overview of obesity (mini learning)

Question 1

What 2 measurements can be used to assess for obesity in adults ?

Answer 1

• waist circumference (when BMI <35)
• BMI

Question 2

What are the male waist circumference ranges considered
a) low risk of obesity ?
b) high risk of obesity ?
c) very high risk of obesity ?

Answer 2

low risk <94 cm
high risk = 94-102 cm
very high risk >102 cm

When BMI is <35

Question 3

What are the female waist circumference ranges considered
a) low risk of obesity ?
b) high risk of obesity ?
c) very high risk of obesity ?

Answer 3

low risk <80 cm
high risk = 80-88 cm
very high risk >88 cm

When BMI is <35

Question 4

What are the BMI ranges ?

Answer 4

18.5 - 24.9 normal/healthy
25 - 29.9 overweight
30 - 34.9 obesity 1
35 - 39.9 obesity 2
40 + obesity 3

Question 5

What method is used to assess obesity in children ?

Answer 5

centile charts

Question 6

What is the definition of obesity ?

Answer 6

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

Question 7

How do BMI measurements differ in the south asian population ?

Answer 7

they have a greater total %fat mass than white populations, so BMI ranges differ…

> 23 overweight (rather than 25)
27.5 obesity (rather than 30)

Question 8

What are the 2 types of body weight distribution?

Answer 8

• gynaecoid (lower fat obesity/pear shaped)
• android (upper fat obesity/apple shaped)

Question 9

Which hormones encourage gynaecoid weight distribution ?

Answer 9

• progesterone
• oestrogen

Question 10

Which complications are associated with android obesity distribution ?

Answer 10

• heart disease
• type 2 diabetes

Question 11

Which hormone encourages android weight distribution ?

Answer 11

testosterone

Question 12

What % of UK adults are overweight or obese ?

Answer 12

63%

Question 13

What % of men are classed as overweight or obese ?

Answer 13

67% of men

Question 14

What % of women are classed as overweight or obese ?

Answer 14

60% of women

Question 15

What health complications are likely to develop in obese children ?

Answer 15

• breathing difficulties
• insulin resistance
• hypertension

Question 16

What health complications are likely to develop in obese adults ?

Answer 16

• CVD
• hypertension
• type 2 diabetes
• musculoskeletal disorders
• cancers
• respiratory problems
• reproductive dysfunction

Question 17

What are the 5 As in the framework about entering into conversations about weight ?

Answer 17

Ask for permission
Assess their willingness/abilities
Advise them of a pathway
Agree on a plan
Assist help them achieve it

Question 18

What are the 4 Ms in the framework used to assess causes and complications of obesity ?

Answer 18

Mental health
Mechanical issues
Metabolic issues
Monetary issues

Question 19

What is the recommended amount of moderate physical activity per week for adults ?

Answer 19

150 mins/weeks

Question 20

How long per day do some patients need to be active for in order to achieve weight loss ?

Answer 20

60-90 mins a day

Question 21

What are the 4 tiers of weight management services in the UK ?

Answer 21

Tier 1. universal intervention (public health campaigns)
Tier 2. community weight management services (run by dieticians)
Tier 3. services run by MDTs (doctors, dieticians, psychologists…)
Tier 4. bariatric services

Question 22

When are patients referred to tier 3 (MDTs) in weight management ?

Answer 22

• tried tier 2
• BMI >40
• BMI >35 with obesity associated comorbidities

Question 23

How long does a typical tier 3 (MDT) weight loss program last ?

Answer 23

6-12 months

aim for 5-10% weight loss

Question 24

When makes a patient eligible to be referred to tier 4 (bariatric surgery) in weight management?

Answer 24

come out of tier 3 with:
- BMI >40
- BMI >35 with obesity associated comorbidities

Question 25

What are the 2 medications used to help patients manage obesity ?

Answer 25

- Orlistat - Liraglutide (Saxenda)

Question 26

What is the MOA of Orlistat?

Answer 26

gastric and pancreatic **lipase inhibitor** *reduces hydrolysis of triglycerides in the intestine, so decreases absorption of dietary fats*

Question 27

What BMI indicates the use of Orlistat ?

Answer 27

>30 or >28 with risk factors

Question 28

What is the MOA of Saxenda ?

Answer 28

**GLP-1 Agonist** *interacts with neurones that regulate appetite/decreases feeling of hunger*

Question 29

In what tier of weight management should Saxenda be offered ?

Answer 29

Tier 3

Question 30

Who is indicated for use of Saxenda ?

Answer 30

- BMI >30 - BMI >27 with risk factors

Question 31

What habits must Saxenda be paired with to be effective ?

Answer 31

- low calorie diet - increased physical activity

Question 32

When should Saxenda be stopped ?

Answer 32

if less than 5% weight reduction after 12 weeks

Question 33

What is line of weight management treatment used prior to bariatric surgery ?

Answer 33

**non-surgical weight management** - lifestyle changes - medications - psychologist help - physiotherapist help - dieticians

Question 34

What is a gastric balloon ?

Answer 34

- temporary - **surgeon inserts gastric balloon** - **stays in for 6-12 months** - should see weight loss

Question 35

What is a gastric band ?

Answer 35

- adjustable, inflatable device at top of stomach - forms a ring around the stomach - **restricts how much food can pass into stomach**

Question 36

What is meant by the term ‘excess weight’ ?

Answer 36

any extra weight that takes a person **over a BMI of 25**

Question 37

What % of ‘excess weight’ can be lost via use of a gastric band ?

Answer 37

~ 50%

Question 38

What is a gastric sleeve ?

Answer 38

- **remove greater curve of the stomach** (80% of stomach) - left with a small, narrow tube

Question 39

What % of ‘excess weight’ can be lost via use of a gastric sleeve ?

Answer 39

70-75%

Question 40

What is a gastric bypass ?

Answer 40

- create a pouch out of top of stomach - **reattach the bowel** to this new stomach pocket, **to bypass rest of stomach** *most invasive*

Question 41

What % of ‘excess weight’ can be lost via use of a gastric bypass ?

Answer 41

up to 80%

Question 42

What are the 4 types of bariatric surgery ?

Answer 42

- gastric balloon - gastric band - gastric sleeve - gastric bypass

Question 43

Which ethnic group are at a greater risk of developing metabolic conditions like type 3 diabetes ?

Answer 43

south asian population

Question 44

What is the criteria for bariatric surgery eligibility in the asia in population ?

Answer 44

- BMI >30

Question 45

What are the challenges posed by gastric balloon surgery ?

Answer 45

- **inability to tolerate** balloon causing vomiting and nausea - **perforation** of balloon - **migration** of balloon

Question 46

What are the challenges posed by gastric band surgery ?

Answer 46

- **slippage** *(stomach slips through band)* - **erosion** into stomach - **infection** of band - **acid reflux** - **swallowing difficulties**

Question 47

What are the challenges posed by gastric sleeve surgery ?

Answer 47

- **non-healing of staple line** - **vitamin B12 deficiencies** *(part of stomach that’s removed produces intrinsic factor used for B12 absorption)*