Obesity Flashcards

1
Q

Obesity

A

Abnormal or excessive fat accumulation sufficient to adversely affect health + reduce life expectancy

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2
Q

Obese BMI

A

30 +

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3
Q

Morbidly obese BMI

A

40 +

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4
Q

Girls with obesity 1975 –> 2016

A

5 million –> 50 million

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5
Q

Boys with obesity 1975 –> 2016

A

6 million –> 74 million

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6
Q

EU average obesity

A

14%

% of population 16+ with BMI 30 or greater

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7
Q

Obesity Tower Hamlets children starting primary school

A

1 in 8

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8
Q

Obesity Tower Hamlets children leaving primary school at 11

A

1 in 4

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9
Q

Tower hamlets borough child obesity

A

5th highest London

6th highest in country

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10
Q

Chicken shop mile

A

197 hot food takeaways

Average of 42 junk food outlets PER SCHOOL

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11
Q

Tower hamlets worst areas compared to England

A

Deprivation
Children under 16 in poverty
Obese children in yr 6

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12
Q

Food deserts (limited food options) in US associated with..

A

Increase in obesity + diabetes

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13
Q

Obesogenic environment

A

Increased food intake
Less exercise
Food industry more interested in profit than public health

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14
Q

Medications + weight issues

A
10-15% weight issues linked to medication
Mood stabilisers
Diabetes Medicines
Corticosteroids
Beta blockers
Allergy relievers
Drugs that prevent seizures + migraines
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15
Q

Insulin + weight gain

A

Inhibits breakdown + release from fat cells
Decreases rate of lipolysis in adipose tissue (lowers plasma FA level)
Stimulates FA and triacylglycerol synthesis in tissues
Increases uptake of triglycerides from blood into adipose tissue
Decreases rate of FA oxidation in muscle + liver

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16
Q

Lipohypertrophy

A

Enlargement of fat cells local to where insulin is injected

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17
Q

T2D drugs that increase insulin and weight

A

Insulin
Sulfonylureas (Glyburide, Glicizide)
TZD

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18
Q

T2D drugs that don’t affect insulin and weight

A

Metformin

DPP IV inhibitors (Januvia, Onglyza, Trajenta)

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19
Q

T2D drugs that decrease insulin and weight

A

SGLT-2 inhibitor

Acarbose

20
Q

Heritability for obesity

A

High (typically 70%)

21
Q

Thrifty gene hypothesis

A

Genes that predispose to obesity would have had a selective advantage in populations that frequently experience starvation
–> ppl that have these genes now in obesogenic environment might be those that overreact –> extremely obese, not just slightly overweight

22
Q

Thrifty gene hypothesis support

A

Many genes in glucose + lipid metabolism subject to positive selection in last 10,000 years
–> especially Asian + African ethnic groups
CREBRF variant?

23
Q

Syndrome monogenic obesity

A

Exceptionally rare
Characterised by mental retardation, dysmorphic features + organ specific abnormalities
–> in ADDITION to obesity

24
Q

Prader-Willi syndrome

A

SNRPN gene
Autosomal dominant
Short physique
Hypotonia + hypogonadism

25
Q

Fragile X syndrome

A

FMR1 gene
Autosomal dominant
Psychological + speech defect
Macro-orchidism

26
Q

Bardet-Biedl + Alstrom syndrome

A

Ciliopathy
The primary cilium has key role in differentiation of adipocytes –> pathogenesis of obesity is in part attributed to defect in adipogenesis
Cilia mediated leptin receptor (LEPR) signalling

27
Q

Non-syndromic monogenic obesity

A

Currently 12 genes have been identified that have roles in energy maintenance as part of leptin-melanocortin pathway
LEP, LEPR, BDNF etc

28
Q

Non- syndromic

A

Single gene disorder that leads to a highly penetrant form of obesity

29
Q

Adipocyte differentiation- obesity

A

Ciliopathies- primary cilia dysfunction
Mutations in Peroxisome-proliferator-activated receptor gamma 2 (PPARgamma2)
–> transcription factor that has key role in adipocyte differentiation

30
Q

Peroxisome-proliferator-activated receptor gamma 2

A

Transcription factor
Key role in adipocyte differentiation
Targeted by TZD drugs

31
Q

Polygenic obesity

A
227 genetic variants involved in different biological pathways have been identified
CNS
food sensing + digestion
adipocyte differentiation
insulin signalling
lipid metabolism
muscle + liver biology
gut microbiota
32
Q

Epigenetic variation

A

Environmental + nutritional influences during critical periods in development (particularly gestation) can have permanent effects on an individual’s predisposition to obesity

33
Q

Adipose tissue

A

Bonafide endocrine organ
Defects can originate in the tissue itself, or its ability to communicate to the brain or the brain response itself, or the downstream effectors, or a combination

34
Q

Apple shape

A

More visceral fat

higher risk weight-related health problem

35
Q

Pear shape

A

Less visceral fat

Lower risk of weight-related health problem

36
Q

Lifespan

A

Obesity-related diseases could cut lifespan by 11 years

37
Q

Obesity as a risk factor

A
CV diseases
Pulmonary diseases
Metabolic diseases
Osteoarticular disease
Cancer
Psychiatric illness
38
Q

Childhood obesity

A

Associated with early onset type 2 diabetes + increased mortality risk of CHD in adulthood

39
Q

Obesity + T2D

A

Chronic inflammation
Altered adipokine levels (high leptin)
Breakdown of fat metabolism (accumulation lipids in tissues)
Breakdown of regulation of glucose metabolism

40
Q

Non alcoholic fatty liver disease

A

Build up of fat in liver
Overweight/obese
Associated with high cholesterol/high BP/T2D
5% UK population

41
Q

Orlistat

A

Gastric and pancreatic lipase inhibitor

Reduces absorption of dietary fat–> doesn’t allow lipase to attach to fat + break it down into absorbable size

42
Q

Surgery

A
First do weight management course
Laparoscopically
Morbid obesity
BMI>35 AND obesity related complications
--> only after conventional medical treatments have failed
43
Q

Surgery procedures- restrictive procedures

A

Restrict ability
Band restricts food passage
Removal of part of stomach

44
Q

Surgery procedures- malabsorptive procedures

A

Reduce ability to absorb nutrients
Can cause nutrient deficiencies, malnutrition, and in some cases anastomotic leaks + dumping syndrome (rapid gastric emptying)

45
Q

Malabsorptive procedures examples

A

Biliopancreatic diversion

Roux-en-Y gastric bypass

46
Q

Restrictive procedures example

A

Adjustable gastric banding
Vertical banded gastroplasty
Sleeve gastroplasty

47
Q

Restrictive plus malabsorptive procedures

A

Dudoenal switch
Roux-en-Y gastric bypass
Intragastric balloon