L10- Obesity and nutrition

Question 1

definition of obesity

Answer 1

an abnormal or excessive fat accumulation that presents a health risk

Question 2

obese BMI

Answer 2

> 30

Question 3

very obese BMI

Answer 3

> 40

Question 4

underweight BMI

Answer 4

<18.5

Question 5

most of the worlds populations live in countries where obesity

Answer 5

kills more than underweight

Question 6

obesity is not distributed equally

Answer 6

•	Ethnicity 
•	Sex 
•	Local inequalities 
•	Deprivation levels
- Local inequalities: Inequality gap between those in deprived and affluent areas- obesity higher in deprived regions

Question 7

what can obesity contribute towards

Answer 7

• Cancers
• Mortality
• CVD
• Liver
• Repro complications
• Osteoarthritis and back pain
• T2D
• Asthma
• Depression and anxiety
• Sleep apnoea
• Huge cost to the NHS- 5.1 billion

Question 8

obesity is not as simple as

Answer 8

energy in energy out

Question 9

how many causes of obesity

Answer 9

108 (>300 interactions)

Question 10

national obesity plan focuses on

Answer 10

• sugar reduction
• local communities
• schools
• retail
• labelling

Question 11

sugar reduction

Answer 11

o Use of tax system

o Ban to end the sale of energy drinks

Question 12

schools

Answer 12

o Physical activity

o Education

Question 13

retail

Answer 13

o Prices

o Location e.g. checkout

Question 14

labelling

Answer 14

e.g. nutrients

Question 15

the single most important intervention is to understand that there is

Answer 15

no single most important intervention

Question 16

weight loss required for therapeutic benefit e.g.

Answer 16

diabetes, hypertension, sleep apnoea, osteoarthritis, stress, PCOS

Question 17

how many tiers of obesity services

Answer 17

4 tiers

Question 18

tier 1

Answer 18

primary activity, population level public health prevention, identifying those at risk, referring into appropriate interventions

commissioned by local authorities

Question 19

example of tier 1 approach

Answer 19

for healthy population inc skill based e.g. cook and eat sessions

community based approaches becoming important

Question 20

tier 2

Answer 20

community based weight management services

Question 21

tier 2 commissioned by

Answer 21

local authority- weight management services for those without complex needs

Question 22

tier 3

Answer 22

specialised weight management services for people with severe and complex obesity

Question 23

tier 3 commissioned by

Answer 23

CCGs

patients with complex needs- includes dietetic and psychological support
- gateway to tier 4

Question 24

tier 4

Answer 24

bariatric surgery

Question 25

tier 4 commissioned by

Answer 25

CCGs

- bariatric surgery- limited capacity

Question 26

studies show weight loss is largely about

Answer 26

diet in the short term but requires physical activity to be sustained

Question 27

example of very effective intervention

Answer 27

bariatric surgefry

Question 28

bariatric surgery

Answer 28

limited capacity in NHS

long term weight loss

Question 29

ghrelin

Answer 29

appetite stimulating

Question 30

PYY and GLP1

Answer 30

satiety hormones

Question 31

challenge of weight loss

Answer 31

weight-maintenance

Question 32

example of drug used to treat obesity

Answer 32

orlistat

Question 33

orlistat mode of action

Answer 33

energy wastage- adjunct to diet for obesity, including weight loss and maintenance

Question 34

other obesity drugs suppress

Answer 34

appetite

Question 35

T@DM remission

Answer 35

Bariatric surgery

low carb]low calories diet

Question 36

what is the role of the doctor

Answer 36

1. Brief advice
   - ‘While you’re here, I just wanted to talk about your weight’
2. Weight stigma
3. Listen
4. Know your limits
   - Dietitians

Question 37

is obesity a disease

Answer 37

• Will it reduce stigma or increased it?
• Workplace protection
• Do we need a medical model?
• Genetics: increased genetic variants and increased risk of obesity
• Obesity descries a collection of 60+ disorders?
• DO we need a medical model?

Question 38

malnutrition

Answer 38

-	3 million people adults are affected
o	30^ hospital admissions
o	35% care home admissions
o	15% outpatient attendances
o	10% GP presentations
-	£20 billion per year on the NHS