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CPB 31: Obesity and Eating Disorders

Understand the causes and consequences of obesity and the treatment options

for patients including exercise, diet, behavioural therapy and

pharmacotherapy. Percentage body fat is the most important measure of obesity Abdominal adiposity is associated with increased mortality, hip is not Abdominal fatVisceral fathormonally active (adipokines, type 2 diabetes) Causes: Energy imbalance (Enegy in =/= energy out) = BMR and activity Metabolic Syndrome: Waist > 102/88cm, BP, triglycerdies, choles., glucose Weight Loss: Reduce intake of energy, increase activity, staying in bed=1150 kcal/day

o 22 kcal required to maintain 1kg, 100kg woman needs 1860-2620 per day.Reduction in intake of 500kcal/day below maintainance results in -0.5kg per wk

All diets seem to work but adherenceis the most important thing LEARNLifestyle, Exercise, Attitudes, Relationships, Nutrition Fasting proves to prolong life in animal data Pharmacotherapy only used in patients who fail to lose weight after dieting

o Orlistatfirst choiceThey will appreciate the role of the different classes of drugs such as

sympathomimetics, antidepressants, anti-epileptic drugs and other

miscellaneous agents.

Sympathomimetics

Increased bp Potential for abuse Sibutramine withdrawn

Antidepressants High doses required

Anti-epileptic Insufficient data

Canabinoid-1 receptor antagonists Rimonabant effective in clinical trials Withdrawn due to psychiatric adverse effects

*Liposuction Reduction in subcutaneous body fat, no evidence of clinical benefit

*Bariatric Surgery

Reduction in consumption or prevention of absorption of food*Surgery recommended for patients with BMI > 40, hyperlipidemia, hypertension, diabetesresolved in 70% of cases

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Students will also understand the nature of eating disorders including

anoerxia, bulimia and binge-eating disorder.

Starvationcommon in the developing world (growth chart measures) MarasmusMuscle wasting and depletion of body fat

o Inadequate intake of all nutrients and total calorieso Characterized by: Hunger, diminished weight/height, emaciated, bradycardia,

hypotension, atrophy of muscle and subcutaneous fat

o KwashiorkorMuscle atrophy but normal body fat

o Inadequate protein but adequate calorieso Clinical Presentation: Anorexia, normal weight/heigh, generalized oedema,

rounded cheeks, dry, peeling skin, distended abdomen, hypopigmented hair

Moderate: (-2)(-3) Severe: