overview of obesity

Question 1

what is obesity?

Answer 1

disease process characterised by excessive body fat accumulation with multiple organ-specific consequences

Question 2

what is the NICE definition of BMI boundaries?

Answer 2

• 18.5-24.9 = healthy weight
• 25-29.9 = overweight
• 30-34.9 = obesity I
• 35-39.9 = obesity II
• 40 + = obesity III

Question 3

what are the caveats with BMI?

Answer 3

• muscular people — overestimate
• south asian populations — higher risk
• older people — lower risk
• children have special charts

Question 4

what affects risk factors for heart disease and type 2 diabetes?

Answer 4

body weight distribution

Question 5

gynaecoid vs android body weight distribution

Answer 5

• gynaecoid = lower fat obesity — pear-shaped
• android = upper fat obesity — apple-shaped

Question 6

in the UK, what % of adults are overweight or obese?

Answer 6

63%

Question 7

raised BMI significantly increases risk of what?

Answer 7

non-communicable diseases:
- CVD, diabetes, MSK disorders, some cancers, respiratory problems, reproductive function, hypertension
- children who are obese can experience breathing difficulties, hypertension, insulin resistance

AS BMI INCREASES, RISK INCREASES

Question 8

what are the psychological consequences of being overweight and obese?

Answer 8

stress —> increased eating, increased cortisol —> weight gain —> weight based stigma —> stress etc etc

Question 9

what are the 4 tiers of behaviour change conversations?

Answer 9

1. tier 1 = universal interventions at a population level eg. sugar tax, media campaigns
2. tier 2 = behavioural intervention at community level eg. primary care, schools
3. tier 3 = specialist services - specialist weight management service
4. tier 4 = surgery — bariatric surgery

Question 10

what can be used to assess obesity in adults?

Answer 10

• BMI = “practical assessment of adiposity”
• waist circumference

Question 11

what are centile charts?

Answer 11

used to measure obesity in children

Question 12

how does orlistat work?

Answer 12

lipase inhibitor — reduces teh absorption of dietary fat. works by inhibiting gastric and pancreatic lipases, which break down triglycerides in the intestine. the TG therefore do not break down to fatty acids, to be absorbed into the blood stream. they are then excreted in the faeces

Question 13

what are common side effects of orlistat?

Answer 13

abdominal pain and diarrhoea — may be minimised be reduced fat intake

Question 14

orlistat is only for who?

Answer 14

for patients with BMI > 30 or BMI 28 with risk factors

Question 15

when should you only continue orlistat > 3 months?

Answer 15

if 5% or more weight loss

Question 16

what is saxenda and how does it work?

Answer 16

GLP-1 agonist

GLP-1 is a hormone that has different roles. One role is to regulate appetite. GLP-1 is released when food is ingested. The GLP-1 travels to and works at the hypothalamus.
Saxenda is a GLP-1 analogue, and works by interacting with neurones involved in the regulation of appetite in the hypothalamus. This decreases the feeling of hunger, causing patients to eat less and thus lose weight.

Question 17

when should saxenda be offered?

Answer 17

only in tier 3 weight management clinics

Question 18

saxenda should only be continued if there is a __% reduction in weight after __ weeks

Answer 18

• 5%
• 12 weeks

Question 19

saxenda is licensed as an adjunct for who?

Answer 19

those with BMI 30 or above or BMI 27 or above, with risk factors, along with a low calorie diet and increased physical activity

Question 20

what is excess weight?

Answer 20

any weight that takes you over a BMI of 25

Question 21

what is a gastric balloon?

Answer 21

a temporary procedure which involves a gastric balloon being inserted using a gastroscope for 6-12 months — see 1.5-2 stone of weight loss

Question 22

what is a gastric band?

Answer 22

adjustable inflatable device which forms a ring around the top of the stomach - works by restricting the amount of food that can pass into the stomach

Question 23

people can expect to lose what % of their excess weight with a gastric band?

Answer 23

50%

Question 24

what’s a gastric sleeve?

Answer 24

a procedure which involves removing the greater curve of the stomach (up to 80%) — left with small narrow tube and the antrum — extremely powerful procedure — results in 70-75% excess weight lost

Question 25

what is a gastric bypass?

Answer 25

involves physically creating a pouch out of the top of the stomach and then reattaching the bowel so that is bypasses the rest of the stomach and the first pass of the bowel

most invasive

gold standard - compare everything else to this

can loose up to 80% of excess weight on average

Question 26

what is gynecoid obesity encouraged by?

Answer 26

oestrogen and progesterone

Question 27

why is android obesity associated with?

Answer 27

• heart disease and T2D
• abdominal fat is released right into the liver
• enouraged by testosterone and excessive alcohol

Question 28

which poses more of a risk - lower fat obesity or upper fat obesity?

Answer 28

upper fat obesity = android