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ENDOCRINE > A. OBESITY > Flashcards

A. OBESITY Flashcards

1
Q

what is obesity

A
  • too much body fat in the ‘wrong place” (abdomen)

‘apple’ = fat in abdomen, do an inflammation test for cytokines, greater risk of complications
‘pear’ = fat in hips, thigh and buttocks, not as great a CV risk

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2
Q

what causes obesity

A
  • chronic +ve energy balance
  • too much energy intake or
  • too little energy expenditure
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3
Q

how do we assess obesity

A
  1. body mass index
    = weight (kg)/height² (m²)
    (18.5-24.9 is healthy)
  2. skin folds thickness
    - assumes a constant relationship between SC and total body fat
    - bicep and triceps common
  3. body shape
    - waist circumference: measure of intra abdominal fat
    - apples or pears: waist:hip ratio
    - risk of high total cholesterol, low HDL cholesterol, high BP
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4
Q

obesity statistics 2021

A
  • 69% men
  • 59% women
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5
Q

what is the biggest threat to women’s health

A

obesity

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6
Q

consequences of obesity

A
  • CHD (angina, heart attack)
  • increases BP
  • increases plasma cholesterol levels
  • increases risk of T2DM
    (additional risk factors for CHD)
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7
Q

what cancer can body fat decrease risk of (probable)

A
  • breast (pre-menopausal)
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8
Q

what cancers can body fatness increase risk of (convincing)

A
  • Oesophagus
  • Pancreas
  • Liver
  • Colorectal
  • Breast (postmen)
  • Endometrium
  • Kidney
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9
Q

what cancers can abdominal fat increase risk of (convincing)

A
  • colorectal
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10
Q

what cancers can body fatness increase risk of (probable)

A
  • Mouth
  • Stomach
  • Gall bladder
  • Ovary
  • Prostate
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11
Q

what cancers can adult weight gain (ie around abdomen) increase risk of (probable)

A
  • breast (postmen)
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12
Q

what study shows a link to breast cancer

A

skirt size increase

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13
Q

causes of obesity

A
  • genetics (leptin deficient?)
  • diet - high fat and high energy density
  • low physical activity
  • pregnancy (difficult to lose weight after)
  • ageing (metabolic rate decreases as older, decrease intake)
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14
Q

what is the first thing that should be done before starting obesity treatment

A
  • achievable target set
  • 5-10% of original weight
  • max weekly loss of 0.5-1kg
  • may still have BMI > 25kg/m²
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15
Q

what is the principle of weight loss

A
  • energy balance must be negative
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16
Q

3 ways of obesity treatment

A
  1. individualised modest energy restrictive diet
  2. very low calorie diets
  3. current POMs
17
Q

individualised modest energy restrictive diet

A
  • 500 kcal/day less than calculated amount
  • slower weight loss, based on healthy eating guidelines - better long term success but need motivation to change
  • should still provide correct balance of nutrients. Based on patient’s age, sex, weight
18
Q

very low calorie diets

A
  • commercially-prepared diet
  • medical supervision only
  • for very obese patients who need to lose weight quickly
    – typically 400- 600 kcal/day for several days/weeks but max of 12 weeks
  • milkshake type preparation + protein, vitamins, minerals
  • rapid weight loss if comply
19
Q

Orlistat

A
  • tetrahydrolipstatin
  • synthesised derivative of lipostatin
  • inhibits gastric and pancreatic lipase so we can’t digest fats taken in and fatty acids not absorbed
  • minimal absorption
  • take before each main meal
  • 30% inhibition of lipases at normal therapeutic doses (lose 200kcal per day)
  • need to combine with a low fat diet
20
Q

side effects of Orilstat

A
  • steatorrhoea = fatty, foul-smelling faeces which may help to reduce fat intake
    (faecal incontinence - adult nappies)
  • reduced absorption of fat so need to monitor fat soluble vitamin status (supplements?)
21
Q

prescribing guidelines for Orilstat

A
  • combine with reduced calorie diet
  • BMI > 30 kg/m² or BMI > 28 kg/m² if other risk factors eg T2DM, hypercholesterolaemia, hypertension
  • should only be continued after 12 weeks if weight loss exceeds 5%
  • treatment > 12 months should only be done after discussion potential benefits and risks with patient
22
Q

dosing of Orilstat

A
  • 120mg immediately before, during, or 1 hour after reach main meal
  • 360mg max each day
  • if meal contains no fat = miss dose
23
Q

what is OTC Orilstat

A
  • Alli
  • 60mg tds
  • combined with reduced fat diet
  • BMI>28
  • review after 12 weeks
  • try diet and exercise approach first
24
Q

what controls our appetite

A

hypothalamus

25
Q

Liraglutide and Semaglutide

A
  • Saxenda and Wegovy
  • GLP-1 receptor agonists
  • SC injection
  • suppress appetite as increased secretion of POMC/ CART - anorexigenic neurons
  • GLP-1 can reduce high fat food intake by suppressing dopamine signalling which has an effect on reward pathways
  • very expensive
26
Q

prescribing guidelines for Liraglutide and Semaglutide

A
  • BMI > 30 kg/m² or BMI > 28 kg/m² if other risk factors
  • care with T2DM: is patient already on GLP-1 agonist?
  • monitor after 12 weeks and stop if less than 5% weight loss
27
Q

how is wegovy also used nowadays

A

weight loss drug

28
Q

Mysimba (naltrexone & bupropion)

A
  • dopamine is released from NTs in brain then taken back into neurones normally - signal switched off
  • when dopamine levels increase, stimulation of opioid receptors which switches off signal
  • bupropion is an inhibitor of dopamine reuptake hence there is an increased level of dopamine to interact with receptors so interferes with reward pathway
  • naltrexone is an opioid receptor antagonist hence switches off feedback mechanism and there is an increase in dopamine in brain
  • similar efficacy as Orlistat
  • not recommended by NICE due to cost-effectiveness
  • licensed but not through NHS, only private
29
Q

Phentermine (US)

A
  • not licensed in UK
  • increases catecholamine levels in brain which increases CV risk
  • peripheral effects: increase HR, BP, palpitations
  • Qsymia approved by FDA 2012 in US and refused by EMEA October 2012 due to CV risk
30
Q

what obesity drugs have been suspended

A
  • Sibutramine due to increasing BP and CV risk
  • Rimonabant due to blocking cannabinoid CB1 receptors which increases risk of depression
31
Q

what obesity drugs are no longer recommended

A

Dexfenfluramine, fenfluramine and phentermine no longer recommended due to increasing BP

32
Q

which hormones stimulate food intake

A

Ghrelin

33
Q

which hormones inhibit food intake

A

Leptin
Insulin
PYY
GLP-1 (for T2DM)

*see last years lectures

34
Q

surgical approaches to treatment of obesity

A
  1. gastric bypass
  2. bariatric surgery

ENDOCRINE (17 decks)

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