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CEP > WEEK 11 > Flashcards

WEEK 11 Flashcards

1
Q

Describe the trend in obesity rates

A

Rates are rising dramatically, both in M+F and in different countries (especially the UK and US), also occurring in children which links into adult obesity

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2
Q

What are the two processes behind obesity pathogenesis?

A

1) Sustained positive energy balance (energy intake>energy expenditure)
2) Resetting body weight “set point” at an increased value (increase in hunger hormone, decrease in satiety hormone)

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3
Q

What societal changes can be made to combat obesity?

A

Food environment (portion distortion-increasing calories in food)
Physical activity environment
Addressing stigma

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4
Q

What individual treatment can be done to combat obesity?

A

Lifestyle and behavioural
Drugs
Surgery (bariatric)

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5
Q

What are the strengths of BMI in assessing obesity?

A 
Cheap and cheerful
Quick
No special equipment required
In people's homes
Very useful at a population level
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6
Q

What is the weakness of BMI in assessing obesity?

A

Doesn’t account for muscle mass and fat mass differentiation

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7
Q

How is body fat distribution an independent determinant of health?

A

Waist fat mass (circumference) correlates with health issues (eg. MI), whereas hip fat mass (circumference) negatively correlates with health issues

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8
Q

LOOK AT THE DIFFERING METABOLIC SYNDROME DEFITIONS IN THE TABLE IN NOTES

A

WHO (insulin resistance plus two other factors)/ATP III (three factors)/IDF (central obesity plus two other factors)

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9
Q

Is the metabolic syndrome a benign disease?

A

No, patients with it have increased prevalence of all-cause and CV mortality, and CHD, MI and stroke

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10
Q

What does central adiposity correlate to?

A

Insulin resistance, therefore obesity correlates with relative risk of T2 diabetes

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11
Q

Detail the process of adipose tissue formation

A

Pluripotent stem cell-(recruitment)->Preadipocyte-(proliferation)->Multiple preadipocytes-(differentiation)->Adipocytes-(lipid accumulation)->Adipose tissue

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12
Q

What is the role insulin plays in adipose tissue mass regulation?

A

Insulin stimulates proliferation of preadipocytes into multiple preadipocytes and differentiation of multiple preadipocytes into adipocytes

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13
Q

What is the main route of management of obesity?

A

Weight loss (5-10% weight loss=reduction in T2 diabetes risk, reduction in CV mortality, improved BP and improvements to sleep apnoea)

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14
Q

LOOK AT THE NICE GUIDELINES FOR MANAGEMENT OF OBESITY WITH RESPECT TO BMI CLASSIFICATION

A

Changes include lifestyle change, diet and physical activity, drugs and surgery

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15
Q

What is the general principle of weight management?

A

Don’t choose weight loss intervention, patient chooses between offered treatments with help of the MDT

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16
Q

What is necessary when considering weight management?

A

Knowing your patient, their wishes and needs and avoiding obesity stigma (don’t be judgemental-lots of factors involved)

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17
Q

What are the factors to consider when choosing between treatment options for obesity?

A

Why? and why now?
Treatment targets (realistic)
Disease severity
Patient needs: how quickly? how much? (rapid vs. slow weight loss)
Causes of obesity/excess weight
Previous unsuccessful treatments
Evidence base for long term weight management

18
Q

LOOK AT TABLE WITH DIFFERENT CAUSES OF OBESITY

A 
(mono-)genetic or syndromic
hypothalamic
endocrine
medication
mental disorders
lifestyle
19
Q

Detail the 4M approach to understanding barriers to achieving patients aims?

A

Mental (eg. knowledge, expectations, self-image, anxiety etc)
Mechanical (eg. pain, obstructive sleep apnoea, oesophageal reflux etc)
Metabolic (eg. T2 diabetes, hypertension, cancer, infertility etc)
Monetary (eg. education, employment, disability, surgery etc)

20
Q

What should you do when considering expected treatment outcomes?

A

Align treatment outcomes with the patient’s outcomes and work with the patient to develop realistic aims/expectations

21
Q

What are the three principles of addressing clinical inertia and understanding previous success and failures?

A

1) escalate treatment dependent on response
2) don’t expose the patient to repeated cycles of ineffective treatment
3) don’t setup the patient for failure

22
Q

What is disease staging?

A

A clinically based measure of severity that uses objective medical criteria to assess the stage of disease progression

23
Q

What is the principle of disease staging for weight management?

A

Weight management shouldn’t be weight centric

24
Q

Give two disease staging methods

A

1) Edmonton Obesity Staging System (EOSS)-stages 0 to 4

2) King’s criteria-stages 0 to 3

25
Q

What three factors are involved in the EOSS?

A

1) Medical
2) Mental
3) Functional

26
Q

Give five of the many factors that make up the King’s criteria

A

1) BMI
2) CV
3) Diabetes
4) Economic
5) Gonadal

27
Q

What is the link between exercise and activity and obesity?

A

CV fitness prevents metabolic syndrome development

28
Q

What are the NICE guidelines on physical activity for preventing obesity?

A

45-60 minutes of moderate-intensity activity per day

29
Q

What are the NICE guidelines on physical activity for avoiding weight gain?

A

60-90 minutes of activity per day

30
Q

What are some recommended types of physical activity?

A

Brisk walking, supervised exercise programmes, swimming, walking certain no. of steps per day

31
Q

What is the main aim for physical activity encouragement?

A

Spending less time inactive

32
Q

What is the main requirement for dietary interventions for obesity?

A

total energy intake

33
Q

What is the recommended dietary intervention for sustainable weight loss?

A

600kcal/day deficit or low-fat diet

34
Q

What are dietary interventions combined with?

A

Expert support and intensive follow-up

35
Q

What are low-calorie diets (800-1600kcal/day) less likely to be?

A

Nutritionally complete

36
Q

Give the three options for pharmacological weight management

A

Ortistat-energy wastage
Naltrexone/Bupropion-appetite suppression
Liraglutide 3.0mg-appetite suppression

37
Q

What are the indications of Ortistat?

A

Adjunct to diet for obesity

38
Q

What are the indications of Naltrexone/bupropion and Liraglutide 3.0mg?

A

adjunct to diet and physical activity for chronic weight management in:

a) obesity BMI
b) overweight BMI with comorbidity

39
Q

What is shown by pharmacological intervention for weight management?

A

Clinically relevant weight loss achieved with lifestyle modification and continuing medication prevents weight regain

40
Q

Give the four types of bariatric surgery

A

1) Adjustable gastric band (inflatable band used to create a small pouch, limiting food consumption)
2) Vertical sleeve gastrectomy (permanently removes most of stomach, leaving sleeve-shaped pouch-decreasing ghrelin (hunger hormone))
3) Roux-en-Y gastric bypass (creates smaller stomach and bypasses part of intestine; increased GLP-1 (satiety hormone))
4) Biliopancreatic diversion (similar to Roux-en-Y, variant called a duodenal switch retains the pyloric valve)

41
Q

What is shown by surgical intervention for weight management?

A

Greater excess weight loss (especially long term) and greater diabetes retention rates/remission compared to standard care

42
Q

What factors are involved at choosing the intervention?

A

Patient preference, cost, side effects profile, contraindications, aim of treatment, presence of CVD or T2 diabetes, presence of MH disorder

CEP (9 decks)

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