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Obesity

Background knowledge 🧠

Definition

  • Obesity is a condition characterised by excessive body fatΒ accumulation.
  • Body Mass Index (BMI) β‰₯ 30 kg/mΒ² defines obesity.

Epidemiology

  • Global epidemic affecting both developed and developing countries.
  • Prevalence in the UK: approximately 28% of adults and 20% of children.
  • Higher rates in lower socioeconomic groups.
  • Increases risk of various comorbidities.

Pathophysiology

  1. Adipose tissue has a expansion limit in relation to excess calorieΒ consumption.
  2. Excess energy cannot be stored within subcutaneous adipose tissue (SAT), so is stored in visceral adipose (VAT) tissueΒ and in the organs (destroys cells and impairs function).

Aetiology

  • Genetic factors: contribute to susceptibility.
  • Environmental factors: sedentary lifestyle, high-calorie diet.
  • Psychological factors: stress, emotional eating.
  • Endocrine disorders: hypothyroidism, Cushing’s syndrome.
  • Metabolic syndrome association.

Types

  • Class I: BMI 30-34.9 kg/mΒ².
  • Class II: BMI 35-39.9 kg/mΒ².
  • Class III (severe): BMI β‰₯ 40 kg/mΒ².
  • Central (visceral) vs. peripheral obesity.

Clinical Features 🌑️

Symptoms

  • Breathlessness.
  • Increased sweating.
  • Snoring.
  • Difficulty performing physical activities.
  • Fatigue.
  • Joint and back pain.

Signs

  • Elevated BMI.
  • Increased waist circumference.
  • Acanthosis nigricans (skin changes).
  • Peripheral oedema.
  • Hypertension.
  • Signs of comorbid conditions (e.g., diabetes).

Investigations πŸ§ͺ

Tests

  • BMI calculation.
  • Waist-to-hip ratio.
  • Blood glucose and HbA1c (diabetes screening).
  • Lipid profile.
  • Thyroid function tests.
  • Liver function tests (fatty liver disease).

Management πŸ₯Ό

Management

  • Aims to achieve weight loss, and maintain weight loss to prevent regain.
  • Lifestyle modification: restricted diet, encourage exercise, behavioural changes.
  • Pharmacotherapy: orlistat, liraglutide.
  • Bariatric surgery: indicated in severe obesity.
  • Regular follow-up and monitoring.
  • Treatment and assessment of associated comorbidities.

Complications

  • Cardiovascular disease.
  • Type 2 diabetes mellitus.
  • Hypertension.
  • Sleep apnoea.
  • Osteoarthritis.
  • Certain cancers (e.g., breast, colon).

Prognosis

  • Depends on severity and management.
  • Weight loss improves prognosis.
  • Effective management reduces risk of complications.
  • Requires lifelong lifestyle changes.

Key Points

  • Obesity is a major public health issue.
  • Multifactorial aetiology.
  • Associated with significant morbidity and mortality.
  • Management involves a multidisciplinary approach.
  • The greater the weight loss, the greater the benefits.
  • Prevention and early intervention are key.

References

  • NICE Guidelines (https://www.nice.org.uk/guidance/cg189).
  • NHS Digital (https://digital.nhs.uk/data-and-information/publications/statistical/statistics-on-obesity-physical-activity-and-diet).

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