FINAL YEAR MBBS · MS MODULE · KMU CURRICULUM
Topic 1. Obesity, Weight Dysregulation & Eating Disorders
Connect the mechanisms, clinical clues and treatment choices in one rapid review.
1. THE TOPIC IN ONE CONNECTED FLOW
Weight dysregulation has biological and behavioral dimensions. In obesity, persistent positive energy balance increases adiposity and its metabolic and mechanical effects. Eating disorders involve harmful restriction or binge–compensate behaviors that may cause medical instability at any body size. Assessment links the patient’s presentation to a safe, individualized treatment pathway.
Susceptibility
Regulatory change
Body effects
Clinical clues
Risk assessment
Targeted care
2. KEY CLINICAL CONNECTIONS
Central adiposity and complications
Increased waist circumference → visceral fat–related insulin resistance → raised glucose, abnormal lipids and cardiovascular risk.
Greater joint load → knee / hip pain and reduced mobility.
Treatment acts at different points
Sustainable energy deficit + activity → improved weight and metabolic function.
Orlistat → reduced fat absorption → oily stools; GLP-1 therapy → increased satiety → nausea may occur.
Selected bariatric procedures → altered gastric capacity / gut signaling → weight reduction, but nutritional follow-up is essential.
Eating-disorder clues change priority
Marked restriction + significantly low weight → suspect anorexia → assess bradycardia and malnutrition.
Binge–purge cycle, even at normal BMI → suspect bulimia → check vomiting-related electrolyte loss; stabilize before psychological treatment if medically unstable.
3. AIM HIGH-YIELD INTEGRATION REVIEW
- ⭐ BMI ≥30 kg/m² identifies adult obesity in standard WHO classification → waist circumference and comorbidities refine actual risk; South Asian metabolic risk may occur at lower BMI.
- Visceral adiposity → inflammatory signaling and insulin resistance → diabetes, dyslipidemia and cardiovascular complications.
- Greater mechanical load → knee / hip osteoarthritis and limited mobility → functional assessment matters alongside weight.
- Orlistat → intestinal lipase inhibition → less fat absorption but oily stools and fat-soluble vitamin concerns; GLP-1-based treatment → satiety and lower intake, with gastrointestinal adverse effects.
- ⭐ Bariatric surgery can provide substantial metabolic benefit in selected patients → sleeve or gastric bypass still requires lifelong nutritional monitoring; persistent vomiting raises concern for thiamine deficiency.
- ⭐ Anorexia nervosa → restrictive intake and significantly low weight → bradycardia, low bone density and risk during refeeding; nutritional rehabilitation and psychological therapy are central.
- ⭐ Bulimia nervosa → binge eating followed by compensatory purging → dental erosion and hypokalemic metabolic alkalosis; eating-disorder-focused CBT is central, with fluoxetine an option.
- Medical instability (syncope, serious bradycardia, arrhythmia or major electrolyte disturbance) → urgent assessment and stabilization before routine outpatient eating-disorder care.