1
Q
What do you think is the key reason obesity is on the increase?
A
- Increased energy intake (from food and drink)
- Portion sizes have increased
- Decreased physical activities
2
Q
How many Australians do you think are now classified as obese? What percentage of Australia is clinically obese?
A
- More than 4 million Australians are classified as obese (BMI over 30)
- Approx. 18% of Australians are obese
3
Q
What do you think the cost of obesity-related disease is in Australia each year?
A
$58 billion
4
Q
How does obesity increase the risk of cardiovascular disease?
A
Being obese puts you at risk of:
- Hypertension
- Diabetes Mellitus
- Atherosclerosis
- 21% of ischaemic heart disease is thought to be attributable to a BMI of above 25
5
Q
How does obesity increase your risk of high blood pressure?
A
- Obesity can lead to an increase in:
a. cardiac output - blood vessels associated with adipose tissue
b. blood volume
c. arterial resistance - atherosclerosis - Increased insulin secretion also:
a. induces thickening of blood vessels leading to thickening and hardening thus increasing BP
b. increased CO as increased adrenalin in secretion
c. increased reabsorption of water and salt thus increasing volume and BP
6
Q
How does obesity put you at risk of increased high blood cholesterol?
A
- Very high blood levels of cholesterol can also increase the risk of heart disease
- High cholesterol, whether high LDLs or HDLs is a risk factor for CVD but LDLs are the most problematic
- LDLs stick to artery walls and cause plague build up
7
Q
How does obesity put you at risk of diabetes (Type 2)?
A
- Obesity is probably the most important risk factor for diabetes
- Obesity promotes insulin secretion through inappropriate activation of gluconeogenesis (liver makes fuel which usually only occur during fasting)
- The type of diet that makes you obese probably also cause dramatic swings in blood glucose levels which further promotes insulin resistance as the cell receptors become less sensitive to insulin
8
Q
How does obesity put you at risk of chronic kidney disease?
A
- Obesity is associated with the early onset of:
a. glomerulomegaly
b. hemodynamic changes of a hyperfiltering kidney
c. increased albuminuria - In patients with sustained obesity, glomerulosclerosis can develop presenting with massive proteinuria
- In addition to this, diabetes (the No. 1 cause of CKD) can increase damage to the blood vessels in the kidneys
9
Q
How does obesity put you at risk of gastro-oesophageal reflux disease?
A
- An obese person is three times more likely to have GORD
- Abdominal fat puts pressure on the lower oesophageal sphincter leading to reflux
- This can progress to oesophageal cancer
10
Q
How does obesity put you at risk of fatty liver disease?
A
- Non-alcoholic fatty liver disease is tightly linked with obesity
- Usually asymptomatic and only detected on a blood test with elevated AST and ALT results
- Fatty liver (steatosis) can progress to non-alcoholic steatohepatitis and then progress to cirrhosis of the liver
11
Q
How does obesity put you at risk of lymphoedema?
A
- Obesity can cause and worsen lymphedema
2. Especially in the lower extremities where pressure from adipose tissue blocks the return of lymph
12
Q
How does obesity put you at risk of cellulitis?
A
- Cellulitis is often caused by an infection of the tissues beneath the skin with either a group of streptococcus or staphylococcus aureus bacteria
- This infection occurs via a small cut, graze etc. in the skin
- Obesity can increase lymphedema and this leads to the development of cellulitis
13
Q
How does obesity put you at risk of stroke?
A
- Diabetes is an individual risk factor of stroke
- Obesity increases the risk of stroke because excess body fat can lead to:
a. difficulty in blood flow
b. increase in blockages - Both of these factors increase the risk of stroke
14
Q
How does obesity put you at risk of Pickwickian syndrome?
A
- Also known at Obesity Hyperventilation syndrome
- Is a form of sleep apnoea
- It occurs when the patient’s obesity puts excessive strain on the pulmonary system
- Individuals with sleep apnoea are at greater risk of high blood pressure, irregular heart rhythms, and stroke
15
Q
How does obesity put you at risk of depression?
A
- Depression and obesity are linked
- People who are depressed often become obese and vice versa
- Treatment such as exercise and stress reduction can help to treat both depression and obesity
16
Q
How does obesity put you at risk of osteoarthritis?
A
- Obesity puts added strain on joints and bones
2. This can directly affect weight bearing joints
17
Q
How does obesity put you at risk of gallbladder disease?
A
- Gallstones are usually made of cholesterol
- Obese individuals tend to produce more cholesterol than normal
- This means that the bile can not dissolve all of the cholesterol and some precipitates out to form stones
18
Q
How does obesity put you at risk of Gout?
A
- Someone with obesity is four times likely to develop Gout
- Gout is a form of arthritis caused by the accumulation of sodium urate crystals in the joints
- Obesity increases the pressure on the joints
- In addition to this, people with an obese BMI have increased uric acid levels in the blood
- These levels can be decreased with weight loss
19
Q
How does obesity put you at risk of Urinary Incontinence (Stress Incontinence)?
A
- There is a direct link between obesity and stress incontinence
- Added weight from abdominal fat can cause stress incontinence by pressing on the bladder
- This extra pressure makes it more likely that the bladder will leak
- Losing weight can reduce the severity
20
Q
How does obesity put you at risk of reproductive disorder?
A
- Being obese can lead to:
a. menstrual disorder (polycystic ovarian syndrome)
b. Infertility - Weight loss has a marked effect on improving the menstrual cycle, spontaneous ovulation and fertility
- Weight loss reduces the level of androgens produces by the body
21
Q
How does obesity put you at risk of complications in pregnancy?
A
- Obesity increases the risk of:
a. miscarriage
b. doubles the chance of developing gestational diabetes
c. pre-eclampsia
d. doubles the risk of neural tube birth defects such as spina bifida
e. requiring a C-section - It also makes it difficult to estimate the size of the foetus, monitors the baby’s heart rate and administers an epidural
22
Q
How does obesity put you at risk of endometrial, breast, prostate, and colon cancer?
A
- Exact mechanism is still unclear
- May be due to increased oestrogen production produced by fat tissue
- May be due to increased level of insulin and insulin-like growth factor which may promote certain tumours
- Obese people usually have low levels of inflammation which has been associated with a cancer risk
23
Q
Fasting glucose
A
- Patients will be tested to see if they have an impaired response to glucose
- They may also be tested:
a. after a meal or;
b. by a GTT (glucose tolerance test) where glucose tests are taken at timed intervals after a glucose challenge
24
Q
Fasting insulin
A
- Is very variable and may not be a reliable test for metabolic syndrome
- However, patients who have elevated insulin levels above normal are said to suffer from metabolic syndrome
25
Lipid profile
1. Measures:
a. HDLs - high density lipoprotein
b. LDLs - low density lipoprotein
c. Triglycerides
2. High HDLs, LDLs or triglycerides can be a risk factor for CVD. High LDLs occur frequently in the obese as cakes, fast foods etc are high in saturated fat (LDLs).
26
Micro-albumin
1. Is an early indicator of chronic kidney disease and helps to identify the disease before other symptoms are present
2. It is used to monitor Diabetic patients according to the WHO criteria
27
hs-CRP
1. C reactive protein is produced in inflammation and infection
2. A low level of inflammation may be tested in order to determine cardiac risk
28
Blood pressure
This simple check of hypertension also provide evidence of atherosclerosis
29
Weight and waist circumference
This is used to document abdominal obesity which has proven to be a risk factor for CVD, diabetes and some cancers
30
Body mass index (BMI)
1. This is an alternate measure to waist circumference
2. It is calculated as follows:
a. weight in kilograms / height in meters square
3. This calculation has flaws as it does not describe the location of the excess weight in the body
e. g. some bodybuilders would be classified as obese even though they have very little body fat
1005
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