Obesity Flashcards
(29 cards)
What are the classifications of overweight and obesity?
Overweight = BMI 25-29.9
Obesity I = 30-34.9
Obesity II = 35-39.9
Obesity III = 40 or more
How does having a high waist to hip ratio affect you?
It indicates central fat distribution - putting you at risk of: T2DM Dyslipidaemia IHD 2* HTN Osteoarthritis of weight-bearing joints Cancer of breast and bowel
What is the main cause of obesity?
Not metabolic disorders
What conditions are associated with obesity?
Genetic: Prader-Willi syndrome, Laurence-Moon syndrome
Hypothyroidism
Cushing’s
Hypothalamic damage (satiety region)
What is key treatment to most obesity?
Lifestyle change - less energy intake and more energy expenditure.
Surgery will only be considered if the patient is over 40kg/m* or is 35-40kg/m* and has other significant disease, repeatedly tried and failed to lose weight and is fit for anaesthesia.
How much does waist circumference increase your risk in relation to your BMI?
Overweight:
Low WC = no increased risk
High WC = increased risk
V High WC = high risk
Obese:
Low WC = increased risk
High WC = high risk
V High WC = very high risk
What is considered a low/high/very high waist circumference?
Men:
Low < 94
High = 94-102
Very high >102
Women
Low < 80
High = 80-88
Very high > 88
There is a numbering system to know which advice to give, what is it?
If someone is overweight and: Low WC = 1 High WC = 2 V High WC = 2 Has comorbidities = 3
If someone is Obesity I and: Low WC = 2 High WC = 2 V High WC = 2 Has comorbidities = 3
If someone is Obesity II and: Low WC = 3 High WC = 3 V High WC = 3 Has comorbidities = 4
If someone is Obesity III and: Low WC = 4 High WC = 4 V High WC = 4 Has comorbidities = 4
Which advice do you give for which number?
1 - General advice on healthy weight and lifestyle
2 - Diet and physical activity
3 - Diet and physical activity and consider drugs
4 - Diet and physical activity, consider drugs and surgery
If someone is clinically obese but you don’t want to hurt their feelings, how do you explain the term ‘obese’?
Obesity, in this setting, is not used to describe how people look, is a clinical term with specific health implications that helps us identify any diseases you may be at risk of.
If someone is obese, what about their life should you explore?
Symptoms Underlying causes Eating behaviours Other comorbidities Physical activity Psychosocial distress FH Willingness and motivation Psychological problems Medication
What are some risks of being obese?
T2DM HTN Metabolic syndrome CVD Osteoarthritis Dyslipidaemia Asthma Gallstones Sleep apnoea Breast/bowel cancer Depression Osteoarthritis Liver/kidney disease Reduced fertility
What objective assessments should you get of someone who is obese?
Blood glucose
HbA1c
BP
When would you consider referral to tier 3 services?
If:
- the underlying cause needs to be assessed
- conventional drug treatment has been unsuccessful
- BMI >50kg/m2
- surgery is being considered
- if the person has complex disease that can’t be managed in tier 2
- specialist interventions (low calorie diet)
What are the tiers of weight management services?
1 - primary care
2 - lifestyle interventions
3 - specialist weight management services
4 - bariatric surgery
What information can you give someone who needs to lose weight?
Praise all successes, however small.
Advise that the process of losing weight takes about 6-9 months and after that the skills change to maintaining weight loss.
Provide process goals NOT JUST OUTCOME GOALS such as physical activity - which is benefical to health even if there is no weight lost. Brisk walking, gardening, cycling, swimming, exercise classes.
Advise that 45-60mins a day prevents obesity but 60-90 mins is needed if have been previously obese.
Advise not to use unduly restrictive and nutritionally unbalanced diets.
Research has shown that it takes the same amount of will power to change 5 things at once than 2 things at once, because less chance of slipping back into old habit.
Advise that it takes 3-4 weeks to develop habits so the first month will be the hardest motivationally.
If someone loses 5% of body weight or more this leads to life long health benefits.
Discuss financial costs
When would you consider bariatric surgery?
If BMI is over 40 BMI 35-40 and comorbidity All other measures have failed Will receive/is receiving tier 3 management Fit for anaesthesia Recognises need for long term follow up
What are the different types of bariatric surgery?
Gastric band Gastric bypass Sleeve gastrectomy Intra-gastric balloon Biliopancreatic diversion
What is a gastric band?
A band is placed around the stomach creating a smaller pouch towards the top. It takes less food to fill this pouch and so you feel full sooner
What is a gastric bypass?
This can be done laproscopically which is called Laproscopic Roux-en-Y surgery. Surgical staples are used to create a small pouch in the top of the stomach, which is then connected to your small intesting, missing out the rest of the stomach = absorb fewer calories.
What is a sleeve gastrectomy?
This is where a large part of the stomach is removed so you can’t eat as much as you could due to the stomach becoming full much faster
What is an intra-gastric balloon?
A soft balloon filled with air or salt water in your stomach is left for max 6 months so you don’t eat as much as you could before
What is a biliopancreatic diversion?
This is similar to a gastric bypass but it is connected further down the small intestine. This can cause more complications so is rarely used
How many people in the UK are obese?
1 in 4 adults
1 in 5 children aged 10-11
