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Metabolism 2 > Obesity > Flashcards

Obesity Flashcards

1
Q

What is the definition of obesity

A

• Obesity is defined as abnormal or excessive fat accumulation sufficient to adversely affect health and reduce life expectancy

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2
Q

what does theBMI use

A

a person’s weight (in kilograms) divided by the square of his or her height (in metres)

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3
Q 
name the ranges for 
- underweight 
- normal weight 
- overweight 
- obese 
for BMI patients
A 
underweight = BMI is less than 18.5
normal weight = BMI is 18.5 to 24.9
overweight = 25 to 29.9
obese = BMI is 30 or greater 
morbidly obese = BMI 40 or greater
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4
Q

what does weight circumference do

A
  • this helps distinguish muscular people from fat people in the BMI
  • weight circumference is the waist hip ratio
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5
Q

what is the downside of the BMI

A

does not distinguish between muscular and obese people

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6
Q

what cause the obesogenic environment

A

increased food intake - appetising cheap available high energy density food

less exercise - electricity, cars, TV, computers

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7
Q

How much of obesity is caused by medication

A

As many as 10% to 15% of weight issues are related to medications:

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8
Q

what drugs can cause obesity

A 
Mood Stabilizers
Diabetes Medicines
Corticosteroids
Beta Blocker
Allergy Relievers
Drugs That Prevent Seizures and Migraines
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9
Q

what else is being proposed for BMI

A

ethnic weight cut offs

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10
Q

what medication can make you gain a lot of fat

A

diabetes medicine such as insulin

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11
Q

How does insulin cause you to gain weight

A
  • it inhibits breakdown and release from fat cells
  • it decreases the rate of lipolysis in adipose tissue (this lowers the plasma fatty acid level)
  • this stimulates fatty acid and triacylglycerol synthesis in tissues
  • it increases the uptake of triglycerides from the blood into adipose tissue.
  • it decreases the rate of fatty acid oxidation in muscle and liver
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12
Q

what is lipohypertrophy

A

Enlargement of fat cells local to where the insulin is injected

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13
Q

what drugs increase insulin

A

Insulin

sulfonylureas

  • glyburdie
  • glicizide

TZD
- these also increase weight

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14
Q

what drugs keep insulin stable

A

Metformin

DPP IV inhibits

  • Januvia
  • Onglyza
  • trajenta
  • these drugs keep insulin stable
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15
Q

what drugs decrease iuslin

A
  • SGLT-2 inhibitor
  • Acarbose

these decrease weight

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16
Q

Is obesity heritable

A

Heritability estimates for obesity are high (typically 70%),

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17
Q

What is the thirfty gene hypothesis

A
  • Genes that predispose to obesity would have had a selective advantage in populations that frequently experienced starvation.
  • People who possess these genes in today’s obesogenic environment might be those that ‘overreact’ not just becoming slightly overweight, but extremely obese.
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18
Q

name the proof for the thrifty gene hypothesis

A

More recent support for the thrifty gene hypothesis was provided by Pritchard et al. 2006
Many genes involved in the glucose and lipid metabolism have been subject to positive selection in the last 10 000 years, especially in Asian and African ethnic groups.

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19
Q

what is syndromic monogenic obesity

A

Syndromic monogenic obesity is exceptionally rare and characterized by mental retardation, dysmorphic features and organ specific abnormalities, in addition to obesity

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20
Q

how many syndromes cause syndromic monogenic obesity

A

More than 30 syndromes reported in the literature

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21
Q

name an example of syndromic monogenic obesity

A

Bardet–Biedl & AlstrÖm syndrome = ciliopathy

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22
Q

describe how bardet-biedl and alstrom can cause obesity

A
  • the primary cilum has a key role in the differentiation of adipocytes
  • the pathogensis of obesity is in part attributed to a defect in adipogensis
  • the cilia mediate leptin receptor (LEPR) signalling
23
Q

what is non syndromic monogenic obesity

A

currently 12 genes have been identified to date that have roles in energy maintenance as part of the leptin-melanocortin pathway.

24
Q

what can cause polygenic obesity

A

Using genome wide association (GWA) 227 genetic variants involved in different biological pathways have been identified:
Central nervous system, food sensing and digestion, adipocyte
differentiation, muscle and liver biology, gut microbiota

25
Q

Name two types of polygenic obesity

A

Adipocyte differentiation

1- Cilopathies (primary cilia dysfunction)

2- Mutations in Peroxisome-proliferator-activated receptor gamma 2 (PPARγ2): a transcription factor that has a key role in adipocyte differentiation (targeted by Thiazolidinediones drugs)
TZD drugs

26
Q

what can also cause obesity

A

epigenetic vacation and geen environment interactions

27
Q

what is the concepts of epigenetic variation

A

concept that environmental and nutritional influences during critical periods in development (particularly during gestation) can have permanent effects on an individual’s predisposition to obesity.

28
Q

adipose tissue is a …

A

bonafide endocrine organ - it connects to all the organs in the body and therefore effects how all the tissues work

29
Q

what are the different types of body shape

A

apple shape

pear shape

30
Q

what shaped body is at more risk of getting weight related heath problems

A

Apple shape = More visceral fat
Higher risk of weight-related health problem

Pear shape = Less visceral fat
Lower risk of weight-related health problem

31
Q

How much can obesity related diseases cut lifespan by

A

11 years

32
Q

what is obesity a major risk factor for

A

cardiovascular diseases

pulmonary diseases (such as sleep apnoea)

metabolic diseases (diabetes & dyslipidaemia)

osteoarticular diseases

for several of the commonest forms of cancer

for serious psychiatric illness

33
Q

what is child hood obesity associated with

A

childhood obesity is associated with early onset type 2 diabetes and with an increased mortality risk for coronary heart disease in adulthood

34
Q

what are the key features of obesity and type 2 diabetes

A
  • Chronic inflammation
  • Altered adipokine levels (high level of leptin) - insensitive to leptin
  • Breakdown of fat metabolism (accumulation of lipids in the tissue)
  • Breakdown of the regulation of glucose metabolism due to high fat metabolism
35
Q

what is non alcoholic fatty liver disease

A
  • this is caused by the build up of fat in the liver
36
Q

who is non alcoholic fatty liver disease seen in

A

Usually seen in people who are overweight or obese.
Also associates with high cholesterol / high BP / T2D.
Estimated to affect up to 5% of the UK population

37
Q

how do you PREVENT obesity

A

1- to inform people about life style

2- promote/develop a “non-obesogenic” environment

38
Q

what treatment is the foundation of obesity treatment

A

lifestyle changes

  • weight loss
  • physical activity programs
  • diet
  • these have poor adherence
39
Q

name a drug treatment that can be used for obesity and how it works

A

Orlistat

  • gastric and pancreatic lipase inhibitor which reduces absorption of dietary fat
  • very unpleasant
40
Q

what do you have to undergo in order to have surgery for obesity

A

Nobody gets surgery without undertaking a weight management course, in which they are taught about diet and nutrition, fitness and exercise

41
Q

what patients does surgery happen in

A

Surgery is performed laparoscopically in patients with:
- Morbid obesity (BMI >40 kg/m2)
- BMI >35 kg/m2 AND obesity-related complications
(after conventional medical treatments have failed)

42
Q

what are the types of surgery

A

restrictive surgery

malabsorptive procedures

43
Q

what conditions cause syndromic monogenic obesity

A

bardet bidel
Alstrum

  • these are both diseases that affect the cilia
44
Q

what do restrictive surgery do

A
  • they remove a portion of the stomach
45
Q

what does a malabsorption procedure do

A
  • these reduce the ability to absorb nutrients

causes nutrient deficiencies, malnutrition and, in some cases, anastomotic leaks and the dumping syndrome*.

46
Q

name some examples of malabsorption procedures

A

e.g. biliopancreatic diversion and Roux-en-Y gastric bypass

47
Q

what is dumping syndrome

A

rapid gastric emptying)

48
Q

name some examples of restrictive procedures

A

adjustable gastric banding,

vertical banded gastroplasty

sleeve gastroplasty

49
Q

name some expamples of restrictive plus malabsorption procedures

A

duodenal switch,

Roux-en-Y gastric bypass,

intragastric balloon

50
Q

what is non syndromic monogenic obesity cause

A
  • linked to the hypothalamus of the brain and the arcuate nucleus and the neurones that can cause food intake and decreased food intake
51
Q

if you fat is subcutnaoues and pear shaped

A

lower risk of health problem

52
Q

if you have more visceral fat..

A

higher risk of health problems

53
Q

90% of obese patients as children will

A

be obese as adults

54
Q

what can diet changes do

A
  • make you constantly hungry and don’t feel as satisfied as you would
  • maintenance of a body weight at. level of 10% below the initial weight was associated with a reduction in total expenditure

Metabolism 2 (40 decks)

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