Learning, Lifestyle, Obesity + Health Screening **

Question 1

BMI ranges

Answer 1

Underweight: <18.5
Healthy: 18.5 - 24.9
Overweight: 25-29.9
Obese: >30

Question 2

How to approach obesity

Answer 2

Make dx of obesity with clear definition + inform them of diagnosis
Assess for treatable comorbidities:
HTN
DM
CAD
OSA
OA

Enquire about effect of obesity on personal + social life
Establish readiness to change
Advise that treatment requires diet, exercise, support + facilitate access to these
Advise parents of healthy activity levels for kids
Challenge parents to make family wide changes in diet and exercise

Question 3

Management of obesity

Answer 3

Readiness to change
Support
Multidisciplinary approach
Dietician
Personal Trainer
Psychology/Psychiatry (Cognitive behavioural therapy)
Obesity specialist/Endocrinologist
Lifestyle
Diet
May consider a weight los diet (reduction in dietary energy)
High protein - Low fat diet
Exercise
30 minutes daily of moderate intensity, increase to 60 minutes daily

Question 4

Rx for BMI >30 if lifestyle measures have failed

Answer 4

Structured behavioural interventions (weight loss program)
Pharmacotherapy (not recommended by Canadian Taskforce)
Orlistat 120mg PO daily-TID
Stop medication if weight loss <5% at 3 months
No effect on mortality
Adverse effects: Bloating, steatorrhea, fecal incontinence
Lack of longterm safety data
Supplement with multivitamin 2h before or after medication
Consider GLP-1/SGLT2 for weight loss in diabetes (in addition to Metformin)

Question 5

Rx for BMI >40 if lifestyle measures have failed

Answer 5

Consider Bariatric Surgery

Question 6

Child BMI ranges based on percentile

Answer 6

Normal - BMI < 85th percentile
Overweight- BMI > 85th percentile
Obese > 97th percentile
Severe Obesity >99th percentile

Question 7

Management of childhood obesity

Answer 7

Structured behavioural interventions
Family-wide changes in diet and activity (family-oriented behaviour therapy)
Avoid counterproductive interventions (e.g., berating or singling out the obese child)
Encourage positive reinforcement
Diet
Family meals
Healthy snacking
Decreased sugar consumption (juices, drinks)
Decrease portion size
Increase vegetables
Activity (WHO recommends 60 minutes moderate-vigorous daily)
Focus on fun/recreational activity
Limit screen time
Limit motorized transport
Limit time spent indoors
Limit sitting (eg. stroller)
Sleep

Question 8

Recommendations for diet

Answer 8

low fat, high fibre, calcium + vit D (1000/d), low sodium, folic acid + B12 if wanting pregnancy

Question 9

Recommendations for substance use

Answer 9

no smoking
no other substances
alcohol <2 drinks/d
<9/w women
<14/w men

Question 10

Recommendations for wt, waist circ + waist to height (when are you at increased risk)?

Answer 10

Wt: Counsel on wt loss if BMI >30
Waist circumference: >80cm in women and >95cm in men = increased risk
Waist to height ratio: 0.5-0.6 = increased risk, >0.6 substantial risk

Question 11

Recommendations for Exercise

Answer 11

150mins mod to vigorous activity weekly, bouts >10 min. Wt bearing 2-4 times weekly, stretching 4-7x weekly

Question 12

Recommendations for Personal safety

Answer 12

seatbelts, avoid sun exposure, hearing protection, noise control programs

Question 13

Recommendations for Oral hygiene

Answer 13

brushing teeth, flossing, fluoride, smoking cessation

Question 14

Source, signs of deficiency + signs of too much Folate

Answer 14

Source: leafy greens, dried beans, legumes, citrus
Signs of deficiency: macrocytic anemia, diarrhea, lethargy
Signs of too much: seizures

Question 15

Source, signs of deficiency + signs of too much Vit B12

Answer 15

Source: beef, pork, milk, cheese, fish
Signs of deficiency: megaloblastic anemia, leukopenia, weakness, peripheral neuropathy

Question 16

Source, signs of deficiency + signs of too much Vit C

Answer 16

Source: citrus, tomatoes, potatoes, red berries, peppers
Signs of deficiency: scurvy, keratosis of hair, impaired wound healing, anemia, depression, lethargy, bleeding
Signs of too much: N/V, renal stones, osmotic diarrhea

Question 17

Source, signs of deficiency + signs of too much Vit A

Answer 17

Source: fish, liver, egg yolk, dairy, leafy greens, orange/ yellow veg
Signs of deficiency: dermatitis, night blindness
Signs of too much: N/V, HA, dizziness, deep bone pain, gingivitis

Question 18

Source, signs of deficiency + signs of too much Vit D

Answer 18

Source: fish, fortified milk, egg yolks, sunlight
Signs of deficiency: osteomalacia, muscle weakness, bone pain
Signs of too much: renal stones, anorexia, renal failure

Question 19

Source, signs of deficiency + signs of too much Vit E

Answer 19

Source: polyunsaturated fats, milk, eggs, wheat, whole grains
Signs of deficiency: anemia, myopathy
Signs of too much: prolonged clotting time, impaired neutrophil function

Question 20

Source, signs of deficiency + signs of too much Vit K

Answer 20

Source: leafy greens, liver ,veg oil
Signs of deficiency: bleeding, purpura, bruising
Signs of too much: jaundice

Question 21

Source, signs of deficiency + signs of too much Ca

Answer 21

Source: leafy greens, fortified orange juice
Signs of deficiency: tetany, arrhythmias, CHF, osteomalacia
Signs of too much: weakness, renal failure, psychosis

Question 22

Source, signs of deficiency + signs of too much Mg

Answer 22

Source: soy, clams, wheat, nuts, dairy, cereal
Signs of deficiency: weakness, convulsions, FTT
Signs of too much: hypotension, cardiac disturbance, resp failure

Question 23

Source, signs of deficiency + signs of too much K+

Answer 23

Source: meat, milk, bananas, prunes, orange, grapefruit, legumes
Signs of deficiency: polyuria, ECG changes, dyspnea, paralysis
Signs of too much: mental confusion, hypotension, ECG changes

Question 24

Source, signs of deficiency + signs of too much Iron

Answer 24

Source: meat, fish, eggs, peas, beans, lentils, soy
Signs of deficiency: microcytic hypochromic anemia, fatigue, tachycardia,
Signs of too much: organ damage

Question 25

When to screen A1c

Answer 25

40-70 y/o overweight = screen as part of CV risk assessment
Moderate risk: q3-5yrs (CKD, PVD, HTN, lipids)
High risk: q1yr (WC >102cm, BMI >30, age >55, GDM, FDR w/ DM)

Question 26

When to screen Lipids

Answer 26

yearly if other metabolic conditions (CKD, HTN, DM)
every 3 years if >50

Question 27

When to screen Renal function

Answer 27

Annual if HTN or DM

Question 28

When to screen for STIs

Answer 28

Sexual health
hep C + HIV if risky behaviour
<25 annually

Question 29

When to screen for AAA

Answer 29

Men 65-80 Abdo US screening (once)

Question 30

BMI calculation

Answer 30

kg/m2

Question 31

Obesity rx

Answer 31

bupropion-naltrexone, orlistat (lipase inhibitor), GLP1 receptor agonist (semaglutide), gastric bypass, sleeve gastrectomy

Question 32

When to screen for obesity

Answer 32

16 y/o

Question 33

Limitations of using BMI

Answer 33

doesn’t count for weight extremes, doesn’t account for variance in body composition, doesn’t account for variance in ethnic groups

Question 34

When do cervical cancer screening guidelines not apply?

Answer 34

Never sexually active, weakened immune system, sx of cervical cancer, prev abnormal screening results, those without cervix

Question 35

Harms of screening

Answer 35

overdiagnosis, hospitalisation or medical intervention, false positives, anxiety, negative consequences of incidental findings, reduced QoL