Obesity

Question 1

Yes or no: It is possible for patients to gain weight without making any changes to their diet or activity levels?

Answer 1

Yes. This is due to metabolic factors.

Question 2

Which one of the following statements best describes the relationship between body weight and energy expenditure?

(a) Reduced body weight results in reduced total energy expenditure

(b) As body weight increases, total energy expenditure increases exponentially

(c) Increased body weight results in increased total energy expenditure

(d) It is difficult to detect an association between body weight and total energy expenditure

Answer 2

(a) Reduced body weight results in reduced total energy expenditure

Question 3

True or false: 50g of maximally activated brown adipose tissue can increase resting metabolic rate by 20%?

Answer 3

True

Question 4

Depression, self-esteem and social anxiety are all possible drivers for lack of movement. How would you classify these drivers?

(a) Mental health

(b) Medication

(c) Bio-medical

(d) Socio-cultural

(e) Genetics

(f) Hormones

Answer 4

(a) Mental health

Question 4

What is hedonic hyperphagia?

(a) Fear of overeating

(b) Overeating in response to hunger

(c) Overeating for reasons unrelated to hunger

Answer 4

(c) Overeating for reasons unrelated to hunger.

Hedonic = The branch of psychology concerned with the study of pleasant and unpleasant sensations.

Hyper = Over/in excess.

Hyperphagia = Excessive eating from excess hunger or increased appetite.

Question 5

True or false: When assessing and treating obesity, focusing on the problematic behaviours is more important than figuring out why the behaviours are occurring?

Answer 5

False

Question 6

Which three of the following questions are helpful to a practitioner during a consultation with a patient who has obesity?

(a) Why does this patient have obesity?

(b) What is the best treatment plan?

(c) What is the patient’s daily energy intake?

(d) How is obesity affecting this patient?

Answer 6

(a) Why does this patient have obesity?

(b) What is the best treatment plan?

(d) How is obesity affecting this patient?

Question 6

True or false: Financial status is a risk factor for obesity, and should be considered in the patient consultation process?

Answer 6

True

Question 6

Which of the following questions would help you begin to assess the root causes of weight gain for a patient with obesity?

(a) Is weight gain due to “slow” metabolism?

(b) Is weight gain due to increased energy intake?

(c) Is weight gain due to reduced activity?

(d) What is the patient’s activity level?

Answer 6

(a) Is weight gain due to “slow” metabolism?

(b) Is weight gain due to increased energy intake?

(c) Is weight gain due to reduced activity?

Question 7

Which one of the following does not determine behaviours related to obesity?

(a) Biology

(b) Psychology

(c) Culture

(d) Environment

(e) Blood group

Answer 7

(e) Blood group

Question 8

Which one of the following does not form part of the ‘4Ms’ for assessing a patient?

(a) Mental

(b) Mechanical

(c) Monetary

(d) Marital status

(e) Metabolic

Answer 8

(d) Marital status

Question 9

Which one of the following is not a determinant of energy expenditure?

(a) Age

(b) Activity

(c) Gender

(d) Genetics

(e) Sunlight exposure

Answer 9

(e) Sunlight exposure

Question 10

Which of the following questions should be included in an assessment for the causes of weight gain?

(a) Are there causes for a reduced energy expenditure?

(b) Is weight gain due to reduced physical activity?

(c) Is the patient on drugs that can stimulate weight gain?

(d) Is there emotional eating?

(e) What is the weight of any children?

Answer 10

(e) What is the weight of any children?

Question 11

What is the meaning of ‘comorbidity’ ?

Answer 11

The simultaneous presence of two or more diseases or medical conditions in a patient.

For example, if you have diabetes and you’re later diagnosed with depression, then depression is a comorbidity.

Question 12

You are working with a weight management multidisciplinary team that has one clinical psychologist. Which of the following patients considering bariatric surgery should you refer to the team psychologist prior to referral for surgery?

(more than one option)

(a) A patient with a known diagnosis of bipolar disorder

(b) A patient who became distressed during a consultation

(c) A patient receiving an anti-depressant under the care of the primary care physician

(d) A patient who reports significant binge eating and some purging behaviours

(e) A patient with a history of self-harm in the last 24 months

Answer 12

(a) A patient with a known diagnosis of bipolar disorder

(d) A patient who reports significant binge eating and some purging behaviours

(e) A patient with a history of self-harm in the last 24 months

Question 13

In which of the following ways might a history of neglect affect a patient’s relationship with food?

(more than one option)

(a) Neglect is associated with suppression of the hypothalamic adrenal axis

(b) Patients learn to use food to help soothe themselves when they feel distressed

(c) Patients are often left hungry when they are young, as there is not enough food available to them

(d) Patients do not learn to identify and understand the physical sensations of hunger and satiety

Answer 13

(b) Patients learn to use food to help soothe themselves when they feel distressed

(c) Patients are often left hungry when they are young, as there is not enough food available to them

(d) Patients do not learn to identify and understand the physical sensations of hunger and satiety

Question 14

True or false: A patient who drinks 21 units of alcohol a week, usually on a Friday and Saturday night, can be considered a good candidate for bariatric surgery?

Answer 14

False. The patient would not be suitable for bariatric surgery without work to reduce their alcohol consumption significantly. They would also need to develop an understanding of the potential for cross-addiction after surgery, and the impact of gastric bypass and sleeve gastrectomy on alcohol absorption.

Question 15

True, or false: Bariatric surgery can lead to diabetes remission in patients with type 1 diabetes?

Answer 15

False. Bariatric surgery can lead to diabetes remission in patients with type 2 diabetes. It is important that the patient and the healthcare professionals are aware that remission in type 1 diabetes does not occur after bariatric surgery, and that the multidisciplinary team needs to work closely with the diabetologists and their teams to ensure the safe management of patients with type 1 diabetes in the pre-, peri- and post- surgical periods.

Question 16

You are working with an adult patient with obesity, and the patient asks which is the “best diet” to follow to lose weight. Which of the following would you recommend?

(more than one option)

(a) A reduced calorie diet, high in protein

(b) A reduced calorie diet, low in fat

(c) A reduced calorie diet, high in fat

Answer 16

Any of these options might be suitable. Reduced-calorie diets result in clinically meaningful weight loss, regardless of which macronutrients they emphasise. The dietary approach should be individualised to the patient.

Question 17

What are the potential barriers to increasing physical activity levels for a patient with obesity?

(more than one option)

(a) Fear of being judged or stigmatised about their weight

(b) Joint problems, osteoarthritis and mobility issues

(c) Laziness

(d) Cost of buying appropriate clothing (e.g. footwear/sports bras)

(e) Lack of social support

Answer 17

(a) Fear of being judged or stigmatised about their weight

(b) Joint problems, osteoarthritis and mobility issues

(d) Cost of buying appropriate clothing (e.g. footwear/sports bras)

(e) Lack of social support

Question 18

Which of the following statements most accurately reflects what is meant by the term “weight bias”?

(a) Not using adjustment in a multivariable analysis for extremes of body weight

(b) Negative social devaluation based on body size or body weight

(c) The much smaller number of underweight as compared to overweight people

(d) Disproportionate increase in adipose tissue in one region of the body

(e) More reality shows about people struggling with obesity than with anorexia

Answer 18

(b) Negative social devaluation based on body size or body weight

Question 19

In which of the following life domains is weight bias unlikely to occur?

(a) Schools

(b) Healthcare settings

(c) Mass media

(d) Employment

(e) None of the above

Answer 19

(e) None of the above

Weight bias is likely to occur in all of these life domains.

Question 20

What is the most common reason that children and adolescents are bullied?

(a) Physical disability

(b) Body weight

(c) Ethnicity

(d) Unusual facial features

Answer 20

(b) Body weight

Various studies have identified body weight as the most common reason for bullying of children and adolescents.

Question 21

Which of the following is the least likely consequence for a person with obesity experiencing negative perceptions from others?

(a) Binge eating

(b) Motivation to seek treatment

(c) Depression

(d) Further weight gain

(e) Avoidance of physical activity

Answer 21

(b) Motivation to seek treatment

Question 22

Which of the following health risks are associated with an internalised perception of weight bias?

(more than one options)

(a) Hypertension

(b) Metabolic syndrome

(c) Higher HBA1c in people with diabetes

(d) Depression

Answer 22

All answers are correct.

Question 23

What is people first language?

Answer 23

Means we put people first, rather than labeling them by their disease or disability. Instead of “obese”, use words like “has obesity”, “with obesity”, “affected by obesity”.

Question 24

Imagine you have obesity. You’re seeing a doctor for the first time. Which of the following sentences would you be likely to find most acceptable?

(more than one answer)

(a) “Should we start with your obesity problem?”

(b) “Could we talk about your weight?”

(c) “Let’s talk about your overweight issues.”

(d) “So, I can see you’re pretty fat…”

(e) “Yikes! What have you been eating?”

(f) “How do you feel about your weight?”

(g) “What words would you like me to use to talk about your weight?”

Answer 24

(b) “Could we talk about your weight?”

(f) “How do you feel about your weight?”

(g) “What words would you like me to use to talk about your weight?”

People are likely to find words like “weight” most acceptable.

Question 25

Practitioners often struggle to provide effective care to patients struggling to lose weight because:

(a) Their patients are poorly compliant

(b) Their patients lack self-control

(c) Their patients lie about what they eat

(d) The practitioner has implicit weight bias

(e) All of the above

Answer 25

(d) The practitioner has implicit weight bias

Question 26

Research has shown that healthcare provider interactions with patients who have higher body weight (versus lower weight) have which of the following features?

(more than on option)

(a) Less time spent in appointments

(b) Less emotional support built

(c) Scheduling longer appointments

(d) More time discussing problems

Answer 26

(a) Less time spent in appointments

(b) Less emotional support built

Question 27

Which of the following statements are correct?

(a) Advise children being bullied about weight problems to have home schooling

(b) Healthcare practitioners should tell patients who experience stigma to avoid places where they feel it occurs most often

(c) Healthcare practitioners should prioritise body weight as the most important outcome of a treatment programme

(d) Healthcare practitioners must talk to patients about stigma and its impact on their lives

(e) Television programmes which focus on competitive weight loss motivate people with weight problems to live healthier lifestyles

Answer 27

(d) Healthcare practitioners must talk to patients about stigma and its impact on their lives

Question 28

Which of the following factors that affect relationship building may reflect weight bias by a healthcare practitioner?

(more than one option)

(a) Tone of voice

(b) Eye contact

(c) A scale that weighs patients up to 250 kg

(d) Facial expression

(e) Gestures

Answer 28

(a) Tone of voice

(b) Eye contact

(d) Facial expression

(e) Gestures

Question 29

Imagine you are planning to work with the media in your town or city to promote the use of people-first language. In planning your pitch, you write down some points to help your audience understand what people-first language is. Which of the following points should appear on your list?

(more than one option)

(a) Put people first, rather than labelling them by their disease or disability

(b) Instead of saying “obese people”, talk about “people who overindulge”

(c) People-first language has an important role to help reduce stigma

(d) None of the above

Answer 29

(a) Put people first, rather than labelling them by their disease or disability

(c) People-first language has an important role to help reduce stigma