Obesity Flashcards
BMI calculation =
Weight (Kg) / height (m) squared
Underweight
<18.49
Normal
18.5-25
Overweight
25-30
Obese class 1
30-35
Obese class 2
35-40
Obese class 3
> 40
The management of obesity consists of a step-wise approach:
conservative: diet, exercise
medical
- orlistat
- liraglutide
surgical
What is Orlistat?
A pancreatic lipase inhibitor used in the management of obesity
Adverse effects include faecal urgency/incontinence and flatulence
A lower dose version is now available without prescription (‘Alli’)
When should Orlistat be prescribed?
as part of an overall plan for managing obesity in adults who have:
- BMI of 28 kg/m^2 or more with associated risk factors, or
- BMI of 30 kg/m^2 or more
- continued weight loss e.g. 5% at 3 months
- Orlistat is normally used for < 1 year
What is Liraglutide?
a glucagon-like peptide-1 (GLP-1) mimetic that is used in the management of type 2 diabetes mellitus (T2DM)
given as a once daily subcutaneous injection
when used in the management of T2DM it was noted to cause weight loss in a significant proportion leading to research interest in its use in obesity
Liraglutide NICE criteria for use?
person has a BMI of at least 35 kg/m²
prediabetic hyperglycaemia (e.g. HbA1c 42 - 47 mmol/mol)
Bariatric surgery: Primarily restrictive operations include?
Primarily restrictive operations:
- laparoscopic-adjustable gastric banding (LAGB)
it is normally the first-line intervention in patients with a BMI of 30-39kg/m^2
produces less weight loss than malabsorptive or mixed procedures but as it has fewer complications - sleeve gastrectomy
stomach is reduced to about 15% of its original size - intragastric balloon
the balloon can be left in the stomach for a maximum of 6 months
Bariatric surgery: Primarily malabsorptive operations include?
biliopancreatic diversion with duodenal switch
- usually reserved for very obese patients (e.g. BMI > 60 kg/m^2)
Bariatric surgery: Mixed operations include?
Roux-en-Y gastric bypass surgery
is both restrictive and malabsorptive in action
