Lecture 27: Management of Obesity

Question 1

what does tier 1 obesity management include?

Answer 1

Population-wide health improvement work:
- community interventions including active referral
- walking groups
- leisure club classes
- cooking classes

Question 2

what does tier 2 obesity management include?

Answer 2

Primary care:
- NHS healthy weight programmes
- lifestyle adviser
- community dietetic
- drug therapy if appropriate supported by local clinic guidance

Question 3

what does tier 3 diabetes management include?

Answer 3

Specialist weight management:
- access to multi-disciplinary team e.g. dietetic led programme, psychological expertise, physiotherapy

Question 4

what does tier 4 diabetes management include?

Answer 4

Specialist surgical service:
- bariatric surgery
- gastric bands
- specialist follow up

Question 5

give an example of a drug used in to help someone lose weight, and describe how it works

Answer 5

Orlistat:
- inhibits pancreatic and gastric lipases
- 60 mg dose can be purchased by patients with BMI > 28 and over 18 years old
- usual prescription dose 120mg 2 times daily
- GI adverse effects with consumption of fat

Question 6

when is bariatric surgery indicated?

Answer 6

• BMI >/= 35
• presence of one or more severe comorbidities which are expected to improve significantly with weight reduction (e.g. severe mobility problems, arthritis, type 2 diabetes)
• evidence of completion of a structured weight management programme involving: diet, physical activity, psychological and drug interventions, not resulting in significant and sustained improvement in comorbidities.