PBL 2 Flashcards
what is the definition of obesity?
A disease marked by excessive generalised deposition and storage of fat, with a BMI of over 30.
what is the definition of overweight?
A condition where the person weighs more than what is considered normal for that height, age, and sex. Marked by a BMI of over 25.
what is leptin deficiency?
Leptin is a hormone that inhibits hunger. Its associated with feeling constantly hungry and quickly gaining weight. Without treatment, the extreme hunger continues and leads to chronic excessive eating (hyperphagia) and obesity.
what is leptin receptor deficiency?
Lack the receptors for leptin so constantly hungry and gain weight quickly (normal weight at birth) – the extreme hunger leads to hyperphagia and obesity.
what is prohormone convertase-1 deficiency?
A rare genetic endocrine disease characterized by early onset of severe intractable diarrhoea and intestinal malabsorption, followed by obesity and hormonal deficiencies due to insufficient activation of several prohormones. It results in hypercortisolism, hypothyroidism, diabetes insipidus, hypogonadism, growth deficiency, and diabetes mellitus.
what is proopiomelanocortin deficiency?
Low levels of adrenocorticotropic hormone (ACTH), leads to a condition called adrenal insufficiency which often results in periods of severely low blood sugar which can cause seizures, elevated levels of bilirubin, early onset of obesity and reduced ability to produce bile. They tend to have red hair and pale skin.
what are MC4R gene deficiencies?
They are characterised by severe obesity, an increase in lean body mass and bone mineral density, increased linear growth in early childhood, hyperphagia beginning in the first year of life and severe hyperinsulinemia.
what is the function of the MC4R gene?
A mediator of the anorexigenic effects of leptin which reduces food intake and increases energy expenditure.
when should an antiobesity drug be considered?
for those with a BMI of ≥ 30 kg/m2, in whom diet, exercise and behaviour changes fail to achieve a realistic reduction in weight
when may an anti-obesity drug be considered with someone of BMI of 28 kg/m3?
In the presence of associated risk factors
which drugs are licensed for use in the UK as an anti-obesity drug?
orlistat
when should discontinuation of orlistat be considered?
after 12 weeks if weight loss has not exceeded 5% since the start of treatment.
describe orlistat mechanism of action?
reversibly inhibiting the gastric and pancreatic lipases. These lipases have an important role in the digestion of dietary fat as they break down the triglycerides into absorbable free fatty acids and monoglycerides
what is the youngest age that can take orlistat?
12
what are some common side effects of orlistat?
fatty or oily poo, needing the toilet urgently, pooing more frequently, oily discharge from rectum, flatulence, stomach pain, headaches or upper respiratory tract infections.
what is the mechanism of action of liraglutide?
agonist of glucagon-like peptide-1 receptor which is coupled to adenylate cyclase so an increase in cyclic AMP stimulates the glucose dependant release of insulin whilst inhibiting the glucose dependant release of glucagon which slows gastric emptying to increase control of blood sugar.
what is the mechanism of bupropion?
dual inhibition of norepinephrine and dopamine reuptake which causes antidepressant action and seems to cause reduced food intake and increased energy expenditure.
what is the mechanism of lorcaserin?
gonist of 5HT2C receptors on the pro-opiomelanocortin neurons in the arcuate nucleus which causes the release if alpha melanocortin stimulating hormone which acts of melanocortin-4 receptor which suppresses appetite.
what is the mechanism of phentermine?
an adrenergic agonist that increases the release of norepinephrine in the hypothalamus which induces appetite suppression and increases resting energy expenditure.
what are some social consequences of obesity?
depression, anxiety, low self-esteem, body dissatisfaction, poor concentration levels, exclusion at school, likely to suffer from prejudice and discrimination, lower employment, fewer friends, lower quality of life, negative emotional reactions to dieting, impaired movility
who could be considered for bariatric surgery?
patients who have a BMI of ≥ 40 kg/m2 (Obesity III, morbid obesity), or between 35–39.9 kg/m2 (Obesity II) and a significant disease (such as type 2 diabetes or high blood pressure) which could be improved with weight loss, and if all appropriate non-surgical measures have been tried but clinically beneficial weight loss has not been achieved or maintained.
they must be fit enough to have anaesthesia and surgery and has been receiving intensive management as part of their programme as well as committing to the need for long-term follow up.
what are the 3 types of bariatric surgery?
gastric band, gastric bypass, sleeve gastrectomy
what is a gastric band?
a band is placed around your stomach, so you do not need to eat as much to feel full
what is a gastric bypass?
the top part of your stomach is joined to the small intestine, so you feel fuller sooner and do not absorb as many calories from food
what is a sleeve gastrectomy?
some of your stomach is removed, so you cannot eat as much as you could before, and you’ll feel full sooner
what happens to lifestyle after bariatric surgery?
diet will be liquid and soft food for a few weeks, an exercise plan will have to be stuck to and regular follow-up appointments must be attended
how soon after a bariatric surgery can you become pregnant?
12-18 months after
what are some risks of bariatric surgery?
excess folds of skin
not gaining enough vitamins and minerals from diet so you will have to take supplements
gallstones are very common
blood clots in legs or lungs
the gastric band may slip out of place or the gut may become blocked or narrowed
what are the 2 genres of bariatric surgery?
restrictive and malabsorption procedures
what do restriction procedures do?
decrease the size of the stomach so you feel fuller sooner
what do malabsorption procedures do?
decrease the absorption of calories in the small intestine
what are some disadvantages to bariatric surgery?
acid reflux chronic nausea and vomiting inability to eat certain foods infections high risk surgery
