Endocrine

Question 1

Obesity: Reversible causes

Answer 1

Drugs- antidepressant, steroids, progesterone
Polycystic ovarian syndrome
Hypogonadism
Growth hormone deficiency
Hypothyroidism
Genetic syndrome-Prader willi, Down and Turner syndrome

Question 2

Obesity: Comorbidities and FHX

Answer 2

IHD/PVD
Diabetes
OSA
Hypertension
Hypertriglyceridemia
HYpercholesterolaemia
Smoking

Question 3

Obesity: Complications

Answer 3

Osteoarthritis
Gallstones
Stress incontinence
Gout
Cancer risk - fat intake associated with COlorectal cancer and Prostate, Breast, endometrial and ovarian cancer

Question 4

Obesity: Risk assessment-increased

Answer 4

BMI>30- obese,
Waist circumference:
>102 in male;
>88 in female

Question 5

Obesity: management

Answer 5

Diet
Physical therapy
Behavioural therapy
Pharmacological therapy
Surgical

Question 6

Diet

Answer 6

Aim to create a calorie deficit 500-1000kcal/day
Women 1000kcal-1200kcal
Men 1200-1600kcal
30% or less fat
15% protein
55% CHO

VLCD-Modifast/optifast -lose 10-20kg/3 months
420kcal/day
increased risk of gallstone and gout
must supplement with benefibre ( against constipation) and low calorie fluid ( 2-2.5L/day)

Question 7

Physical therapy

Answer 7

30 minutes of moderate exercise daily.
Exercise that uses 150kcal/day or 1000kcal/week
Example: gardening 30-45mins, stair walking 15mins, walking 2.5km in 35 mins, onlyarms movement with weight for those in wheelchair or bobbing up and down on the seat for those really obese ( weigh >160kg)
Leaving bus stop 1 stop earlier, hydrotherapy and raking leaves.
Parking further than usual
walking up the stairs at work.
Seek to introduce new form of physical activity- cycling, boxing

Question 8

Behavioural therapy

Answer 8

Seek to assess whether the weight loss has been sought on their initiative
Assess the events leading to a desire to lose weight ( physician to understand patient situation and motivation )
Patient understanding of the required treatment
Patient’s expectation of how much weight they can lose within a time period.
Discuss risky situation , precipitants for eating and learn the alternatives.

Question 9

Pharmacological

Answer 9

BMI between 25-35 without complications ( DM, IHD)—->advise 3-6 months of lifestyle changes (diet, exercise) before considering medications and VLCD
Don’t forget to exclude OSA.

AIM: Weight loss of 10% of body weight /6 months— sustainable over 5 years at a rate of 1kg/week
As per up todate: GLP-1 agonist
SGLT-2 inh
Orlistat
Topiramate/

Question 10

Super obese ( BMI > 40): What to do?

Answer 10

Important to achieve weigt stabilization
Patient this obese usually gain weight from immobilisation ( 6-12kg/year weight gain)
GLP-1 agonist- assist with satiety

Question 11

VLCD / MODIFAST/OPTIFAST

Answer 11

BENEFITS: improved hypertension and lipid profile
450kcal/day-initially only VLCD then allow foods 1-2 normal meals
for 12-16 weeks only
Expect weight loss of 2kg/week
ADDITIONALLY: 2 LITRE OF WATER /DAY
BENEFIBRE- FOR FIBRE TO PREVENT CONSTIPATION
Side-effects: dry skin, hair loss, gout and increased hepatic enzymes

Question 12

Diabetes Mellitus

Answer 12

Diagnosis:
HBA1c >6.8
Fasting BSL >7.0
2 hours post prandial/ glucose tolerance test >11.1

Question 13

Diabetic foot ulcer ( PVD and PN)

Question 14

Erectile dysfunction

Answer 14

Physical - health, effects of drugs and alcohol
Psychological

Physical- hypertension, diabetes, peripheral neuropathy
hypothyroidism, Hyercholesterolaemia, Obesity,
sleep apnoea, Stroke, cancer ( Prostate cancer-
85% of men with previous prostate cancer),
arthritis, parkinson disease. Thrombosis/ blood
clotting problems.
medications- beta blocker, antidepressants

Psychological- depression and anxiety, relationship issues

Question 15

Treatment guidelines:

Question 16

Lipid target

Answer 16

LDL-chol < 2.0 for primary prevention
< 1.8 for secondary prevention
Total cholesterol < 5.0