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 fat Visceral fat hormonally 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 adherence is the most important thing LEARN Lifestyle, 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 Orlistat first choice

They 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Sympathomimetics Increased bp Potential for abuse Sibutramine withdrawn Antidepressants High doses required Anti-epileptic Insufficient data Canabinoid-1 receptor antagonists Rimonabant effective in clinical trials Withdrawn due to psychiatric adverse effects *Liposuction Reduction in subcutaneous body fat, no evidence of clinical benefit *Bariatric Surgery Reduction in consumption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, diabetes resolved in 70% of cases

Students will also understand the nature of eating disorders including anoerxia, bulimia and binge-eating disorder.
Starvation common in the developing world (growth chart measures) Marasmus Muscle wasting and depletion of body fat o Inadequate intake of all nutrients and total calories o Characterized by: Hunger, diminished weight/height, emaciated, bradycardia, hypotension, atrophy of muscle and subcutaneous fat o Kwashiorkor Muscle atrophy but normal body fat o Inadequate protein but adequate calories o Clinical Presentation: Anorexia, normal weight/heigh, generalized oedema, rounded cheeks, dry, peeling skin, distended abdomen, hypopigmented hair Moderate: (-2) (-3) Severe: <(-3) Treatment: ReSoMal & F-75 (Therapeutic milk formula 75kcal/100mL) o Rehab phase: switch to F-100, slowly increase to 150-220 kca/kg/day o Begin supplementation with vitamins esp Vitamin A, iron & folate Refeeding Syndrome o Characterized by: hypophosphatemia, hypokalemia, hypomagnesemia, Vitamin and trace mineral deficiencies, volume overload, edema o Risk Factors: Extent of weight loss, rapidity of weight gain o Feed strategy: Correct electrolyte imbalance, calorie intake to reflect energy expenditure, increase 300-400kcal every 3-4 days, +1kg a week

They will appreciate the role of drugs in treating these disorders.

Anorexia No benefit of anti-depressants but olanzapine may benefit? Bulimia Floxetine approved for bulimia, tricyclic anti-depressants also effective Binge Eating Floxetine (Selective serotonin reuptake inhibitor) recommended, topiramate (anti-epileptic) more effective