obesity symposium

Question 1

describe gut hormones for energy intake? 2

Answer 1

• Satiety= anorexigenic gut hormones (cholecystokinin (CCK), pancreatic polypeptide, peptide YY, glucagon-like peptide, oxyntomodulin)
• Hunger= orexigenic hormones (ghrelin)

Question 2

how does the CNA drive energy intake?

Answer 2

• Interplay between gut hormones and the hypothalamus via the vagus nerve

Question 3

how does adipose drive energy intake? 3

Answer 3

• Leptin is anorexigenic
• Reduces adiposity in rodents but not in humans
• Signaller for satiety in deficiency- signals starvation

Question 4

name 2 stress hormones?

Answer 4

• adrenaline

- cortisol

Question 5

describe genetics and obesity? 3

Answer 5

• MC4R mutation found in up to 5% of kids leading hyperphagia
• Leptin deficient individuals can be treated with leptin to treat obesity
• Appetite is genetically determining with a growing number of genetic mutations associated with small increases in appetite and higher prevalence of obesity

Question 6

describe microbiomes and obesity?

Answer 6

• People at higher weight have less variety and quantity of microbes in their gut

Question 7

describe external drivers for energy intake? 5

Answer 7

• Environment
• Economic
• Social
• Cultural
• Education

Question 8

describe from idealism to pragmatism? 5

Answer 8

• People are often desperate to lose weight
• Weight gain is easy, weight loss is hard and maintaining weight loss is even harder
• Learning to listen and guide behaviour is more effective than giving advice
• Diet of starvation= binge is driven by and creates low self esteem
• Fat shaming is real and can lead to worse health outcomes

Question 9

give examples of fear inducing statements? 4

Answer 9

• You ought
• You need
• You should
• I want

Question 10

give examples of weight discussing questions? 5

Answer 10

• What’s been happening with your weight
• What are you planning to do?
• What are your thoughts?
• How is it working for you?
  how will you fit that into your life?
• What might get in the way?

Question 11

describe the weight stigma and the effect on health? 4

Answer 11

• Fear of stigma can lead to avoidance of seeking medical care which creates barriers to obesity prevention
• Weight stigma is correlated with a variety of disordered eating patterns such as binge eating, emotional eating, restrictive eating and eating anxiety
• Plays a fundamental role in the development of metabolic syndrome
• In some cases, can cause suicidal acts

Question 12

describe energy expenditure? 4

Answer 12

• BMR increases as you gain weight and decreases as you lose weight
• Muscle is more metabolically active
• Influenced by age and genetics
• Body protects from weight loss through metabolic adaptations to weight loss, and hunger in response to weight loss

Question 13

describe the slowing of weight loss? 2

Answer 13

• Energy out= as we lose weight, the body’s metabolism slows, therefore we burn less calories at rest
• Energy in= feedback to regulation of body weight. The body will resist weight loss by increasing appetite

Question 14

describe some important considerations when advising on dietary approaches for weight loss? 5

Answer 14

• Nutritionally adequacy
• Cultural acceptance
• Economic affordability
• Safety
• Efficacy

Question 15

describe general healthy diet and lifestyle principles? 6

Answer 15

• Rich in high fibre foods
• Low in added sugar, refined grains and ultra-processed foods
• Increased physical activity
• High quality protein foods
• Realistic goal setting
• Healthcare professional support may be useful

Question 16

describe low fat diets? 3

Answer 16

• Fat is the densest macronutrient; high fat foods may promote consumption of excess calories due to being highly palatable and poorly satiating
• Focus on the replacement of fat with fruit and vegetables as a method of ensuring nutritional adequacy
• Application of low-fat dietary guidelines and weight loss intervention have not led to a reduction of obesity prevalence in the UK

Question 17

describe the Mediterranean diet? 3

Answer 17

• Fish, whole grains, fruit, vegetables, nuts, mono-unsaturated fats
• Moderate in alcohol
• Low in red meat and processed meat and sugary foods

Question 18

describe meal replacements and low energy diets? 4

Answer 18

• 800 calories a day via liquid only
• Food reintroduction
• Weight maintenance support
• Can lead to constipation and weight regain

Question 19

what is intermittent fasting? 2

Answer 19

• Restriction of overall energy intake via periods of restricted and unrestricted food intake
• May provide metabolic benefit

Question 20

describe long term weight maintenance? 6

Answer 20

• Essential and often overlooked
• Diet quality
• Developing behavioural and self-monitoring skills
• Support
• Physical activity
• Individualisation

Question 21

what is obesity?

Answer 21

a disorder in which excess body fat has accumulated to an extent that health may be adversely affected

Question 22

what is general obesity?

Answer 22

fat distributed over the whole body

Question 23

what is central abdominal obesity? 2

Answer 23

• fat is distributed mainly in chest and abdomen

- associated with higher risks of diabetes, raised blood lipids and greater cardiovascular morbidity

Question 24

what is the health impact of obesity? 6

Answer 24

• Increased mass of fat causes changes at cellular and metabolic levels
• Increased weight causes increased wear and tear in joints
• Increased fat around the airway provokes asthma and sleep apnoea
• Increased fat in blood alters the insulin response
• Associated inactivity has independent effects including mental health
• Body self-image changes and there is an impact from the perception and reality of wider cultural and societal attitudes

Question 25

what are the health risks of obesity in adults? 12

Answer 25

• Increased hypertension risk
• Weight on joints
• Low back pain
• Type 2 diabetes
• Atherosclerosis
• Cancer
• Stress incontinence
• Sleep apnoea
• Asthma
• Liver disease
• Gall stones
• Pancreatsis
• Depression

Question 26

what are the health risks of obesity in children? 6

Answer 26

• Type 2 diabetes
• Asthma
• Sleep apnoea
• Hypertension in adulthood
• Bowlegs- tibia vara
• Emotional and behavioural problems

Question 27

describe the assessment of obesity in primary care? 10

Answer 27

• Assess eating behaviour and lifestyle
• Risk factors
• Advise on management
• Consider drugs
• Referral to surgery
• Counselling
• Appetite suppressants?
• Vitamin D supplements
• Type 2 diabetes treatments
• Weekly subcutaneous injection?

Question 28

describe the requirements for bariatric surgery? 4

Answer 28

• When other interventions fail
• BMI>40
• BMI 35-40 with co-morbidity
• Obese Asian patients with type 2 diabetes

Question 29

describe bariatric surgery intervantions? 3

outcomes? 4

Answer 29

• Laparoscopic adjustable band
• Sleeve gastrectomy
• Roux-en-Y-Y/laparoscopic gastric bypass
• 65% type 2 DM remission
• Reduces total cholesterol
• 85% of sleep apnoea will resolve
• Over 10 years 25% will regain weight