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Obesity

Background knowledge ๐Ÿง 

Definition

  • Obesity is a condition characterized by excessive body fat accumulation.
  • Body Mass Index (BMI) โ‰ฅ 30 kg/mยฒ 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.

Aetiology and Pathophysiology

  • 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/mยฒ.
  • Class II: BMI 35-39.9 kg/mยฒ.
  • Class III (severe): BMI โ‰ฅ 40 kg/mยฒ.
  • Central (visceral) vs. peripheral obesity.

Clinical Features ๐ŸŒก๏ธ

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 ๐Ÿงช

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 ๐Ÿฅผ

Management

  • Aims to achieve weight loss, and maintain weight loss to prevent regain.
  • Lifestyle modification: restricted diet, encourage exercise, behavioral 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 apnea.
  • 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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