Management of Obesity

Question 1

Is the prevalence of obesity increasing or decreasing?

Answer 1

Increasing

Question 2

What are some co-morbidities that obesity increases the risk of?

Answer 2

Question 3

What are the 1st and 2nd top causes of cancer?

Answer 3

1) Smoking
2) Obesity

Question 4

Explain tier 1 to 4 of adult weight management?

Answer 4

Tier 1:

• Healthy Helpings programme really helps with losing weight

Tier 2:

• Non-surgical weight management can be done by medicine:
  
  • Orlistat
    
    • Inhibits pancreatic and gastric lipases
    • 60mg dose can be used by patients with BMI more than or equal to 28 and over 18 years older
    • Usual prescription dose is 120mg 3 times per day
    • GI adverse effects with consumption of fat
    • Only used where diet, physical activity and behavioural changes are supported
    • Therapy should only be continued beyond 12 weeks if patients has lost at least 5% of body weight

Tier 3:

• Example of programme is Weigh Forward
• Combination of evidence based psychological model, dietetic input and physical activity for a holistic, person centred care approach

Tier 4:

• Bariatric surgery
  
  • Variety of procedures performed on people who are obese to help with weight loss
    
    • Gastric bypass
    • Gastric band
    • Vertical banded gastroplasty
  • BMI >= 35 and presence of one or more severe comorbidities that would improve with weight reduction
  • Also needs evidence they will comply with structured weight loss management programme involving diet, physical activity, psychological and drug interventions

Question 5

What is tier 1 of adult weight management?

Answer 5

Population widehealth improvement work such as community interventions:

• Healthy Helpings programme helps with losing weight
• walking groups
• leisure club classes
• cooking classes

Question 6

What is tier 2 of adult weight management?

Answer 6

Non-surgical weight management done by primary care:

• NHS healthy weight programmes
• lifestyle advice
• community dietetic
• drug therapy if appropriate

Question 7

What is an example of a drug that can be used for tier 2 management of weight?

Answer 7

Orlistat

Question 8

What is the action of orlistat?

Answer 8

Inhibits pancreas and gastric lipases

• inhibition reduces fat absorption

Question 9

Who can orlistat be prescribed to?

Answer 9

60mg dose to patients with BMI more than or equal to 28 and over 18 years old

Question 10

What is orlistat only used with?

Answer 10

Where diet, physical activity and behavioural changes are supported

Question 11

How long should orlistat therapy be given for?

Answer 11

Should only be given for longer than 12 weeks if patient has lost at least 5% of body weight

Question 12

What is tier 3 of adult weight management?

Answer 12

Specialist weight management:

• access to MDT
• psychological expertise
• physiotherapy

Question 13

What is an example of a programme for losing weight?

Answer 13

Weigh Forward

Question 14

What is tier 4 of adult weight management?

Answer 14

Specialist surgical service:

• bariatric surgery
• gastric bands
• specialist follow up

Question 15

What are some examples of bariatric surgery procedures?

Answer 15

Gastric bypass

Gastric band

Vertical banded gastroplasty

Question 16

What is the criteria for a patient to qualify for bariatric surgery?

Answer 16

BMI >= 35 and presence of one or more severe comorbidities that would improve with weight reduction

Also needs evidence will comply with structured weight loss management programme involving diet, physical activity, psychological and drug interventions