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2025 Part Twos > Bariatrics: Obesity and metabolic surgery > Flashcards

Bariatrics: Obesity and metabolic surgery Flashcards

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1
Q

What percentage of adults worldwide are overweight?

A

39%

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2
Q

What percentage of adults worldwide are classified as obese?

A

19%

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3
Q

What percentage of adults in New Zealand are obese?

A

32%

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4
Q

What is the obesity percentage among Māori adults in New Zealand?

A

47%

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5
Q

What percentage of Pacific adults in New Zealand are obese?

A

65%

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6
Q

What trend is observed in obesity rates over time?

A

Increasing

This suggests a growing public health concern related to obesity.

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7
Q

What are the BMI ranges for underweight and normal weights?

A

<18.5
>18.5-24.9

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8
Q

What are the BMI ranges for overweight and obesity class 1

A

25-29.9
30-34.9

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9
Q

What are the BMI ranges for Obesity class II, morbid obesity, and super obesity?

A

35-39.9
>40
>50

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10
Q

What are the drawbacks of BMI for quantifying obesity?

A

Criticisms – Asian population develop obesity complications at lower BMI than western, also tends to over estimate health effects in patients with high lean muscle mass (athletes, Pacific Island patients)

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11
Q

What is obesity a risk factor for? (list 11+)

A

Obesity is a risk factor for many diseases including cancer, type 2 diabetes, cardiovascular disease, dyslipidaemia, hypertension, ischemic heart disease, non-alcoholic fatty liver disease, respiratory issues, musculoskeletal disorders, and others. GORD PCOS

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12
Q

Name three types of cancer associated with obesity.

A
  • Breast cancer
  • Endometrial cancer
  • Colorectal cancer
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13
Q

What is the role of enteroendocrine cells (EEC)?

A

EEC sense luminal factors and secrete gut hormones that alert the CNS about nutrient presence in the lumen.

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14
Q

What is the GBE axis involved in?

A

The Cut brain endocrine (GBE) axis is involved in controlling energy homeostasis through interactions between gut hormones and the CNS.

adipocyte-brain endocrine interactions are key

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15
Q

What are the two types of adipose tissue?

A
  • Brown adipose tissue
  • White adipose tissue
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16
Q

What is the function of brown adipose tissue?

A

Brown adipose tissue is involved in non-shivering thermogenesis.

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17
Q

What does white adipose tissue store?

A

White adipose tissue stores cholesterol and triglycerides and acts as an endocrine organ.

Produce immune factors such as leptin, adiponectin, adipocytokines (IL-6 and TNF), enzymes (aromatase, 17β-hydroxysteroid dehydrogenase

All can contribute to inflammation and have a significant effect on obesity related comorbidities

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18
Q

What hormones are produced by adipose tissue?

A
  • Leptin
  • Adiponectin
  • Adipocytokines (IL-6 and TNF)
    enzymes (aromatase, 17β-hydroxysteroid dehydrogenase

All can contribute to inflammation and have a significant effect on obes

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19
Q

True or False: Bariatric surgery is purely weight loss surgery.

A

False

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20
Q

What are the two main anatomical reasons for weight loss after bariatric surgery?

A
  • Restrictive
  • Malabsorptive
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21
Q

What is the role of gut peptides post metabolic surgery?

A

Gut peptides cause satiety and are secreted by EECs that increase in number after surgery.

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22
Q

What is hedonic hunger?

A

Hedonic hunger refers to the desire to eat for pleasure rather than for physiological need.

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23
Q

Fill in the blank: After RYGB and LSG, _______ hunger is reduced.

A

hedonic

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24
Q

What is the impact of weight loss on functional impairment from arthritis?

A

Weight loss has a beneficial effect on functional impairment from arthritis.

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25
What is the significance of GLP-1 in obesity treatment?
GLP-1 improves insulin secretion, increases beta-cell proliferation, and aids in weight loss.
26
What are the NICE guidelines for obesity surgery?
* BMI > 40 kg/m2 * BMI > 35 kg/m2 with significant co-morbidity * Failed appropriate non-surgical weight loss attempts
27
Name two relative contraindications for obesity surgery.
* Untreated psychiatric conditions * Severe medical comorbidities
28
What is the role of a multidisciplinary team in bariatric surgery?
The multidisciplinary team is key to delivering safe and successful surgery.
29
What pre-operative intervention is recommended for patients undergoing bariatric surgery?
* Smoking cessation * Alcohol reduction * Good glycaemic control
30
What is the purpose of the STOP-Bang questionnaire?
To screen for obstructive sleep apnea (OSA) in obese patients.
31
Fill in the blank: Pre-operative weight loss can be achieved using _______ diet.
[Optifast]
32
What should be monitored during the anaesthetic phase for bariatric surgery?
* Oxygen saturation * Vagal responses * Blood pressure
33
What is the importance of bile acid in post-operative care?
Bile acids stimulate GLP-1 and have beneficial effects on dyslipidaemia and insulin resistance.
34
What is the economic burden of obesity?
Obesity is responsible for significant economic costs and impacts global health.
35
What is the main goal of bariatric surgery?
To provide long-term weight loss and maintenance.
36
What is the risk of mortality reduction after bariatric surgery?
30.7% lower mortality risk after bariatric surgery.
37
What does the GBE axis involve?
Enteroendocrine cells (EEC) sense luminal factors (absorbed nutrients – via sensory transporters) These cells are activates to secrete gut hormones (Eg GLP1) that alert CNS that nutrients are in lumen Signals metabolic control centres in hindbrain and hypothalamus to control energy homeostasis Results in responses such as – reduced food intake, increased energy expenditure, increased satiety, insulin release, glucose homeostasis, increased GI motility, gut secretion and nutrient utilisation
38
Via what mechanisms does bariatric surgery cause weight loss?
Anatomical reasons: Restrictive and Malabsorptive Physiological/Metabolic hormone mediated
39
What are the physiological/Metabolic hormone mediated effects of bariatric surgery?
mediated via Neural (vagus) and Enteric Endocrine cells ( GLP-1 and PYY) Reduced food intake: early satiety and reduced appetite Changes in Food preferences: avoidance fatty foods Increase Energy expenditure
40
What is the primary purpose of post-obesity surgery?
Not purely weight loss surgery, but results in anatomical alterations that produce complex physiological interactions
41
What are the two original understandings of the mechanism of action of bariatric procedures?
Restrictive and malabsorptive effects | We now know there are metabolic and neurohormonal effects also
42
What mechanisms (in addition to restrictive and malapsorptive effects) are now understood to be involved in bariatric surgery?
Metabolic and neurohormonal effects
43
Which two types of cells are involved in the hormone-mediated physiological effects after bariatric surgery?
Neural (vagus) and enteric endocrine cells
44
What hormones are involved in the physiological/metabolic effects post-surgery?
GLP-1 and PYY | Pancreatic polypeptide YY (PYY) is located in enteroendocrine cells of t ## Footnote Glucagon-like peptide 1 (GLP-1) is a hormone released from enteroendocrine L cells.
45
What effect does bariatric surgery have on food intake?
Reduced food intake due to early satiety and reduced appetite
46
What change in food preferences is observed after bariatric surgery?
Avoidance of fatty foods
47
How does bariatric surgery affect energy expenditure?
Increase in energy expenditure
48
Fill in the blank: Post-obesity surgery results in complex physiological interactions that involve signalling between gut and _______.
brain
49
What do patients report after metabolic surgery regarding pre-meal hunger?
Decreased pre-meal hunger compared to low-calorie diets
50
What are gut peptides and where are they secreted from?
GLP-1, GLP -2, and PYY secreted by EECs that reside in intestinal epithelium | EECs are sensory cells within the intestine that secrete biologically ac
51
What is the effect of metabolic surgery on EEC cells?
Increases the number of EEC cells and their secretion of GLP-1, GLP-2, and PYY
52
What role does vagal signalling play in metabolic surgery?
Activated by paracrine action of gut hormones in response to ingested nutrients and by stretch receptors
53
How does vagal signalling change after metabolic surgery?
Increased vagal signalling after all surgery types
54
What other signalling does hypothalamic signalling involve?
Same vagal afferents signal hypothalamus as well as gut peptides
55
What are the effects of changes in gut microbiota after bariatric surgery? ?
Changes to gut microbiota can change microbial fermentation and thus signalling of EECs
56
What happens to bile acid plasma levels post RYGB and LSG?
Higher plasma levels that remain high for 3-4 years post op
57
What roles might bile acids play post-surgery?
Intestinal hypertrophy, gut hormone secretion, control of energy expenditure, glucose metabolism, changes in gut flora
58
What happens to hedonic hunger after RYGB and LSG?
Reduced hedonic hunger
59
What changes in food intake are observed after RYGB and LSG?
Increased intake in fruit and vegetables with no fixation on energy-dense, sweet/fatty food
60
What effects do GLP-1 and PYY have on taste sensation?
Altered taste sensation, palatability, and hedonic properties of sweet and fatty stimuli
61
What happens to diet-induced energy expenditure after RYGB?
Increased diet-induced energy expenditure
62
How might bile acids modulate energy expenditure?
Possibly through increased brown adipose tissue or skeletal muscle thermogenesis
63
What is the exact mechanism of increased energy expenditure post-surgery?
Not understood
64
Name some factors, besides weight loss, that contribute to the improvement of comorbidities after obesity surgery.
* Gut hormones * Bile acid kinetics * Adipocyte derived factors * Anatomical factors * Change in eating behaviour
65
What is the effect of calorie restriction on liver fat?
Results in reduced liver fat and improved hepatic insulin sensitivity
66
Weight loss improves peripheral insulin sensitivity, which benefits which conditions?
* T2DM * NASH * NAFLD * Metabolic syndrome
67
What protective effects does weight loss have against cancer?
Reduces release of growth factors and inflammatory cytokines
68
What hormone is known for improved insulin secretion and increased beta-cell proliferation?
GLP-1
69
What contribution does PYY make in the context of obesity surgery?
Contributes to improvement in dyslipidaemia
70
How do bile acids affect GLP-1?
Bile acids stimulate GLP-1
71
List the beneficial effects of bile acid kinetics.
* Beneficial effect on dyslipidaemia * Reduce insulin resistance
72
What do adipocyte derived factors do to improve insulin resistance?
Reduce inflammatory cytokines
73
True or False: Weight loss is the only factor in improving comorbidities after obesity surgery.
False
74
What is a significant benefit of obesity surgery besides weight loss?
Comorbidity improvement/resolution ## Footnote Weight loss is just one factor in improving or resolving comorbidities.
75
What is the annual death toll attributed to obesity worldwide?
2.8 million deaths ## Footnote This statistic highlights the severe health impact of obesity globally.
76
How many life-years of ill health are caused by obesity each year?
38.5 million life-years ## Footnote This figure underscores the extensive health-related issues linked to obesity.
77
What is the percentage reduction in mortality after bariatric surgery?
30.7% lower ## Footnote This statistic indicates the effectiveness of bariatric surgery in improving survival rates.
78
What complications are reduced as a result of bariatric surgery?
* Diabetes complications * Obesity-related cancers * Myocardial infarctions (MIs) * Strokes * Obstructive sleep apnea (OSA) * Cardiovascular disease ## Footnote These reductions showcase the comprehensive health benefits of bariatric surgery.
79
What is the BMI threshold for considering surgery according to NICE guidelines?
BMI > 40kg/m2 ## Footnote Surgery may also be considered for BMI > 35kg/m2 with significant comorbidities.
80
What are some comorbidities that can lower the BMI threshold for surgery?
* Type 2 Diabetes Mellitus (T2DM) * Hypertension (HTN) * Hyperlipidaemia * Obstructive Sleep Apnoea (OSA) * Non-alcoholic fatty liver disease (NALFLD) * Non-alcoholic steatohepatitis (NASH) * Pseudotumour cerebri * Gastroesophageal reflux disease (GORD) * Asthma * Functional disability ## Footnote These conditions can justify surgical intervention at a lower BMI.
81
What must be demonstrated before considering surgery for obesity?
All appropriate non-surgical measures have been tried but have failed to achieve or maintain weight loss >6 months ## Footnote This includes intensive weight loss strategies.
82
What is required from a patient before considering obesity surgery?
* Willingness to receive intensive management in a specialist obesity service * Fitness for anaesthesia and surgery * Commitment to long-term follow-up ## Footnote These factors ensure the patient is prepared for the surgical process.
83
In which patients should surgery be considered first line?
Patients with BMI > 50 ## Footnote These patients are often at higher risk for obesity-related complications.
84
For which diabetic patients should surgery be considered?
Diabetics with BMI 30-35 whose diabetes cannot be controlled by optimal medical treatment ## Footnote This applies when other interventions have failed.
85
What are absolute contraindications for obesity surgery?
* Comorbidities independent of BMI that weight reduction will not reduce risk * Type 1 Diabetes * Hereditary hyperlipidaemia ## Footnote These conditions may not benefit from surgical intervention.
86
What are some relative contraindications for obesity surgery?
* Untreated psychiatric conditions * Psychosis * Severe personality disorder * Eating disorders * Drugs and alcohol abuse * Medical noncompliance * Severe medical comorbidities * Severe cardiac disease (CHF) * Coagulopathy * Frailty ## Footnote These factors may complicate surgical outcomes.
87
What is an important consideration regarding the quality of life and mortality risk in patients undergoing surgery?
Surgery may improve quality of life but will not reduce mortality risk if the patient is unlikely to live long enough ## Footnote This highlights the importance of patient selection.
88
Where should obesity surgery be carried out?
In a high volume centre ## Footnote High volume centres typically have more experience and better outcomes.

2025 Part Twos (74 decks)

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