L12 (T1): The aetiology and pathophysiology of obesity
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Questions and Answers

What is the speaker's profession?

  • Consultant
  • Surgeon
  • Acute physician (correct)
  • Endocrinologist

    • What is the main focus of the speaker's talk?

  • Exploring the causes of unconscious bias
  • Promoting a specific weight loss program
  • Advocating for empathy towards people living in bigger bodies (correct)
  • Discussing the technical aspects of bariatric surgery

    • What is the correct term used to refer to individuals with obesity according to the speaker?

  • Overweight person
  • Obesity sufferer
  • Obese individual
  • Person living with obesity (correct)

    • Where does Dr. Satish Parthasarathy work?

    <p>Princess Royal Hospital</p> Signup and view all the answers

    What will be explored in the first part of the talk?

    <p>Conscious and unconscious bias towards persons living with obesity</p> Signup and view all the answers

    What is the speaker's advice regarding the duration of the session?

    <p>There will be a 5-minute break in the middle</p> Signup and view all the answers

    What are the main topics covered by the speaker in the talk?

    <p>Genetics, GI and brain signaling, effects of obesity, treatment opportunities, and barriers</p> Signup and view all the answers

    How does the speaker suggest obesity should be understood?

    <p>Through broad concepts, not detailed information</p> Signup and view all the answers

    What does the audience prompt to consider regarding individuals living with obesity?

    <p>Challenges such as transportation and societal stigma</p> Signup and view all the answers

    How is obesity discussed in the talk?

    <p>As a neurobehavioral hereditary disorder heavily influenced by the environment</p> Signup and view all the answers

    What is highlighted as impacting judgments and perceptions in the talk?

    <p>Implicit bias</p> Signup and view all the answers

    What does the speaker suggest implicit bias can lead to?

    <p>Quick judgments and assumptions about individuals living with obesity</p> Signup and view all the answers

    Which method for measuring body composition is mentioned as potentially inaccurate in very large individuals?

    <p>Bio impedance electrical analysis</p> Signup and view all the answers

    What is the BMI category for class three obesity?

    <p>≥40</p> Signup and view all the answers

    What is a potential implication of societal views on who should receive healthcare, as mentioned in the text?

    <p>Potential rationing decisions</p> Signup and view all the answers

    What is the prevalence of obesity among men and women in the UK, as stated in the text?

    <p>One in four</p> Signup and view all the answers

    What does the text suggest about the use of BMI in assessing metabolic health?

    <p>It may not accurately reflect metabolic health</p> Signup and view all the answers

    What is the potential influence on obesity prevalence mentioned in the text?

    <p>Complex interplay of genetics, environment, and evolutionary factors</p> Signup and view all the answers

    What impact does public attitudes towards obesity have?

    <p>Contribute to stigmatization and discrimination, impacting job opportunities and career advancement</p> Signup and view all the answers

    Why do people struggle to identify when someone is obese despite increasing obesity rates?

    <p>The media and societal norms perpetuate negative stereotypes about obesity</p> Signup and view all the answers

    What is a consequence of healthcare policies disqualifying obese individuals from certain treatments?

    <p>Decreased healthcare seeking behavior and increased mortality</p> Signup and view all the answers

    Why does research into obesity receive less funding than HIV and digestive diseases despite high prevalence?

    <p>Bias against obesity stemming from the misconception that it is a conscious choice rather than a medical condition</p> Signup and view all the answers

    What is a consequence of internalized stigma and shame associated with obesity?

    <p>Decreased healthcare seeking behavior and increased mortality</p> Signup and view all the answers

    Why do healthcare professionals need to address bias and advocate for policies that address the social and healthcare inequalities associated with obesity?

    <p>To provide support and decrease bias against obese individuals in healthcare settings</p> Signup and view all the answers

    What has led to a significant shift in the way we consume calories?

    <p>Globalization and westernization</p> Signup and view all the answers

    How much has sugar consumption in places like Congo increased due to globalization and westernization?

    <p>Nearly 850%</p> Signup and view all the answers

    What did a study look at related to obesity and find strong correlations in certain areas?

    <p>2.1 million SNPs</p> Signup and view all the answers

    What did overfeeding studies on male twins show about weight gain?

    <p>Driven by genetic makeup</p> Signup and view all the answers

    What did calorie restriction studies reveal about weight loss?

    <p>Influenced by genetic factors</p> Signup and view all the answers

    What highlights the complex interplay between globalization, genetic factors, and obesity?

    <p>The findings of the studies</p> Signup and view all the answers

    What percentage of people in UK society believe that 'most overweight people could lose weight if they tried'?

    <p>53%</p> Signup and view all the answers

    What percentage of people in UK society feel that a very overweight person would be less likely to be offered a manager job?

    <p>75%</p> Signup and view all the answers

    What do explicit bias and implicit bias reflect in the context of obesity bias?

    <p>Conscious and automatic/intrinsic influences</p> Signup and view all the answers

    What is a potential reason for the bias against people living in larger bodies?

    <p>Lack of self-discipline</p> Signup and view all the answers

    What is the common perception about why most overweight people cannot lose weight, according to the text?

    <p>Lack of willpower</p> Signup and view all the answers

    What do the beliefs about weight loss and job opportunities in the UK society suggest about societal attitudes?

    <p>Potential bias based on weight</p> Signup and view all the answers

    What does the text imply about the challenges of addressing implicit bias?

    <p>It is deeply ingrained and resistant to change</p> Signup and view all the answers

    What is the prevailing belief about overweight people's ability to lose weight, according to the text?

    <p>They lack motivation and effort to lose weight</p> Signup and view all the answers

    What is the main focus of the talk?

    <p>Understanding conscious and unconscious bias towards people living with obesity</p> Signup and view all the answers

    What is the potential implication of societal views on healthcare, as mentioned in the text?

    <p>Reduced access to treatment opportunities for individuals living with obesity</p> Signup and view all the answers

    What is the correct term used to refer to individuals with obesity according to the speaker?

    <p>People living with obesity (PLWO)</p> Signup and view all the answers

    What is highlighted as impacting judgments and perceptions in the talk?

    <p>Unconscious bias towards people living with obesity</p> Signup and view all the answers

    Why do healthcare professionals need to address bias and advocate for policies that address the social and healthcare inequalities associated with obesity?

    <p>To ensure fair and equal treatment for individuals living with obesity</p> Signup and view all the answers

    What did the speaker suggest implicit bias can lead to?

    <p>Disparities in healthcare for individuals living with obesity</p> Signup and view all the answers

    What is a consequence of internalized stigma and shame associated with obesity?

    <p>Reduced motivation for health behaviors</p> Signup and view all the answers

    What is the BMI category for class three obesity?

    <p>40 or higher</p> Signup and view all the answers

    Which of the following comorbidities is NOT associated with obesity?

    <p>Type 1 diabetes</p> Signup and view all the answers

    What is the BMI range for class three obesity?

    <p>40 and above</p> Signup and view all the answers

    What is the most common type of cancer associated with obesity?

    <p>Breast cancer</p> Signup and view all the answers

    What is the term used to refer to individuals with obesity according to the speaker?

    <p>Individuals living in larger bodies</p> Signup and view all the answers

    At what BMI range does life expectancy decrease as BMI increases?

    <p>20-24.9</p> Signup and view all the answers

    Which of the following is a potential consequence of internalized stigma and shame associated with obesity?

    <p>Avoidance of seeking medical help</p> Signup and view all the answers

    What is the relative risk of death associated with obesity, as indicated by the text?

    <p>Increases with increasing BMI</p> Signup and view all the answers

    What is the BMI category for class three obesity?

    <p>40–50</p> Signup and view all the answers

    What data was the Prospective Studies Collaboration based on?

    <p>541,452 male and female subjects</p> Signup and view all the answers

    What is the main aim of obesity treatment?

    <p>Health improvements associated with weight loss</p> Signup and view all the answers

    What is the impact of adiposity and fat distribution on metabolic health?

    <p>Negative impact</p> Signup and view all the answers

    What factors contribute to the increased risk of Type 2 diabetes (T2DM)?

    <p>Pathophysiology of insulin resistance</p> Signup and view all the answers

    What are the BMI categories for overweight and obesity?

    <p>25–30, 30–35</p> Signup and view all the answers

    Which closely associated cardiovascular risk factors are included in metabolic syndrome?

    <p>High triglycerides, low HDL cholesterol</p> Signup and view all the answers

    What is the incremental cost-effectiveness ratio of metabolic surgery for BMI ≥40 over 20 years?

    <p>£2000 - £4000 per QALY</p> Signup and view all the answers

    What is the primary composite outcome in the time-to-event analysis for GLP1 receptor agonists?

    <p>Death from cardiovascular causes, non-fatal myocardial infarction, or non-fatal stroke</p> Signup and view all the answers

    What is the BMI threshold recommended by NICE for expedited bariatric surgery for those with recent onset T2DM?

    <p>BMI &gt;35</p> Signup and view all the answers

    Which pharmacotherapy drug has specific licensing criteria and is known as Victoza for T2DM treatment and Saxenda for obesity?

    <p>Liraglutide</p> Signup and view all the answers

    What is a potential complication of metabolic surgery mentioned in the text?

    <p>Nutrient deficiencies</p> Signup and view all the answers

    What percentage of patients with Type 2 Diabetes Mellitus achieved 15 kg weight loss or more with Very Low Calorie Diets (VLCD)?

    <p>24%</p> Signup and view all the answers

    What is the long-term adherence to lifestyle changes challenging due to, according to the text?

    <p>Larger weight loss making maintenance harder</p> Signup and view all the answers

    What is the minimum duration of engagement with a non-surgical weight-loss programme required before considering surgery?

    <p>12-18 months</p> Signup and view all the answers

    What is a potential problem with Tier 3 weight management services?

    <p>Limited medical input</p> Signup and view all the answers

    What was Emily's weight at the age of 12?

    <p>100kg</p> Signup and view all the answers

    What procedure did Emily undergo at the age of 21?

    <p>Laparoscopic gastric band</p> Signup and view all the answers

    What was Emily's weight after starting Liraglutide treatment in November 2021?

    <p>95kg</p> Signup and view all the answers

    What was the duration of engagement with the Tier 3 service before Emily had revision surgery?

    <p>1 year</p> Signup and view all the answers

    What mutation was found in Emily, leading to loss of function?

    <p>GPR10</p> Signup and view all the answers

    What type of weight management service did St Richards Integrated Bariatric Service provide?

    <p>6 months, full medical assessment</p> Signup and view all the answers

    What did Emily undergo in October 2020 before starting Liraglutide treatment?

    <p>Revision surgery</p> Signup and view all the answers

    What is the tiered approach to weight management services mentioned in the text?

    <p>Semaglutide/Wegovy and Liraglutide/Saxenda</p> Signup and view all the answers

    What mutation did Emily have, as mentioned in the text?

    <p>GPR10 mutation</p> Signup and view all the answers

    At what age did Emily undergo a privately fitted laparoscopic gastric band?

    <p>21</p> Signup and view all the answers

    What was the result of Emily's use of Liraglutide?

    <p>17% weight loss</p> Signup and view all the answers

    What is emphasized as effective communication about weight in the text?

    <p>An empathetic, respectful, and collaborative approach</p> Signup and view all the answers

    According to the text, what is a requirement before surgery as per NHS England 2013 guidelines?

    <p>5 years of obesity and a 12-24 month non-surgical weight-loss program</p> Signup and view all the answers

    What did Emily's case study demonstrate, as mentioned in the text?

    <p>Abnormal weight gain from childhood, multiple medical interventions, and genetic testing</p> Signup and view all the answers

    What does Emily's personal success story reflect, as mentioned in the text?

    <p>A significant change in her life and acceptance of her weight</p> Signup and view all the answers

    What does Emily's journey highlight, as mentioned in the text?

    <p>The complex and multifaceted nature of weight management and the importance of personalized care</p> Signup and view all the answers

    Study Notes

    The Impact of Globalization and Genetic Factors on Obesity

    • Globalization and westernization have led to a significant shift in the way we consume calories, with easy access to non-locally produced food.
    • This adaptive behavior has resulted in a 20% increase in brain volume compared to apes, due to expanded access to sugar, oil, crops, and animal products.
    • Sugar consumption in places like Congo has increased by nearly 850% due to globalization and westernization.
    • There has been a 36% change in the average way people consume calories globally.
    • Obesity is genetically mediated in part, with studies exploring the heritability of obesity and the impact of single nucleotide polymorphisms (SNPs).
    • There are approximately 6 million SNPs that can influence disease processes or normal behavior in people.
    • A study looked at 2.1 million SNPs related to obesity and found strong correlations in certain areas.
    • Around 140 SNPs related to obesity were identified, and an obesity risk score was calculated based on the number of SNPs.
    • Different genes contribute to waist-to-hip ratio and brain function, but SNPs play a significant role in polygenic obesity.
    • Overfeeding studies on male twins showed that weight gain was driven by genetic makeup, with minimal variation within twin pairs.
    • Calorie restriction studies also revealed that weight loss was similarly influenced by genetic factors, with minimal variation within twin pairs.
    • These findings highlight the complex interplay between globalization, genetic factors, and obesity, emphasizing the need for further research and understanding.

    Weight Loss Interventions for Type 2 Diabetes

    • Very Low Calorie Diets (VLCD) for patients with Type 2 Diabetes Mellitus (T2DM) show promising results with 24% achieving 15 kg weight loss or more and 46% inducing remission of T2DM.
    • Long-term adherence to lifestyle changes is challenging, with the larger weight loss making maintenance harder.
    • Pharmacotherapy options such as Orlistat and GLP1 receptor agonists like Liraglutide and Semaglutide have shown positive effects on weight and diabetes prevention.
    • Metabolic surgery, previously known as bariatric surgery, has been found to help patients live longer and maintain weight loss, with incremental cost-effectiveness ratios of £2000 - £4000 per QALY over 20 years for BMI ≥40.
    • Roux-en-Y gastric bypass and Sleeve gastrectomy are effective surgical options, each with specific benefits and risks.
    • Metabolic surgery can treat T2DM, reduce BMI and HbA1C, and decrease the need for diabetes medications.
    • However, metabolic surgery comes with several potential complications, including nutrient deficiencies, dumping syndrome, hypoglycemia, and significant nutritional disturbance.
    • NICE recommends expedited bariatric surgery for those with recent onset T2DM and BMI >35, and to consider surgery for those with BMI >30, specifically lowering BMI by 2.5 points for high-risk populations.
    • NHS England has a position statement on bariatric/metabolic surgery, with specific criteria for eligibility and consideration as a first-line treatment for those with a BMI >50 kg/m2.
    • The primary composite outcome in the time-to-event analysis for GLP1 receptor agonists was the first occurrence of death from cardiovascular causes, non-fatal myocardial infarction, or non-fatal stroke.
    • GLP1 receptor agonists like Liraglutide, also known as Victoza for T2DM treatment and Saxenda for obesity, are effective at low and high doses, with specific licensing criteria.
    • Pharmacotherapy drugs like Orlistat and GLP1 receptor agonists have shown positive effects on weight and diabetes prevention, with specific dosing and licensing criteria.

    Challenges in Weight Management Services and a Personal Success Story

    • NHS England 2013 guidelines require 5 years of obesity and a 12-24 month non-surgical weight-loss program before surgery
    • The tiered approach to weight management services includes Semaglutide/Wegovy and Liraglutide/Saxenda
    • Issues with Tier 3 services include variable provision, outcomes, structure, and engagement length
    • Tier 3 providers may have limited medical input in deciding surgery referrals
    • West Sussex and South Coast Tier 3 services have varying durations and limited medical assessments
    • Effective communication about weight requires an empathetic, respectful, and collaborative approach
    • Emily's case study demonstrates abnormal weight gain from childhood, multiple medical interventions, and genetic testing
    • Emily underwent a privately fitted laparoscopic gastric band at age 21 and was referred to Tier 3 service at age 22
    • Emily had a GPR10 mutation and underwent revision surgery to bypass and started Liraglutide, resulting in a 17% weight loss
    • Emily's personal success story reflects a significant change in her life and acceptance of her weight
    • Emily's journey highlights the complex and multifaceted nature of weight management and the importance of personalized care
    • The challenges and successes in weight management services underscore the need for comprehensive and individualized approaches.

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    Description

    Test your knowledge on the impact of globalization and genetic factors on obesity with this quiz. Explore the influence of global food consumption patterns, genetic predispositions, and the interplay between nature and nurture in the development of obesity.

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