Obesity Flashcards
What measurements can be used to classify weight?
body mass index (BMI)
waist circumference
waist to height ratio
How is overweight and obese determined using BMI?
overweight
25 < BMI < 29
obese
> 27.5 = BAME ethnicity
> 30 = white ethnicity
What are health consequences associated with being obese?
decreased life expectancy
development of type 2 diabetes
cardiovascular disease
cancer
- colorectal, prostate
- breast, endometrium, gall bladder
osteoarthritis
gallstones
sleeping difficulty
alterations in lover functions
abnormalities of the reproductive system
- infertility, pregnancy complications
When does waist circumference become a health risk?
women
> 80cm = increased health risk
> 88cm = substantially increased health risk
men
> 94cm = increased health risk
> 102cm = substantially increased health risk
What is waist to height ratio used for?
best discriminator for hypertension, diabetes, and dyslipidemia in both sexes
What medications are associated with obesity?
oral hypoglycaemic agents,
antidepressants,
anticonvulsants,
antipsychotics,
corticosteroids,
oral contraceptives,
beta blockers and
pizotifen
What are realistic weight loss goals?
weight loss of no more than 0.5–1 kg (1 to 2 pounds) per week
maintaining an overall 10% loss of original weight is a realistic target
How much physical activity should be done to lose weight?
to lose weight
- 150 minutes a week of moderate activity or 75 mins a week of vigorous activity
heart failure
- any capacity = e.g. 20-30 mins a day
to prevent obesity
- 45–60 minutes of moderate-intensity activity a day
How should diet be changed to lose weight?
diets that have a 600 kcal/day deficit or that reduce calories by lowering the fat content (low-fat diets) are recommended
eat at least 2 portions of fish per week, including a portion of oily fish
eat at least 4 to 5 portions of unsalted nuts, seeds and legumes per week
mediterranean diet
reduce salt intake and fluid restriction
What is orlistat? When should it be prescribed?
orlistat 120mg tds
- inhibits fat absorption by inhibiting gastric and pancreatic lipase
- must be taken with food
prescribed when patients BMI is >28 with co-morbidities or >30 alone
What are contraindications for orlistat?
hypersensitivity to the active substance or to any of the excipients
people taking ciclosporin
- causes a decrease in ciclosporin plasma levels
people taking warfarin or other oral anticoagulants
- INR could be affected
people with chronic malabsorption syndrome
people with cholestasis (condition where the flow of bile from the liver is blocked)
pregnant or breast-feeding women
children - orlistat should not be used in children or adolescents below the age of 18.
What are the cautions when taking orlistat?
use of an additional contraceptive method is recommended to prevent possible failure of oral contraception that could occur in case of severe diarrhoea
treatment with orlistat may impair the absorption of fat-soluble vitamins
- fat soluble vitamins are A, D, E and K
What are the adverse effects associated with orlistat?
‘Diet-related treatment effects’ include
- wind (flatulence), with or without oily spotting / sudden bowel motions / soft stools / fatty oily stools (steatorrhoea).
gastrointestinal side effects are less likely if they eat a lower fat diet and that such effects typically occur within the first few weeks and tend to settle with time
What are he drug interactions orlistat?
amiodarone
– a decrease in plasma levels of amiodarone has been observed
levothyroxine
– increased risk of hypothyroidism
antiepileptic medication
- is an increased risk of convulsions
When can liraglutide (saxenda) be prescribed for weight loss?
they have a BMI of
- at least 35 kg/m2 for white ethnicity
- at least 32.5 kg/m2 for members of minority ethnic groups)
or
they have
- an initial BMI of > 30kg/m² (obese), or > 27kg/m² to <30kg/m² (overweight) in the presence of at least one weight-related comorbidity
they have non-diabetic hyperglycaemia
they have a high risk of cardiovascular disease based on risk factors
