Obesity

Question 1

What is obesity

Answer 1

the WHO defines obesity as the abnormal or excessive accumulation of fat that may impair health

Question 2

What is normal waist circumference for men and women

Answer 2

women: <80cm
Men: <94cm

Question 3

When should waist circumference not be used

Answer 3

WC is not useful in patients with a BMI >35 - very difficult to measure.
Instead, can go off weight, fitness and how they feel in their clothes.

Question 4

What is metabolic syndrome

Answer 4

A group of conditions that increases your risk of type II diabetes, stroke and CVD. Examples of these conditions include hyperlipidemia, hypertension, insulin resistance and obesity.

Question 5

What are the consequences of obesity

Answer 5

• hyperlipidemia
• CVD
• stroke
• type 2 diabetes
• hypertension
• sleep apnea
• asthma
• reproductive complications
• liver disease
• certain cancers - (breast, uterus etc)

Question 6

What are the causes of obesity

Answer 6

• genetics and metabolism
• lack of physical activity
• food consumption - quality, quantity and frequency
• food environment
• societal influences
• finances and fundings
• individual phychology

Question 7

Explain how the food environment effects obesity

Answer 7

Lots of inexpensive, ready-to-eat foods that are high in energy and fat and have incentives such as multi-item deals and supersize offers.

Question 8

What is the set point theory

Answer 8

• Everyone has a natural set weight maintained by homeostasis
• set weight can change and increase due to life events such as aging and pregancy
• It is difficult to lose weight and return to set weight due to a hypothalamic response, hormonal response (increase in ghrelin, decreased leptin) and metabolic response causing lowered energy expenditure, during weight loss.

Question 9

What is the main strategy in terms of diet and lifestyle to lose weight

Answer 9

High fiber, high protein diet (satiety inducing), adequate sleep to help regulate hormones and regular exercise.

Question 10

What are the intervention options for weight loss

Answer 10

• Diet and lifestyle
• physical activity
• behaviour change support
• medication
• surgery

Question 11

What are the nice guidelines (NG264)

Answer 11

• Offer lifestyle interventions
• medications - semaglutide, liraglutide and tirzepatide
• Surgery referral for BMI >40 or >35 with comorbidities
• Expedited surgery for recent onset type 2 diabetes

Question 12

What are the health benefits of weight loss

Answer 12

• Improved physical capacity
• Improve biochemical indices - such as lipid profiles
• Decreased blood pressure
• Reduced joint pain
• Improved gynaecological health

Question 13

How do people maintain weight loss

Answer 13

Weight loss maintainers (maintain 10% of their weight loss for 1 year) eat low fat, low calorie diet, self-monitor, eat breakfast, exercise and have a consistent meal pattern during the week and weekend.

Question 14

What % weight loss should people with obesity lose

Answer 14

5-10%
15-20% in those with a BMI >35.

Question 15

Why is a structured meal plan important

Answer 15

Having 3 balanced meals per day is important, as is having them at set times and only including snacks when hungry. A regularly spaced eating pattern will help prevent excessive hunger and cravings and help people stick to the programme.

Question 16

What are diet options for losing weight

Answer 16

Very low calorie diet
intermittent fasting
low CHO diet
low fat diet
5:2 diet

Question 17

what is the Very low calorie diet and what are the side effects

Answer 17

This usually involves eating around 800 kcal a day and usually done by replacing meals with shakes, soups or snacks. It is done to achieve rapid weight loss and can help people put their diabetes into remission.
It is done for a maximum of 12 weeks.
Side effects: GI issues, hunger cramps, fatigue, dizziness.

Question 18

What is the 5:2 diet

Answer 18

Invovles restricting calorie intake for 2 days of the week (500-600kcal) and sticking to baseline calories for the reminding days
This evidence based with greater reduction in insulin with IER vs CER on restricted and unrestricted days of the diet.
May be difficult to stick to this diet in the long term.

Question 19

Explain the low CHO diet

Answer 19

this involves eating <130g of CHO each day and helps with weight loss by using glycogen stores and inducing ketosis and gluconeogenesis.
Low GI, high fiber options should be favored. Sugar should be limited, starch in moderation and eat more fibre. Therefore, aim to eat fruit, non-starchy veg, legumes and wholegrains and limit simple sugars and refined grains.

Question 20

What are the benefits of physical activity

Answer 20

Helps to improve sleep, cardiovascular health, mood, fitness and reduces risk of non-communicable disease.

Question 21

How much exercise should adults do

Answer 21

Adults are recommended to do 150 minutes of moderate intensity exercise such as walking or cycling - increases your heart and breathing rate
Can also do 75 minutes of vigorous intensity exercise a week such as running.
TO prevent obesity must people need to do 45-60 minutes of moderate intensity acitivy a day and people who have been obese and have lost weight may need to do 60-90 minutes of activity to avoid regaining weight.

Question 22

Why is exercising along with weight loss important

Answer 22

To help prevent muscle loss and reduced bone density, especially in older adults.

Question 23

What are some suggestions to help increase physical activity

Answer 23

• incorporate 3, 10 min walks, use resistance bands or follow fitness youtube videos
• reduce screen time
• Increase walking or cycling as a form of travel
• Increase activity during leisure time such as during breaks at work and school
• increase acitivty as part of daily routine - taking the stairs instead of the lift.

Question 24

What is orlistat, its % weight loss and side effects.

Answer 24

Orlistat is a fat binder, reducing the absorption of dietary fat
5-6% weight loss
side effects include reduced absorption of vitamins and smelly stools

Question 25

What is liraglutide (saxenda), its % weight loss and side effects.

Answer 25

It is a GLP-1 agonist 8% weight loss, taken once daily side effects include vomiting, diarrhea and nausea.

Question 26

What is semaglutide (wegovy), & weight loss and side effects. what

Answer 26

wegovy is a GLP-1 agonist 15% weight loss and injected weekly GI side effects

Question 27

What is tirzepatide (mounjaro), its weight loss and side effects.m

Answer 27

Mounjaro is a GLP-1/GIP agonist - it increase incretin hormones, reduces hepatic gluconeogenesis and slows gastric emptying. 20% weight loss and weekly injections GI side effects.

Question 28

what are the side effects of weight loss drugs.

Answer 28

- Nutritional deficiencies due to limited food intake - Pancreatitis- rare - GI side effects - nausea vomiting - GORD - Abdominal pain

Question 29

What medications can cause weight gain

Answer 29

Diabetic therapies - insulin, sulfonylureas psychiatric therapies - amitriptyline, mirtazapine, setraline anti-psychotic drugs - haloperidol, clozapine, chlorpromazine, olanzapine antiseizure - sodium valproate, gabapentin steroids - cortisone.

Question 30

What is bariatric surgery

Answer 30

Changes the way we eat and absorb food, resulting in weight loss

Question 31

What is the NICE bariatric surgery criteria

Answer 31

BMI of >40 or between 35-40 with other significant comordities that would be improved with weight loss The person agrees to low term follow-up

Question 32

What is a sleeve gastrectomy.

Answer 32

The stomach is divided vertically from top to bottom and the size is reduced by 75%. It physically restricts the size of the stomach and reduces ghrelin production. It is irreversible EWL is 49-81%

Question 33

What is a gastric bypass

Answer 33

A small gastric pouch is created and it is the only part of the stomach to receive food A new exit from the pouch, bypasses the remaining stomach and a portion of the small intestine It is restrictive, has a hormonal effect (GLP-1 production is quicker) and malabsorption % EWL is 62-94%

Question 34

Why is the liver reduction diet needed,

Answer 34

A large liver can limit the surgeons view of the gastro-oesphageal area and make it more difficult to access the stomach the liver reduction diet forces the body to use glycogen from the liver, shrinking it and making it softer and easier to move.

Question 35

What is the liver reduction diet

Answer 35

800-100kcal diet, <100g CHO, low fat and high protein. Examples of diets include slim fast meal replacement, milk and yoghurt diet and food based diet (1 portion CHO, 3 times a day, 2 portions of fruit, 2 portions of dairy, unlimited non-starchy veg. Constipation can be an issue

Question 36

What are the post-bariatric surgery diet stages.

Answer 36

1. Liquid diet 2. Smooth/pureed diet 3. soft diet 4. solid food It involves the gradual re-introduction of food over 12 weeks - need to drip feed the stomach food.

Question 37

Describe stage 1 - liquid diet

Answer 37

Liquids only - aim for 2 liters a day take sips initially and gradually increase the volume Important to drink slowly avoid gulping Examples of drinks include, SSM, smooth yoghurt, soup, smoothie, skimmed milk powder, slimfast, complan, avoid fizzy drinks and alcohol.

Question 38

Describe stage 2 - smooth/pureed.

Answer 38

This is pureed/blended food - use a blender, food processer and add extra fluid as required. Aim for 2-3 tablespoons. 4-6 times a day eat slowly and stop when full. examples: smooth porridge, yoghurt, pureed meat and mash

Question 39

Stage 3 - soft diet

Answer 39

Continue with foods from stage 3 but introduce some variety. soft foods can have lumps Try have a tea plate size portion and avoid snacks E.g. Weetabix, inside of a jacket potatoes with beans, cheese, cottage cheese, minced meat, scrambled or poached egg, casserole, Shepard's pie

Question 40

Stage 4 - solid texture.

Answer 40

This stage happens around 2-6 months after surgery Normal consistency diet based on healthy eating guidelines Meals should consist of fruit and veg, protein, wholegrain CHO and dairy and should be served on a smaller plate. Chew food well, eat slowly and stop when full. If snacking chose fruit, yoghurt, nuts, seeds, low kcal cereal bar.

Question 41

What are good eating habits patients can develop

Answer 41

Small bite size realistic portion size separate eating and drinking spend 15/20 mins per meal stop when full don't return for leftovers.

Question 42

Potential complications of surgery

Answer 42

Weight re-gain excess skin nutritional deficiencies dumping syndrome bone disease altered body image.

Question 43

What is dumping syndrome

Answer 43

Dumping syndrome occurs due to altered gastric volume capacity, resulting in the rapid delivery of nutrients into the duodenum. This can cause early dumping syndrome (GI symptoms and hyperglycemia) or late dumping syndrome due to the rapid absorption of glucose causing hypoglycemia

Question 44

How can you prevent dumping syndrome

Answer 44

1. avoid simple sugars such as table sugar, syrups, honey, sweets and ice-cream 2. have regular eating patterns such as 3 meals a day and 2-3 snacks if necessary 3. GI - chose low GI foods and eating CHO with fat can slow CHO absorption

Question 45

What are big predictors of weight gain

Answer 45

- liquid calories - eating soft sloppy foods - snacking - eating and drinking at the same time - food going down too quickly so not feeling full