Obesity Flashcards
What is a healthy BMI?
18.5-24.9
What BMI is overweight?
25-29.9
What BMI is obese?
> 30
What BMI is morbidly obese?
> 35 with co-morbidities
or >40
What does the Ob gene control?
Production of leptin & fat storage
What genetic syndrome, associated with hypogonadism, is linked to obesity?
Prader-willi
Associated risks of obesity
Metabolic
Cardiovascular
GI
DM2
CHD, HTN, stroke, dyslipidaemia
GORD, gallbladder disease
Associated risks of obesity
Respiratory
Mental health
Obstructive sleep apnoea, breathlessness
Depression & anxiety
When talking to a patient about obesity, what 4 things do you need to discuss?
Their WILLINGNESS to lose weight
FEELINGS about being overweight
Assess any underlying CAUSES
Assess RISK of complications
What 2 groups are at a greater risk of complications?
Afro-carribeans & Asians
Management for BMI <35
When should you consider drug treatment?
Who should you consider for bariatric surgery?
Lifestyle advice
Consider referral to weight management services
Consider drug treatment in people with risk factors only AFTER LIFESTYLE ADVICE
Consider for bariatric surgery if asian
Management for BMI >35
Lifestyle advice
Referral to weight management services
Consider starting drug treatment
Consider need for bariatric surgery
What are examples of behavioural interventions?
Goal setting, reinforcement of changes, slow eating
What drug treatment is first line?
Orlistat
How does orlistat work?
What are the SEs?
Inhibits lipase relase, so triglycerides are excreted
SE: steatorrhoea, bowel urgency, oily leakage, flatulance
What advice do you give to someone starting on orlistat?
Mildly hypocalorific diet
Take with water immetiately before-1 hour after eating
What should someone on orlistat do if they miss a meal?
Omit a dose
also applicable if meal contains no fat
When would you discontinue someone on orlistat?
If they have not lost >5% body fat in 12 weeks
What is another drug that can be used?
Liraglutide
How does liraglutide work?
Slows gastric emptying & helps the pancreas produce more insulin
What are the 4 indications for someone having bariatric surgery?
- BMI >40 or >35 with co-modbidities
- Tried all other measures
- Commitment to long-term follow-up
- Fit for anaesthesia
What are the 2 kinds of bariatric surgery?
Gastric band: placed around stomach so don’t need to eat as much to feel full
Gastric bipass: top part of stomach is joined to the small intestine
What are the risks of bariatric surgery?
Excess skin folds
Malhourishment (less seomach to absorb so will need to take supplements)
Gallstones
DVT
What are some risks of gastric band?
Slipping out of place, narowing, leakage
