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203 - Theme 1 - The Endocrine System > L11 - Appetite and weight > Flashcards

L11 - Appetite and weight Flashcards

(54 cards)

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1
Q

Definitions of obesity

A

A personal failing
-lack of self-discipline

A medical problem
-Aetiology
=>genetic
=>environmental

A neurobehavioral hereditary disorder heavily influenced by the environment

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2
Q

Definition of homeostasis

A

Precise matching of energy intake and energy expenditure

  • average decade of adult life
  • approx 10 million kcal consumes
  • tendency towards slight average weight gain
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3
Q

Measurements used

A

BMI

Waist circumference

Skin-fold thicknesses

Bioelectric impedance analysis

Ethnicity specific cut-offs

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4
Q

BMI ranges

A

< 18.5 underweight

18.5-24.9 normal

25-29.9 overweight

30-39.9 obese

> /= 40 morbid obesity

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5
Q

Obesity in England

A

2010-2013: prevalence of obesity in England stabilised at 25%

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6
Q

Medical problems associated with obesity

A

30,000 (6%) UK deaths attributable to obesity

  • metabolic syndrome /type 2 diabetes
  • cardiovascular disease
  • respiratory disease
  • liver disease
  • cancer
  • reproductive dysfunction
  • joint problems
  • psychological morbidity
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7
Q

Co-morbidities and obesity

A

the higher the BMI, the higher the rusk of patients that have 3 or more co-morbidities

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8
Q

In what range of BMI do health risks start?

A

In the overweight BMI range

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9
Q

What is metabolic syndrome?

A

Constellation of closely associated CV risk factors

  • visceral obesity
  • dyslipidaemia
  • hyperglycaemia
  • hypertension

Insulin resistance is the underlying pathophysiological mechanism

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10
Q

BMI vs body fat distribution

A

central vs peripheral

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11
Q

What is metabolic syndrome associated with?

A

Central (visceral) fat

Body mass index >30

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12
Q

Type 2 DM: risk determined by?

A

age

obesity

family history

ethnicity

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13
Q

Type 2 DM: targets

A

rich in poor countries

poor in rich countries

*source of socioeconomic inequality in health

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14
Q

Type 2 DM: increased prevalence in?

A

ageing population

obesity
-T2 DM younger

increased detection/diagnosis
-50% cases T2 DM picked up on routine examination

increased survival with T2 DM

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15
Q

CV disease

A

‘Metabolic syndrome’ PLUS

^blood vol and blood viscosity

^vascular resistance

^hypertension

^left ventricular hypertrophy

^coronary artery disease

^stroke

  • ^=increased
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16
Q

Respiratory system problems caused by obesity

A

obstructive sleep apnoea

hypoxia/hypercapnia

pulmonary hypertension
-RH failure

accidents
-daytime somnolence

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17
Q

GI/Liver problems caused by obesity

A

Non-alcoholic fatty liver

Non-alcoholic steatohepatitis

May progress to cirrhosis, portal hypertension, hepatocellular cancer

Gallstones

Reflux

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18
Q

Cancers caused by obesity

A

Approx 10% of cancer deaths in non-smokers attributable to obesity

Types of cancer include:
-breast, endometrial, oesophagus, colon, gall bladder, renal, thyroid

Mechanisms include:
-increases insulin, increased free IGF-1, increased oestrogen, dip-cytokines, reflux

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19
Q

Reproductive system problems caused by obesity

A

Polycystic ovarian syndrome

  • oligomenorrhoea, hirsutism, acne
  • subfertility
  • endometrial hyperplasia
  • insulin resistance

Male hypogonadism

Adverse pregnancy outcomes

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20
Q

Joint problems caused by obesity

A

Osteoarthritis

Gout

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21
Q

Psychological problems caused by obesity

A

Depression

Eating disorders

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22
Q

Aetiology of obesity: GENETICS => rare

Study These Flashcards
A

Obesity associated syndromes

  • Prader-Willi
  • Bardet-Biedl
23
Q

Aetiology of obesity: GENETICS => common

Study These Flashcards
A

polygenic

susceptibility genes

heritability of weight
heritability of height

24
Q

Aetiology of obesity: GENETICS => other causes

Study These Flashcards
A

Hypothyroidism

Cushing’s syndrome

25
Aetiology of obesity: ENVIRONMENT => diet
high fat high sugar 'coca-colinisation' of developing world socio-economic factors
26
Aetiology of obesity: ENVIRONMENT => physical activity
20-25% total energy expenditure obesity prevalence related to proxy measures of physical activity - car ownership - TV viewing socio-economic factors
27
Aetiology of obesity: foetal programming
'Programming':stimuli/insults at critical periods have persistent biological effects Stressors in utero - ?udnernutrition, ?trace elements, ?other - crudely represented by birth weight Mechanism: epigenetic modification of gene expression Example: - 'programmed' adrenal axis overactivity in adulthood - causal factor for metabolic syndrome - increased vulnerability to CHD
28
Life course model
Factors operating at every stage of life affect health outcomes later in life Pathway of risk between events and health outcomes Worst outcome associated with: - low birth weight - excessive weight gain in infancy/childhood - adult obesity
29
Aetiology of obesity: Gut Microbiome
Differences in gut bacteria -can be induced by diet e.g. high fat diet Transplantation of faecal material alters insulin sensitivity The gut micriobiome is influenced by diet and influences disease risk, it is integral to host homeostasis as well
30
Regulation of appetite and weight: slow-acting hormones
regulate body weight Leptin Insulin Signal % body fat to hypothalamus - decreases food intake - increases energy expenditure
31
Regulation of appetite and weight: rapid-acting peptides
regulate meal sizes released from GI tract - cholecystokinin (CCK) decreases eating - ghrelin increases eating - PYY decreases eating up to 12hrs act via hypothalamus
32
Regulation of appetite and weight: leptin (mice)
ob/ob mouse -leptin deficient db/db mouse -mutation of leptin receptor ob gene product = leptin leptin treatment reduces obesity in ob/ob mouse
33
Regulation of appetite and weight: leptin (humans)
Starvation signal Permissive effect on puberty/reproduction ``` Obese humans Very rare: -leptin deficiency -mutation of leptin receptor Usually: -^ [leptin] with ^ fat -?'leptin resistant'? -?decreased CNS leptin transport ```
34
Treatment: lifestyle modification => diet
500-1000kcal energy deficiency Low energy density - decrease sat fat, sugar - increase fruit & veg (sub for other foods) Decrease portion sizes, snacking Structured meals/meal replacements may help promote greater weight loss
35
Treatment: lifestyle modification => physical activity
Exercise 7 days a week - 30 mins moderate-high intensity OR - 60 mins low intensity Target 10,000 steps/day -^ 500 step increments Regardless of weight/weight loss, exercise increases health
36
VLCD and T2 DM: principle
primary care programme patients with T2DM diagnosis < 6 years prior VLCD (830 kcal/day) for 3-5 months - initially, total diet replacement with formulae - then stepped food reintroduction (2-8 weeks) - long-term maintenance with structured support
37
VLCD and T2 DM: outcomes
12 month outcomes reported 24% of patients achieved 15kg weight loss or more 46% induced remission of T2DM -normal HbA1c off all medication for 2 months >10kg weight loss: 73% remission
38
Lifestyle modification: usual targets
10% weight loss 1-2 lb (0.5-1kg) per week some evidence that ambitious goals promote more weight loss
39
Lifestyle modification: problems
most patients can achieve approx 5-10% weight loss/1 year yo-yo dieting/regaining weight loss obesogenic environment weight loss results in increased hunger, reduced satiety and decreased metabolic rate
40
Lifestyle modification: best hope
sustainable lifestyle changes diet combines with exercise/physical activity ongoing management is required to maintain weight loss
41
Treatment: pharmacological therapy => the past
25 years research 123 products 1 currently licensed = orlistat
42
Treatment: pharmacological therapy => ORLISTAT mechanism
binds and inhibits lipases in the lumen of the gut prevents the hydrolysis of dietary fat into absorbable free fatty acids/glycerol excrete approx 1/3 dietary fat
43
Treatment: pharmacological therapy => ORLISTAT adverse effects
flatulence, oily faecal leakage, diarrhoea reduced absorption of fat soluble vitamins - ADEK - supplement
44
Treatment: pharmacological therapy => METFORMIN
best 1st line agent for over-weight/obese patients with T2DM all other oral hypoglycaemic agents and insulin cause weight gain used in diabetes prevention trials but not licensed for this use recommended by NICE for prevention of T2DM in adults at high risk
45
Treatment: pharmacological therapy => problems
can only increase by 3-4 fold the proportion of patients who achieve 5% weight loss in a year weight re-gain after treatment stopped
46
Treatment: pharmacological therapy => future
all identified gut peptides/neuropeptides/their receptors are potential therapeutic targets/options -gut hormones in combination most likely way forwards
47
Surgical treatment: laparoscopic adjustable banding
restrictive only inject/withdraw saline to adjust the diameter of the band
48
Surgical treatment: Roux-en-Y gastric bypass
restrictive malabsorptive alterations in gut hormones and bile acid flow contribute to weight loss micronutrient deficiencies -supplement with iron, B12, folate, calcium, vit D Dumping syndrome -GI & vasomotor symptoms
49
Surgical treatment: Roux-en-Y gastric bypass effects
endocrine factors important in effects - plasma from operated rats to sham-operated rats - ate 1/3 less increased satiety seems to be key -F-MRI studies
50
Advantages of surgical treatment
weight loss 25-30% resolve or improve co-morbidities -brings cost savings
51
Disadvantages of surgical treatment
preoperative mortality/morbidity -depends on procedure and experience of surgeon long-term follow up -micronutrient deficiencies some weight re-gain -patients will still be obese expense -through cost effective by 2-5 years, depending on co-morbidties and weight
52
UK position bariatric surgery: NICE guidelines
``` NICE 2006 -after failure of other options if -BMI > 40 kg/m-2 -BMI > 35 with co-morbid conditions Or first line BMI > 50 kg/m-2 ``` NICE 2014 - recent onset T2DM: - expedite bariatric surgery if BMI>35 - consider surgery if BMI>30
53
UK Position bariatric surgery: | NHS guidelines
NHS England 2013 As per NICE but….. Must have been obese for at least 5 years Must engage with non-surgical weight-loss programme for 12-24 months first
54
Public health/societal
Schools -PE, lunches, vending machines Urban design Marketing/media/social media -food labelling, food ads

203 - Theme 1 - The Endocrine System (11 decks)

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