Tier 3 & 4 Weight Management

Question 1

Complications of obesity

Answer 1

• adipocytes enlarge and divide and leads to reduced adiponectin (increases inflammation)
• inflammatory cytokines cause systemic inflammation
• insulin resistance

Question 2

Benefits of weight loss (5-10%)

Answer 2

• reduction in T2DM
• improves BP
• improves blood lipid profiles
• reduction in CV mortality
• improvements in sleep apnea
• improvements in HR-QoL

Question 3

Control of appetite

Answer 3

• hunger: ghrelin (stomach) and NPY activates NPY/AgRP neuron which activates LHA and increases energy intake and decreases expenditure
• satiety: PYY, leptin, GLP1. Activates POMC which activates PVN which decreases energy intake and increases energy expenditure

Question 4

Pharmacotherapy for obesity

Answer 4

• orlistat: lipase inhibitor and allows excretion in faeces. Leads to 3.4% weight loss at 1 year
• phentermine/topiramate: noradrenergic/neurostabiliser leads to 8.9% weight loss at one year
• lorcaserin: 5-HT receptor agonist leads to 3.2% weight loss at one year
• naltrexone/ buproprion: opiod receptor agonist. Leads to 4.8% weight loss at 1 year
• liraglutide: GLP1 analogue leads to 5.4% weight loss at 1 year

Question 5

Bariatric surgery: how is works, level of weight loss

Answer 5

• engenders the endocrine system which causes reduced taste for high fat and sugar
• in the uk offered for those with bmi of 40 or 35 with comorbidities
• gastric bypass leads to 32% weight loss
• gastric sleeve leads to 25% weight loss
• gastric band leads to 16% weight loss
• metabolic procedures: vertical sleeve gastrectomy, gastric bypass