1B obesity Flashcards
What is obesity?
A condition of abnormal or excessive fat accumulation in adipose tissue, to the extent that health is impaired
What is the BMI cut off for overweight and obesity?
> 24.8 - overweight
29.9 - obesity I
What drives obesity?
- Sedentary lifestyles
- Not living near parks/open spaces
- Using cars instead of walking
- More screen time
- Lower education levels
- Poverty
- Social deprivation
What comorbidities are associated with obesity?
- Depression
- Sleep apnoea
- Stroke
- MI
- Hypertension
- Diabetes
- Peripheral vascular disease
- Bowel cancer
- Gout
- Osteoarthritis
What do we do if someone comes into GP with obesity?
- Determine degree of overweight or obesity
- Assess lifestyle, comorbidities, willingness to change
- Consider referral to specialist care
- Management- lifestyle changes, drug treatment
- Specialist assessment and management- surgery and follow up
What is the main drug we can give to obesity patients?
- Orlistat- derivative of an endogenous lipstatin produced by Streptomyces toxytricini
- It’s a gastric and pancreatic lipase inhibitor
- Reduces dietary fat absorption by 30%
What is orlistat’s efficacy, side effects and attrition level?
- Reduces weight by 3%
- Side effects are fatty and oily stool, faecal urgency, oily spotting, faecal incontinence in 7%
- Possible deficiencies of fat-soluble vitamins
- No long term data on orlistat on obesity-related morbidity and mortality
- Attrition rates were high - 33%
What levels of BMI do we consider bariatric surgery for?
- First line for BMI >50 kg/m2
- BMI of 40 kg/m2 or more
- BMI of 35-40 kg/m2 and other comorbidities
- BMI of 30-35 kg/m2 for newly diagnosed T2DM
Aside from BMI, what are the other requirements of bariatric surgery?
- Non-surgical measures have failed to achieve or maintain adequate clinically beneficial weight loss for at least 6 months
- Receiving or will receive intensive specialist management
- Generally fit for anaesthesia and surgery
- Commit to the need for long-term follow-up
What are the three types of bariatric surgery?
- Gastric bypass
- Gastric band
- Sleeve gastrectomy
What is gastric bypass?
Top part of stomach is joined to small intestine, so you feel fuller and don’t absorb as many calories from food
What is gastric band?
A band is placed around your stomach so you don’t need to eat as much to feel full
What is sleeve gastrectomy?
Some of your stomach is removed, so you can’t eat as much as you could before and you’ll feel full sooner
How effective is bariatric surgery?
Very effective- you can lose up to 1/4 of your body weight through it
