overview of obesity (mini learning) Flashcards
What 2 measurements can be used to assess for obesity in adults ?
- waist circumference (when BMI <35)
- BMI
What are the male waist circumference ranges considered
a) low risk of obesity ?
b) high risk of obesity ?
c) very high risk of obesity ?
low risk <94 cm
high risk = 94-102 cm
very high risk >102 cm
When BMI is <35
What are the female waist circumference ranges considered
a) low risk of obesity ?
b) high risk of obesity ?
c) very high risk of obesity ?
low risk <80 cm
high risk = 80-88 cm
very high risk >88 cm
When BMI is <35
What are the BMI ranges ?
18.5 - 24.9 normal/healthy
25 - 29.9 overweight
30 - 34.9 obesity 1
35 - 39.9 obesity 2
40 + obesity 3
What method is used to assess obesity in children ?
centile charts
What is the definition of obesity ?
a disease process, characterised by excessive body fat accumulation with multiple organ-specific consequences
How do BMI measurements differ in the south asian population ?
they have a greater total %fat mass than white populations, so BMI ranges differ…
> 23 overweight (rather than 25)
27.5 obesity (rather than 30)
What are the 2 types of body weight distribution?
- gynaecoid (lower fat obesity/pear shaped)
- android (upper fat obesity/apple shaped)
Which hormones encourage gynaecoid weight distribution ?
- progesterone
- oestrogen
Which complications are associated with android obesity distribution ?
- heart disease
- type 2 diabetes
Which hormone encourages android weight distribution ?
testosterone
What % of UK adults are overweight or obese ?
63%
What % of men are classed as overweight or obese ?
67% of men
What % of women are classed as overweight or obese ?
60% of women
What health complications are likely to develop in obese children ?
- breathing difficulties
- insulin resistance
- hypertension
What health complications are likely to develop in obese adults ?
- CVD
- hypertension
- type 2 diabetes
- musculoskeletal disorders
- cancers
- respiratory problems
- reproductive dysfunction
What are the 5 As in the framework about entering into conversations about weight ?
Ask for permission
Assess their willingness/abilities
Advise them of a pathway
Agree on a plan
Assist help them achieve it
What are the 4 Ms in the framework used to assess causes and complications of obesity ?
Mental health
Mechanical issues
Metabolic issues
Monetary issues
What is the recommended amount of moderate physical activity per week for adults ?
150 mins/weeks
How long per day do some patients need to be active for in order to achieve weight loss ?
60-90 mins a day
What are the 4 tiers of weight management services in the UK ?
Tier 1. universal intervention (public health campaigns)
Tier 2. community weight management services (run by dieticians)
Tier 3. services run by MDTs (doctors, dieticians, psychologists…)
Tier 4. bariatric services
When are patients referred to tier 3 (MDTs) in weight management ?
- tried tier 2
- BMI >40
- BMI >35 with obesity associated comorbidities
How long does a typical tier 3 (MDT) weight loss program last ?
6-12 months
aim for 5-10% weight loss
When makes a patient eligible to be referred to tier 4 (bariatric surgery) in weight management?
come out of tier 3 with:
- BMI >40
- BMI >35 with obesity associated comorbidities
What are the 2 medications used to help patients manage obesity ?
- Orlistat
- Liraglutide (Saxenda)
What is the MOA of Orlistat?
gastric and pancreatic lipase inhibitor
reduces hydrolysis of triglycerides in the intestine, so decreases absorption of dietary fats
What BMI indicates the use of Orlistat ?
> 30
or
28 with risk factors
What is the MOA of Saxenda ?
GLP-1 Agonist
interacts with neurones that regulate appetite/decreases feeling of hunger
In what tier of weight management should Saxenda be offered ?
Tier 3
Who is indicated for use of Saxenda ?
- BMI >30
- BMI >27 with risk factors
What habits must Saxenda be paired with to be effective ?
- low calorie diet
- increased physical activity
When should Saxenda be stopped ?
if less than 5% weight reduction after 12 weeks
What is line of weight management treatment used prior to bariatric surgery ?
non-surgical weight management
- lifestyle changes
- medications
- psychologist help
- physiotherapist help
- dieticians
What is a gastric balloon ?
- temporary
- surgeon inserts gastric balloon
- stays in for 6-12 months
- should see weight loss
What is a gastric band ?
- adjustable, inflatable device at top of stomach
- forms a ring around the stomach
- restricts how much food can pass into stomach
What is meant by the term ‘excess weight’ ?
any extra weight that takes a person over a BMI of 25
What % of ‘excess weight’ can be lost via use of a gastric band ?
~ 50%
What is a gastric sleeve ?
- remove greater curve of the stomach (80% of stomach)
- left with a small, narrow tube
What % of ‘excess weight’ can be lost via use of a gastric sleeve ?
70-75%
What is a gastric bypass ?
- create a pouch out of top of stomach
- reattach the bowel to this new stomach pocket, to bypass rest of stomach
most invasive
What % of ‘excess weight’ can be lost via use of a gastric bypass ?
up to 80%
What are the 4 types of bariatric surgery ?
- gastric balloon
- gastric band
- gastric sleeve
- gastric bypass
Which ethnic group are at a greater risk of developing metabolic conditions like type 3 diabetes ?
south asian population
What is the criteria for bariatric surgery eligibility in the asia in population ?
- BMI >30
What are the challenges posed by gastric balloon surgery ?
- inability to tolerate balloon causing vomiting and nausea
- perforation of balloon
- migration of balloon
What are the challenges posed by gastric band surgery ?
- slippage (stomach slips through band)
- erosion into stomach
- infection of band
- acid reflux
- swallowing difficulties
What are the challenges posed by gastric sleeve surgery ?
- non-healing of staple line
- vitamin B12 deficiencies (part of stomach that’s removed produces intrinsic factor used for B12 absorption)
