Lecture 15: Obesity Flashcards
What is obesity?
- Abnormal or excessive fat accumulation that may impair health.
- Energy intake exceeds expenditure over time
What are the categories of BMI for healthy weight, overweight and obese?
- Healthy: 18.5-24.9
- Overweight: 25-29.9
- Obesity 1: 30-34.9
What are the primary health risks associated with obesity?
- Cardiovascular disease
- Type 2 diabetes
- Cancer
- Musculoskeletal problems
- Mental health
- Reduced life expectancy
What are Key NICE recommendations for discussing obesity with patients?
• Use non-stigmatising language
- focus on health improvements rather than weight,
- be mindful of cultural and personal beliefs.
- tailored to individual needs
- encourage all family members to eat healthy and physical activity
What are key components of a behavioural intervention for weight management?
- Multicomponent approach addressing diet, physical activity and behaviour change
What dietary modifications are recommended for weight management?
• Reduce portion sizes
- modify nutrient intake
- maintain a balanced diet
- limit high-calorie foods.
- pattern and timing of eating
What is the recommended advice for fruit and veg?
- At least 5 portions a day
- Provide vitamins, mineral, fibres
- Could be fresh, frozen or canned
What is the recommended advice for excercise?
- At least 150 mins of moderate exercise or 75 mins of vigorous a week
- Includes aerobic, strength training
- Helps control weight, reduce disease risk, strengthen muscles and bones
What is the recommended advice for fibre?
- At least 30g a day
- Helps with digestion, prevents constipation,
- Whole grains, brown rice, whole wheat bread, beans, lentils, fruits, veg
What is the recommended advice for oily fish?
- At least 1 portion a week
- It helps reduce inflammation, improve heart health and support brain function
- Salmon, mackerel, sardines
What is the recommended advice for salt?
- No more than 6g a day
- Too much can cause HTN, heart disease, stroke
- Avoid processed foods, checks labels
What is the recommended advice for fats?
- Saturated and trans fats can raise cholesterol
- Good sources: olive oil, avocados, nuts and oily fish
What is the recommended advice for sugars?
- No more than 30g (7 cubes) of added sugars
- Can cause weight gain, tooth decay and increase risk of type 2 diabetes
- Sugary drinks, processed foods, breakfast cereals
What are low energy and very low energy diets?
- Low energy: 800-1200 calories a day within a specialist service for people living with obesity, overweight and diabetic (2)
- Very low evergy: less than 800 a day within a specialist service for people living with obesity and have a clinically assessed need to lose weight. Ensure both are no longer than 12 weeks and have ongoing clinical support
What is the safe and sustainable rate of weight loss?
- 0.5-1 kg per week
- Achieved by reducing energy intake by 600 calories a day
What are the main pharmacological treatments for obesity?
- Orlistat (lipase inhibitor)
- GLP-1 receptor agonist (Liraglutide, Semaglutide)
What is the mechanism of action of Orlistat?
- Inhibits pancreatic lipase, reducing fat absorption in the digestive system
- Acts locally
What are the common side effects of Orlistat?
- Oily stools
- Flatulence
- Diarrhoea
- Possible vitamin deficiency (A,D,E,K)
Who is eligible for orlistat treatment?
- BMI = or over 30
- BMI over 28 with risk factors (type 2 diabetes, hypertension)
What are the important counselling points for Orlistat?
- Take with meals containing fat (immediately, during or upto 1hr after)
- Review at 12 weeks only continue beyond 12 months after discussing potential benefits and risk
- Stools may be bulky, pale, oil, foul smelling
- Red flag: rectal bleeding
- Interacts with anti-epileptics
- May effects absorption of vitamins and minerals: consider multivitamins taken at least 2hrs after orlistat or bedtime
How do GLP-1 receptor agonists help in weight loss?
- Delay gastric emptying, increase satiety and reduce appetite
- Liraglutide is a daily SC injection, semaglutide is a weekly SC injection
What are the key eligibility criteria for GLP-1 agonists?
- BMI =/over 30
- BMI over 27 with at least 1 weight related co-morbidity (e.g. diabetes, hypertension)
When should GLP-1 agonists be stopped?
- If over 5% of initial weight has been lost after 6 months on the highest tolerated dose
Who qualifies for Bariatric surgery?
- BMI of over 40
- Or 35-40 with a significant co-morbidity (T2DM, HTN)
- Fit for anesthesia and surgery
- Failed non-surgical measures
- Committed for long-term follow up
