Obesity

Question 1

list some of the health problems directly linked to obesity (6)

Answer 1

1) Cardiovascular disease
2) Type 2 diabetes
3) Fatty liver disease
4) Gallstones
5) GORD
6) Psychological and psychiatric morbidities

Question 2

Obesity is generally classified using body mass index (BMI). What BMI score indicates obesity and why should BMI scores be used with caution?

Answer 2

1) ≥ 30 kg/m

2) Not a direct measure of adiposity, particularly in patients who are very muscular or have muscle atrophy

Question 3

Waist circumference may provide an indication of total body fat and a risk of obesity-related health problems. state what figures in males and females would indicate:

1) increased risk of obesity-related health problems
2) very high risk of obesity-related health problems

Answer 3

1) Men: ≥ 94 cm (≥ 90 cm for Asian men) increased risk
↳ Women ≥ 80 cm are at increased risk

2) ≥ 102 cm in men and ≥ 88 cm in women: very high risk

Question 4

with regards to the management of obesity, what changes should be monitored in patients? (4)

Answer 4

Weight, blood pressure and blood lipids, and for other associated conditions.

Question 5

what should be considered or reviewed in an initial assessment of an obese patient?

Answer 5

1) Potential underlying causes (e.g. hypothyroidism)

2) Review of the appropriateness of current medications which are known to cause weight gain,

Question 6

List some of the drugs known to cause weight gain

Answer 6

1) Atypical antipsychotics, TCAs
2) B-blockers
3) insulin (in type 2), sulphonylureas, thiazolidinediones
4) lithium
5) sodium valproate

Question 7

when should drug treatment be considered in obese patients?

Answer 7

1) BMI of ≥ 30 kg/m2, in whom diet, exercise and behaviour changes fail to achieve a realistic reduction
2) BMI of ≥ 28 kg/m2 In the presence of associated risk factors
↳Drug treatment should never be used as the sole element of treatment

Question 8

The effect of management should be monitored on a regular basis. Why should less strict goals be set in those with type 2 diabetes?

Answer 8

Rates of weight loss may be slower

Question 9

Orlistat, is the only drug in the UK that is recommended for the management of obesity. How does it work?

Answer 9

Lipase inhibitor, reduces the absorption of dietary fat

↳(may also be used to maintain weight loss rather than to continue to lose weight)

Question 10

outline the licencing of orlistat and who would be eligible?

Answer 10

1) BMI of ≥ 30 kg/m2 or
2) BMI of ≥ 28 kg/m2 in the presence of other risk factors
↳ Type 2, hypertension, hypercholesterolemia

Question 11

Discontinuation of treatment with orlistat should be considered if what criteria has not been met?

Answer 11

After 12 weeks if weight loss has not exceeded 5% since the start of treatment

Question 12

Apart from orlistat, which other drugs can be used in the management of obesity?

Answer 12

Methylcellulose and sterculia [unli]- make you feel full although little evidence

Question 13

When would bariatric surgery be considered in those who are obese?

Answer 13

1) BMI of ≥ 40 kg/m2
2) Or between 35–39.9 kg/m2 and a significant disease (e.g. type 2 diabetes or high BP) which could be improved with weight loss, and if all appropriate non-surgical measures have been tried

Question 14

What is the typical dose of orlistat and how should it be administered and when should it be omitted?

Answer 14

1) 120mg up to TDS
2) Taken immediately before, during, or up to 1 hour after each main meal
3) If a meal is missed or contains no fat, the dose of orlistat should be omitted

Question 15

which other drug should sometimes be prescribed along with oralistat ?

Answer 15

Vitamin supplementation: especially Vit D as its a fat soluble vitamin