W2L9 Disorders of body weight

Question 1

Def obese

Answer 1

Chronic, progressive, relapsing, multi-factorial, neurobehavioral disease, inc body fat promote adipose tissue dysfunction & abn fat mass= adverse metabolic, biomechanical, psychosocial health consequences

Question 2

Causes of obesity

Answer 2

1. Simple obesity(mos com)
   - Chronic mismatch energy balance.
   - Aff by genetic, environmental, behavioural factors (excess food intake, physical inactivity, metabolic rate)
2. Endocrinal:
   - Cushing syndrome, Polycystic ovary syn, Hypothyroidism, Hypogonadism, Insulinoma
3. Drugs:
   - corticosteroids, antidepressants, contraceptive pills, antipsychotics,oral hypoglycemics, insulin.
4. Hypothalamic disorders:
   - Trauma, tumour or granuloma .
5. Rare genetic syn:
   - Laurence moon beidl, Prader Willi syn

Question 3

Methods of assessment

Answer 3

1. Anthropmetric measures:
   - Height, body weight,
   -Waist circumference
   >94cm(M), >80cm(F)
   -Hip circumference
   -Waist hip ratio
   >0.9(M), >0.85(F)
2. Assess fat %:
   -Fat % >32%(F)+ >25%(M)
   -US, CT ,MRI -DEXA
   -Bioimpedance
3. Lab inv:
   - Fasting lipid panel
   - Liver fx -TFT
   - Fast gluc & HbA1c

Question 4

Hazards of obesity

Answer 4

1. Endocrinal & metabolic :
   -T2DM -Meta syn
   -Dyslipidemia:
   • Menstrual Irregularity & amenorrhea.
   • Polycystic ovarian syn
2. Respiratory:
   -Obs sleep Apnea
   -Dyspnea, restrictive ventillatory defect
3. Musculoskeletal:
   -Osteoarthritis(Back pain)
4. Psycho-social: depress, low self esteem

Question 5

Goals Guidelines for obesity managment

Answer 5

• Improve pt health
• Improve quality of life
• Improve body weight & composition

Question 6

Life style modification program

The main treatment

Answer 6

• Aim=lose about 10% body weight-6 mon
• Nutrition:Low calorie diet(500- 1000 kcal/d)
• Phys act: Initial 30min moderate intensity 3-5x/week,>=60 min
• Behavioural therapy

Question 7

Pharmacotherapy

Answer 7

1. Indication:
   - unable weight loss > 6mon & BMI >30 kg/m2,
   - or >27 kg/m2 w concomitant obesity-related disease
2. Drugs:
   - orlistat, locaserine, liraglutide

Question 8

Significant weight loss

Answer 8

Loss more than 5% of usual body weight over 6 to 12 months

Question 9

Causes

Answer 9

1. Weight loss:
   - Thyrotoxicosis,Malabsorption
2. Poor appetite:
   - adrenal fail,depression
3. Cachexia