Obesity

Question 1

What has developed significantly over the past decade in obesity management?

Answer 1

The use of bariatric surgery.

Question 2

What do NICE guidelines recommend for very obese patients?

Answer 2

They recommend early referral for bariatric surgery, particularly if there are other conditions caused by obesity.

Question 3

What is the BMI range for patients considered very obese?

Answer 3

BMI 40-50 kg/m^2.

Question 4

What are primarily restrictive operations in bariatric surgery?

Answer 4

Laparoscopic-adjustable gastric banding (LAGB), sleeve gastrectomy, and intragastric balloon.

Question 5

What is laparoscopic-adjustable gastric banding (LAGB) typically used for?

Answer 5

It is normally the first-line intervention in patients with a BMI of 30-39 kg/m^2.

Question 6

What is the effect of sleeve gastrectomy?

Answer 6

It reduces the stomach to about 15% of its original size.

Question 7

How long can an intragastric balloon be left in the stomach?

Answer 7

For a maximum of 6 months.

Question 8

What is an example of a primarily malabsorptive operation?

Answer 8

Biliopancreatic diversion with duodenal switch.

Question 9

Who is biliopancreatic diversion with duodenal switch usually reserved for?

Answer 9

Very obese patients, typically those with a BMI > 60 kg/m^2.

Question 10

What type of operation is Roux-en-Y gastric bypass surgery?

Answer 10

It is both restrictive and malabsorptive in action.

Question 11

What is the formula for calculating BMI?

Answer 11

BMI = weight (kg) / height (m) squared

Question 12

What is the BMI range for underweight?

Answer 12

BMI < 18.49

Question 13

What is the BMI range for normal weight?

Answer 13

BMI 18.5 - 25

Question 14

What is the BMI range for overweight?

Answer 14

BMI 25 - 30

Question 15

What is the BMI range for Obese class 1?

Answer 15

BMI 30 - 35

Question 16

What is the BMI range for Obese class 2?

Answer 16

BMI 35 - 40

Question 17

What is the BMI range for Obese class 3?

Answer 17

BMI > 40

Question 18

What are the steps in the management of obesity?

Answer 18

The management consists of a step-wise approach: conservative (diet, exercise), medical, or surgical.

Question 19

What is Orlistat?

Answer 19

Orlistat is a pancreatic lipase inhibitor used in the management of obesity.

Question 20

What are the adverse effects of Orlistat?

Answer 20

Adverse effects include faecal urgency/incontinence and flatulence.

Question 21

What is the lower dose version of Orlistat available without prescription?

Answer 21

‘Alli’

Question 22

What are the NICE criteria for prescribing Orlistat?

Answer 22

It should be prescribed for adults with a BMI of 28 kg/m² or more with associated risk factors, or BMI of 30 kg/m² or more, and continued weight loss (e.g. 5% at 3 months).

Orlistat is normally used for < 1 year.

Question 23

What is Liraglutide?

Answer 23

Liraglutide is a glucagon-like peptide-1 (GLP-1) mimetic used in the management of type 2 diabetes mellitus (T2DM).

Question 24

How is Liraglutide administered?

Answer 24

It is given as a once daily subcutaneous injection.

Question 25

What effect does Liraglutide have when used in T2DM management?

Answer 25

It was noted to cause weight loss in a significant proportion, leading to research interest in its use in obesity.

Question 26

What are the current NICE criteria for the use of Liraglutide?

Answer 26

The person must have a BMI of at least 35 kg/m² and prediabetic hyperglycaemia (e.g. HbA1c 42 - 47 mmol/mol).