesity in primary care
Assess eating behaviour, lifestyle, risk factors environment, willingness to change, psychological problems, medical problems and medication
Advise on management: diet (avoid very low calorie [<800]), exercise, behaviours,
Consider drugs
Referral for surgery
List some different treatments for obesity
Diet/exercise
drugs
surgery
Describe how to give diet based treatment
Set realistic target 5-10% weight / weekly loss 0.5-1.0 kg
Focus on long-term lifestyle change rather than short term quick fix
Balanced healthy eating diet
Multi-component – diet and variety of activities
Regular physical activities that are part of daily life (walking, gardening)
Identify high risk situations, encourage in face of lapses
Ongoing support
Describe the use of drugs in treatment of obesity
Sibutramine - promotes satiety by inhibiting Noradrenaline and Serotonin re-uptake
Orlistat – a lipase inhibitor, can cause steatorrhoea (fatty stools) – consider need for Vitamin D supplements
Avoid use of bulking agents (methyl cellulose), diuretics, dexamphetamine and thyroxine.
Metformin and Acarbose (Type 2 DM drugs) have no proven efficacy and are not licensed for obesity along
List the potential outcomes of bariatric surgery
Type 2 Diabetes Mellitus – 65% will achieve remission in 2 years post-surgery however 1/3 of these will re-develop diabetes within 5 years
Hypertension – Effect from weight loss is variable and can be unpredictable; some patients can stop antihypertensives
Dyslipidaemia – Surgery reduces total cholesterol, LDL and triglycerides while increasing HDL. Consider continuation of statins
Over 10 year period – around 25% of patients will regain any lost weight
How does weight loss work?
Eat less calories than you expend
Why is weight loss so difficult?
Obesogenic environment.
Genetics, family history, pharmacology, physical and mental health.
Microbiome.
= difficulty maintaining lower calorie diet
Body “protects” from weight loss through
Metabolic adaptations to weight loss
Hunger in response to weight loss
How much weight loss is enough to improve health outcomes? Is it worth it?
Almost any amount of weight loss is beneficial: weight reductions as small as 2-5% can improve metabolic control
What are our options for dietary interventions
Calorie deficit- 500Kcal les than requirements
Very low calorie diet- Meal replacements as in DIRECT
Intermittent fasting- The 5:2 diet
Time Restricted eating – Eating within a certain period in 24 hrs.
Health at every size approach- Focusing on health not weight
