case 6 - overview of obesity

Question 1

what is healthy BMI

Answer 1

18.5-24.9 is healthy weight

Question 2

what is overweight BMI

Answer 2

25-29.9 is overweight

Question 3

what is obesity II BMI

Answer 3

30-39.9 is obesity II

Question 4

what is obesity III BMI

Answer 4

40+ is obesity III

Question 5

what are the low and high risk waist circumferences and when are they considered

Answer 5

considered in adults with a BMI less than 35

Men <94cm is low risk, 94-102 is high risk and >102cm is very high risk
Women <80cm is low risk, 80-88cm is high risk, >88cm is very high risk

Question 6

what are centile charts

Answer 6

are used to measure for obesity in children

Question 7

what are the caveats with BMI

Answer 7

muscular people: overestimated
South Asian population: higher risk
Older people: lower risk
Children have special charts

Question 8

what did NICE state about BMI

Answer 8

that it is not a direct measurement of adiposity but it is a practical measure of adiposity in adults

Question 9

what is gynaecoid

Answer 9

lower fat obesity
- pear shaped
- encouraged by oestrogen and progesterone
- less health risk than upper body obesity

however, after menopause, naturally an upper body obesity appears

Question 10

what is andrioid

Answer 10

upper fat obesity
- apple shaped
- associated with heart disease and type 2 DM
- abdominal fat is released right into the liver
- this kind of fat is encouraged by testosterone and excessive alcohol

Question 11

what are the key differences in male and female obesity

Answer 11

Obesity of the male (android) type shows a dominant visceral and upper thoracic distribution of adipose tissue, whereas in the feminine (gynecoid) type adipose tissue is found predominantly in the lower part of the body (hips and thighs).

Android obesity is clearly a cardiovascular risk factor, more so than gynecoid obesity. Hereditary factors contribute significantly to the occurrence of this pathology in families, although environmental factors play a role in its development.

Android obesity is associated with metabolic anomalies which also characterize the syndrome X: resistance to insulin, arterial hypertension and dyslipidemia.

Question 12

what does the predisposition of individuals with android obesity to become diabetic rest on

Answer 12

rests in part on genetic and in part on environmental factors

Question 13

what are two determining factors for type II diabetes

Answer 13

Hyperinsulinemia and a high flux of free fatty acids act at the level of liver and endocrine pancreas to increase resistance to insulin and to decrease insulin secretion, two determining factors for type II diabetes.

Question 14

what are the facts of obesity globally

Answer 14

Globally, obesity nearly tripled since 1975
>1.9 billion adults are overweight
13% of the worlds population of adults are obese
38 million children under 5 are overweight or obese
>340 million children and adolescents overweight and obese

Question 15

what are the statistics on obesity in england 2020

Answer 15

63% UK adults are overweight or obese
67% of men and 60% of women were classed as overweight or obese
Lowest levels in London, highest levels in north east and west midlands

711,000 hospital admissions with obesity as primary or secondary diagnosis in UK
15% increased from 2016/17

Question 16

what are the physical health consequences of being overweight and obese

Answer 16

raised BMI significantly increases risk of non-communicable diseases
CVD, diabetes, MSK disorders, some cancers, respiratory problems, reproductive function, hypertension
Children who are obese can experience breathing difficulties, hypertension, insulin resistance
as BMI increases, risk increases

Question 17

what are the psychological consequences of being overweight and obese

Answer 17

weight stigma (including among HCPs)
Anxiety and depression
Shame and guilt

Question 18

what is tier one in behaviour change

Answer 18

Tier 1: universal interventions
prevention and reinforcement of health eating and physical activity
Population level e.g media, campaigns, sugar tax

Question 19

what is tier two on behaviour change

Answer 19

Tier 2: behavioural interventions
prevention and reinforcement of health eating and physical activity including behaviour change conversations
Community level e.g primary care, schools

Question 20

what is tier 3 on behaviour change

Answer 20

Tier 3: specialist services
non-surgical intensive management by MDT for individuals living with obesity and complex needs
Specialist weight management service

Question 21

what is tier 4 on behaviour change

Answer 21

Tier 4: surgery
surgical and non-surgical bariatric surgery supported for MDT for individuals living with morbid obesity
Bariatric surgery

Question 22

what skill do we use for conversations about behaviour change

Answer 22

motivational interview skills (OARS)

Question 23

what is orlistat and what is the MoA

Answer 23

is a lipase inhibitor, reducing the absorption of dietary fat. It works by inhibiting gastric and pancreatic lipase, which break down triglycerides in the intestine

The triglycerides therefore do not break down to fatty acids, to be absorbed into the blood stream
They are then excreted into the faeces

abdominal pain and diarrhoea are common this may be minimised by reduced fat intake

Question 24

what is liraglutide (Saxenda) and what is its MoA

Answer 24

It is a GLP-1 agonist
GLP-1 hormone has different roles, one being to regulate appetite
GLP-1 is released when food is ingested
The GLP-1 travels to and works at the hypothalamus

Saxenda is a GLP-1 analogue, and works by interacting with neurones involved in the regulation of appetite in the hypothalamus.
This decreases the feeling of hunger, causing patients to eat less and thus lose weight.

Question 25

when should saxenda be offered

Answer 25

in tier 3 weight management clinics

Question 26

what complications make you eligible for bariatric surgery

Answer 26

• BMI of 35 and other medical complications makes you eligible for bariatric surgery
• As well as just a BMI of 40
• Asian people with BMI of 30 plus diabetes is eligible