Obesity

Question 1

What is obesity?

Answer 1

This is a chronic adverse condition due to an excess amount of body fat.

Question 2

What is used to determine obesity?

Answer 2

BMI

Question 3

How does obesity often present?

Answer 3

The presentation may range from asymptomatic to presentation complicated by multiple comorbidities including cancer, CAD, diabetes, HTN, gout and osteoarthritis.

Question 4

Aetiology of obesity

Answer 4

Caloric intake that, over time is greater than the caloric expenditure.
Factors associated with this include:
Genetic predisposition
Hormonal disturbances (hypothyroidism, hypercortisolism, insulinoma)
Cultural influences (beliefs about beauty and body image, eating habits)
Behavioural dynamics (larger portion size, eating disorder, mental illness, poor dietary habits)
Environmental causes (low socioeconomic level)

Question 5

Diagnosis of obesity

Answer 5

BMI measurement (weight and height) 
Waist circumference
Consider doing: 
FBCs 
TFTs 
ECG
Polysomnography 
-These tests are done if secondary causes of obesity are suspected.

Question 6

Risk factors for obesity

Answer 6

Hypothyroidism 
Hypercortisolism 
Corticosteroid therapy 
Age > 40 years 
Poor pregnancy 
Peri and post-menopause 
Sleep deprivation

Question 7

Differentials of obesity

Answer 7

Hypothyroidism (primary)
Hypothyroidism (central)
Cushing’s syndrome

Question 8

Management of obesity

Answer 8

• Diet and exercise is the initial approach for obese patient who wishes to lose weight.
• Orlistat can be used
• Psychological therapy
• BMI >40 is an indication for bariatic surgery

Question 9

Complications of obesity

Answer 9

ACS 
T2DM 
Hypercholesterolaemia 
HTN 
NAFLD
Metabolic syndrome 
Cancer

Question 10

How is BMI used to assess body weight?

Answer 10

Healthy- 18.5-24.9
Overweight- 25-29.9
Obese I- 30-34.9 
Obese II- 35-39.9 
Obese III- >40

Question 11

When should you consider bariatic surgery?

Answer 11

• BMI of >40 or BMI between 35-40 with significant disease (T2DM or HTN).
• All appropriate non-surgical measures have been tried and failed.
• The patient has been receiving or will receive management in a tier 3 service.
• Person commits to the need for long-term follow up
• Patient is fit for anaesthesia and surgery

Question 12

When should you consider tier 3 service for obesity?

Answer 12

Consider if:

• Underlying cause needs to be assessed
• Person has complex disease
• Drug treatment being considered in person with BMI >50
• Surgery being considered