PUBLIC HEALTH: Obesity

Question 1

Define obesity?

Answer 1

Having a very high amount of body fat in relation to lean body mass

A BMI of 30 and above

Question 2

What is BMI?

Answer 2

Weight / height squared

The persons weight in relation to their height

Question 3

List some morbidities associated with obesity?

Answer 3

Hypertension
Type 2 diabetes
CHD
Stroke
Osteoarthritis
Sleep apnoea
Cancers

Question 4

Central obesity is associated with a higher risk of type 2 diabetes. True or false?

Answer 4

True

Question 5

List some factors that affect a persons maintenance of their weight?

Answer 5

Energy intake
Type of food they eat
Appetite, which is genetically acquired
Mood
Metabolic rate
Genes
Drugs

Question 6

How can you help someone lose weight?

Answer 6

Change their eating habits: i.e. eat at a table, rather than subconsciously in front of the TV

Set a strategy with targets

Provide positive enforcement

Group support networks

Individual dietary advice

Question 7

Name the only drug available to treat obesity? How does it work?

Answer 7

Orlistat

Causes severe diarrhoea if they eat fat, so it puts them off eating fat

Question 8

Is orlistat effective?

Answer 8

It is, if the patient sticks to it

Many patients can’t tolerate it due to the symptoms

Question 9

Management of obesity?

Answer 9

Diet
Exercise
Peer support

Drugs: orlistat

Surgery

Question 10

Based on BMI, which patients are eligible for bariatric surgery?

Answer 10

BMI over 50 straight away

BMI over 40 pretty much straight away

BMI over 35 PLUS serious co-morbid disease treatable with surgery

Question 11

What criteria must a patient fill before they are eligible for bariatric surgery?

Answer 11

BMI over 35 with co-morbidities
BMI over 40 regardless

Obese for over 5 years

Failure of conservative treatment: diet, drugs etc.

No alcoholism
No major psychiatric disorder

Not likely to get pregnant

Question 12

Name some conservative treatments of obesity?

Answer 12

Dieticians
Weight watchers
Orlistat
Medical weight loss clinic

Physiotherapy
Hypnotherapy

Question 13

What are the aims of bariatric surgery?

Answer 13

Remove as much excess weight as possible

To help reduce co-morbidities

Question 14

What two types of bariatric surgery are there?

Answer 14

Restriction: of size of stomach, reducing volume of food the person can eat

Malabsorption: reduce ability of body to absorb what food is put in

Question 15

Which is the most commonly performed bariatric operation?

Describe it?

Answer 15

Sleeve operation

reduce stomach size by about 70%, so it is like a sleeve

Very effective as it reduces the amount of food the person can eat

Question 16

How does a gastric band operation work?

How is it performed?

Answer 16

Laparoscopically

Band filled with saline, goes around the stomach just below the oesophagus

Tightness can be adjusted by filling and emptying band with saline

Question 17

How do you decide which operation to give an obese person?

Answer 17

Patient choice

Depends on their eating habits
I.e. a nibbler won’t benefit from a gastric band

Question 18

How does obesity harm a community?

Answer 18

Less physically active so less productivity

Increased sickness absence

Cost on NHS, social care, wider economy

Question 19

What type of people are more likely to be obese?

Answer 19

People from deprived areas
Older age groups
Black and minority
Disabled