obesity

Question 1

what are the BMI classifications according to NICE for obesity?

Answer 1

18.5-<25=healthy
25-<30=overweight
obesity 1=up to 35
obesity 2=up to 40
obesity 3=40+

Question 2

what are some exceptions that mean you have different BMI thresholds?

Answer 2

south asians -lower threshold of risk
muscular builds
older people -higher thresholds of risk

Question 3

what are the secondary causes of obesity?

Answer 3

hypothalamic disorders
genetic syndromes
hypothyroidism
cushing’s syndrome
medications
bulimia

Question 4

how could hypoparathyroidism cause weight gain?

Answer 4

low calcium -chronically more fatigued -less physical activity

Question 5

which genetic syndromes are associated with obesity?

Answer 5

prader willi
laurence moon
bardet biedel
cohen’s
alstrom’s

Question 6

which medications are associated with obesity?

Answer 6

steroids
TCAs
phenothiazines (eg chlorpromazine)
clozapine
sodium valproate
sulfonylureas (eg gliclazide)
insulin

Question 7

what are the most common cancers due to obesity in men and women?

Answer 7

men: liver,pancreas
women: uterus, kidney

Question 8

what is the 4 tier NHS weight management?

Answer 8

tier 1-universal, advice in community
tier 2-primary care, can involve referral to commercial weight loss programme
tier 3-specialist weight management -liquid diets, anti-obesity meds, endocrine investigation, assessment for surgery
tier 4-super specialised inc surgery

Question 9

what are the different types of diets that can help with obesity?

Answer 9

1) low kcal diet -under 2000
2) very low kcal diets -<800. NICE recommends can’t use for more than 12 weeks.
3) low carb diets. this inc keto diets -20g or less of carbs a day
4) intermittent fasting
5) time restricted eating
6) low glycaemic index foods

Question 10

which anti obesity drugs are licensed in the UK?

Answer 10

orlistat
liraglutide (saxenda)
semaglutide (ozempic/wegovy)

Question 11

what does orlistat do, how can you take it, and important info about it?

Answer 11

lipase inhibitor -prevents absorption of fats
BMI 28+ with RFs or 30+, aged 18-75
take tablet before every fat containing meal
check weight in 12 weeks and discontinue if haven’t lost 5%

Question 12

what do GLP analogues do and 2 examples of them?

Answer 12

bind to GLP receptor to increase insulin secretion, suppress glucagon, and slow gastric emptying

Question 13

what are 2 examples of GLP analogues?

Answer 13

liraglutide
semaglutide

Question 14

what are the BMI thresholds for bariatric surgery?

Answer 14

> 40 with no comorbidities
35 with comorbidities
30 with diabetes or metabolic syndrome but limited evidence as to whether benefit

Question 15

what are the non BMI criteria for bariatric surgery?

Answer 15

• have worked with structured weight management programme for 6m-1y
• have made sustainable lifestyle changes
• have no major mental health issues
• have stopped smoking
• comorbidities have been optimised
• patient keen and motivated
• patient prepared for long term lifestyle change

Question 16

what are the main options for bariatric surgery?

Answer 16

laparoscopic adjustable gastric band
vertical sleeve gastrectomy
roux-y-gastric bypass (RYGB)

Question 17

what happens in a laparoscopic adjustable gastric band?

Answer 17

adjustable band goes around top of stomach
can be adjusted via reservoir under skin

Question 18

what happens in vertical sleeve gastrectomy?

Answer 18

part of stomach removed so rest is smaller (sleeve)

Question 19

what happens in RYGB?

Answer 19

small pouch made in stomach and food goes through that to small bowel
connection made between duodenum and small bowel so digestive juices can get to food

Question 20

what is the most effective bariatric surgery for weight loss?

Answer 20

gastric bypass

Question 21

what are the long term impacts of bariatric surgery?

Answer 21

nutrient deficiencies
protein malnutrition
loose skin
dumping syndrome

Question 22

what happens in dumping syndrome?

Answer 22

range of symptoms that occur when food is emptied too quickly from stomach into small intestine, filling it with undigested food that is not adequately prepared to allow efficient absorption.

Question 23

what are the early symptoms of dumping syndrome and why?

Answer 23

food (hyperosmolar) going into small bowel quickly -water quickly shifts from vasculature into small intestine:
N+V, palpitations, sweating, bloating, cramping, diarrhoea, dizziness, fatigue

Question 24

what are the later symptoms of dumping syndrome?

Answer 24

hypoglycaemia, weakness, confusion, hunger, sweating, dizziness

Question 25

what is the treatment for dumping syndrome?

Answer 25

ietary changes -smaller meals more often, eating slowly, avoid sugary foods and nutrient rich drinks, complex carbs, high soluble fibre foods, protein in each meal, no alcohol

Question 26

what is the general recommended amount of calories to eat per day for men and women?

Answer 26

men -2500
women -2000

Question 27

how many calories and protein does a meal replacement product usually contain?

Answer 27

200-230 kcal
15g protein

Question 28

what is the aim of starting a liquid diet prior to bariatric surgery?

Answer 28

reduce the size of the liver pre-operatively which reduces the risk of complications during the surgery -makes liver easier to be safely moved aside