Obesity

Question 1

What is a healthy BMI?

Answer 1

18.5-24.9

Question 2

What BMI is overweight?

Answer 2

25-29.9

Question 3

What BMI is obese?

Answer 3

> 30

Question 4

What BMI is morbidly obese?

Answer 4

> 35 with co-morbidities

or >40

Question 5

What does the Ob gene control?

Answer 5

Production of leptin & fat storage

Question 6

What genetic syndrome, associated with hypogonadism, is linked to obesity?

Answer 6

Prader-willi

Question 7

Associated risks of obesity
Metabolic
Cardiovascular
GI

Answer 7

DM2

CHD, HTN, stroke, dyslipidaemia

GORD, gallbladder disease

Question 8

Associated risks of obesity
Respiratory
Mental health

Answer 8

Obstructive sleep apnoea, breathlessness

Depression & anxiety

Question 9

When talking to a patient about obesity, what 4 things do you need to discuss?

Answer 9

Their WILLINGNESS to lose weight
FEELINGS about being overweight
Assess any underlying CAUSES
Assess RISK of complications

Question 10

What 2 groups are at a greater risk of complications?

Answer 10

Afro-carribeans & Asians

Question 11

Management for BMI <35

When should you consider drug treatment?
Who should you consider for bariatric surgery?

Answer 11

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

Question 12

Management for BMI >35

Answer 12

Lifestyle advice
Referral to weight management services
Consider starting drug treatment
Consider need for bariatric surgery

Question 13

What are examples of behavioural interventions?

Answer 13

Goal setting, reinforcement of changes, slow eating

Question 14

What drug treatment is first line?

Answer 14

Orlistat

Question 15

How does orlistat work?

What are the SEs?

Answer 15

Inhibits lipase relase, so triglycerides are excreted

SE: steatorrhoea, bowel urgency, oily leakage, flatulance

Question 16

What advice do you give to someone starting on orlistat?

Answer 16

Mildly hypocalorific diet

Take with water immetiately before-1 hour after eating

Question 17

What should someone on orlistat do if they miss a meal?

Answer 17

Omit a dose

also applicable if meal contains no fat

Question 18

When would you discontinue someone on orlistat?

Answer 18

If they have not lost >5% body fat in 12 weeks

Question 19

What is another drug that can be used?

Answer 19

Liraglutide

Question 20

How does liraglutide work?

Answer 20

Slows gastric emptying & helps the pancreas produce more insulin

Question 21

What are the 4 indications for someone having bariatric surgery?

Answer 21

1. BMI >40 or >35 with co-modbidities
2. Tried all other measures
3. Commitment to long-term follow-up
4. Fit for anaesthesia

Question 22

What are the 2 kinds of bariatric surgery?

Answer 22

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

Question 23

What are the risks of bariatric surgery?

Answer 23

Excess skin folds
Malhourishment (less seomach to absorb so will need to take supplements)
Gallstones
DVT

Question 24

What are some risks of gastric band?

Answer 24

Slipping out of place, narowing, leakage

Question 25

What advice would you give to women after bariatric surgery

Answer 25

Avoid getting pregnant for 12-18 months

Question 26

What is it important to tell patients about after the operation?

Answer 26

Soft food diet for the following weeks
Exercise plan
Regular follow up

Question 27

Give 2 good resourses for support

Answer 27

British nutrition foundation

NHS - support groups nearby