T1 L18: Appetite and weight

Question 1

What are some medical problems associated with obesity?

Answer 1

• Metabolic syndrome
• T2 diabetes mellitus
• Cardiovascular disease
• Respiratory disease
• Liver disease
• Cancer
• Reproductive dysfunction
• Joint problems
• Mental health problems

Question 2

What cardiovascular problems arise with obesity?

Answer 2

• high blood volume and blood viscosity
• Increased vascular resistance
• Hypertension
• Increased risk of left ventricular hypertrophy
• Coronary artery disease
• Stroke

Question 3

What respiratory problems arise with obesity?

Answer 3

• Obstructive sleep apnoea
• Hypoxia/hypercapnia
• Pulmonary hypertension increasing risk of right heart failure
• Accidents like daytime somnolence

Question 4

What is Hypercapnia?

Answer 4

Build up of CO2 in the bloodstream

Question 5

What is daytime somnolence?

Answer 5

Excessive daytime sleepiness

Question 6

What GI-liver problems arise with obesity?

Answer 6

• Non-alcoholic fatty liver disease (NAFLD) 20% will then progress to non-alcoholic steatohepatitis and another 20% into cirrhosis and chronic liver disease
• Gallstones
• Acid reflux

Question 7

Which types of cancer are more likely with obesity?

Answer 7

Breast, endometrial, oesophageal, colon, gall bladder, thyroid, renal

Risk increased by increased insulin increased free EGF-1, increased oestrogen, adipo-cytokines, reflux

Question 8

Which problems to do with joints arise with obesity?

Answer 8

Osteoarthritis and gout

Question 9

What is gout?

Answer 9

Gout causes sudden swelling and severe pain in your joints commonly caused by too much uric acid within the body

Question 10

Which mental health condition are most likely with obesity?

Answer 10

• Eating disorders
• Depression
• Dementia

Question 11

What genetic factors cause obesity?

Answer 11

Obesity related syndromes: Prader-willies and Barder-biedi

Obesity is most commonly polygenic

Question 12

What are some causes of obesity?

Answer 12

• Genetics
• Hypothyroidism
• Cushing’s syndrome
• Environmental Eg, diet, physical activity

Question 13

Give examples of slow-acting hormones that regulate body weight

Answer 13

Leptin and insulin

Question 14

Give examples of rapid-acting peptides that regulate meal sizes

Answer 14

• Cholecystokinin (CCK) inhibits eating
• Ghrelin stimulates eating
• PYY inhibits eating for up to 12 hours

All released from the GI tract and they act via the hypothalamus

Question 15

What is the role of leptin in obesity?

Answer 15

Rarely, someone can have a leptin deficiency caused by a mutation to the leptin receptor which causes obesity

Question 16

What is Orlistat?

Answer 16

A drug used to treat obesity.

Mechanism: It binds to and inhibits lipases in the lumen of the gut to prevent hydrolysis of dietary fat into absorbable fatty acids. People will excrete 1/3 of dietary fat

Question 17

What are the side-effects of the drug Orilstat?

Answer 17

• Flatulence
• Oily faecal leakage
• Diarrhoea
• Decreased absorption of fat soluble vitamins so supplements need to be taken

Question 18

Which 2 drugs are best for when an obese person has T2 diabetes mellitus?

Answer 18

Metformin and Liraglutide

Question 19

What is a laparoscopic adjustable band?

Answer 19

A band around the stomach that restricts how much can be eaten at once

You can inject/withdraw saline to adjust the diameter of the band

Question 20

What is a Roux-en-Y gastric bypass and what are the complications?

Answer 20

The stomach and small bowel are surgically attached to cause restriction and malabsorption of what is eaten causing weight loss

Complication: Micronutrient deficiencies, dumping syndrome, post-prandial hypoglycaemia

Question 21

What are the advantages of surgical treatments to obesity?

Answer 21

• Weight loss

- Resolve or improve co-morbidities

Question 22

What are the disadvantages of surgical treatments to obesity?

Answer 22

• Perioperative mortality-morbidity
• Complications
• Some weight re-gain
• Expense

Question 23

What are the guidelines for having a bariatric surgery in the UK?

Answer 23

• Must be obese for at least 5 years

- Must engage in non-surgical weight-loss programme for 12-24 months first