T1 L18: Appetite and weight Flashcards
What are some medical problems associated with obesity?
- Metabolic syndrome
- T2 diabetes mellitus
- Cardiovascular disease
- Respiratory disease
- Liver disease
- Cancer
- Reproductive dysfunction
- Joint problems
- Mental health problems
What cardiovascular problems arise with obesity?
- high blood volume and blood viscosity
- Increased vascular resistance
- Hypertension
- Increased risk of left ventricular hypertrophy
- Coronary artery disease
- Stroke
What respiratory problems arise with obesity?
- Obstructive sleep apnoea
- Hypoxia/hypercapnia
- Pulmonary hypertension increasing risk of right heart failure
- Accidents like daytime somnolence
What is Hypercapnia?
Build up of CO2 in the bloodstream
What is daytime somnolence?
Excessive daytime sleepiness
What GI-liver problems arise with obesity?
- 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
Which types of cancer are more likely with obesity?
Breast, endometrial, oesophageal, colon, gall bladder, thyroid, renal
Risk increased by increased insulin increased free EGF-1, increased oestrogen, adipo-cytokines, reflux
Which problems to do with joints arise with obesity?
Osteoarthritis and gout
What is gout?
Gout causes sudden swelling and severe pain in your joints commonly caused by too much uric acid within the body
Which mental health condition are most likely with obesity?
- Eating disorders
- Depression
- Dementia
What genetic factors cause obesity?
Obesity related syndromes: Prader-willies and Barder-biedi
Obesity is most commonly polygenic
What are some causes of obesity?
- Genetics
- Hypothyroidism
- Cushing’s syndrome
- Environmental Eg, diet, physical activity
Give examples of slow-acting hormones that regulate body weight
Leptin and insulin
Give examples of rapid-acting peptides that regulate meal sizes
- 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
What is the role of leptin in obesity?
Rarely, someone can have a leptin deficiency caused by a mutation to the leptin receptor which causes obesity
What is Orlistat?
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
What are the side-effects of the drug Orilstat?
- Flatulence
- Oily faecal leakage
- Diarrhoea
- Decreased absorption of fat soluble vitamins so supplements need to be taken
Which 2 drugs are best for when an obese person has T2 diabetes mellitus?
Metformin and Liraglutide
What is a laparoscopic adjustable band?
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
What is a Roux-en-Y gastric bypass and what are the complications?
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
What are the advantages of surgical treatments to obesity?
- Weight loss
- Resolve or improve co-morbidities
What are the disadvantages of surgical treatments to obesity?
- Perioperative mortality-morbidity
- Complications
- Some weight re-gain
- Expense
What are the guidelines for having a bariatric surgery in the UK?
- Must be obese for at least 5 years
- Must engage in non-surgical weight-loss programme for 12-24 months first
