SYMPOSIA I

Question 1

Central abdominal obesity [2]

Answer 1

Higher risk of diabetes, raised blood lipids and greater cardiovascular morbidity and mortality

Waist circumference above 94cm in men, 80cm in women

Question 2

Children and obesity stats

Answer 2

One in ten children in reception is obese

One in five children in year 6 is obese

95% of children with type 2 diabetes are overweight, 83% are obese

60% of obese children have sleep apnoea

Question 3

Children and obesity impact

Answer 3

Cardiovascular risk

Musculoskeletal - tibia vara, slipped femoral epiphysis, knee pain, ankle and foot problems

Mental health - low self esteem, emotional and behavioural problems

Question 4

Metabolic syndrome [5]

Answer 4

Increased waist circumference and at least 2 of the following:

Reduced HDL

Raised BP

Raised fasting glucose

Raised blood triglyceride

Question 5

Health impact in adults

Answer 5

Circulatory system - increased hypertension

Musculoskeletal - weight on joints, low back pain

Metabolic and endocrine - type 2 diabetes, dyslipidaemias with atherosclerosis, gout

Cancer - increased risk of breast, colon and endometrial cancers

Reproductive and urological problems - POS, infertility, childbirth risks, erectile dysfunction

Respiratory system - sleep apnoea and asthma

Liver disease - non alcoholic fatty liver disease

Gastrointestinal - gastro oesophageal reflux, gall stones, pancreatitis

Psychological and social - low self esteem, stress, depression, reduced libido

Question 6

Circulatory system [1]

Answer 6

Circulatory system - increased hypertension

Question 7

Musculoskeletal [2]

Answer 7

Musculoskeletal - weight on joints, low back pain

Question 8

Cancer [3]

Answer 8

Cancer - increased risk of breast, colon and endometrial cancers

Question 9

Reproductive and urological problems [4]

Answer 9

Reproductive and urological problems - POS, infertility, childbirth risks, erectile dysfunction

Question 10

Respiratory system [2]

Answer 10

Respiratory system - sleep apnoea and asthma

Question 11

Liver disease [1]

Answer 11

Liver disease - non alcoholic fatty liver disease

Question 12

Gastrointestinal [3]

Answer 12

Gastrointestinal - gastro oesophageal reflux, gall stones, pancreatitis

Question 13

Psychological and social

Answer 13

Psychological and social - low self esteem, stress, depression, reduced libido

Question 14

Drugs

Answer 14

Sibutramine - inhibits noradrenaline and serotonin reuptake, promoting satiety

Orlistat - lipase inhibitor, can cause steatorrhea

Avoid use of bulking agents

Metformin and acarbose (type 2 diabetes drugs) have no proven efficacy for obesity

Question 15

DiRECT

Answer 15

(diabetes remission clinical trial) - 15kg or more weight loss and remission of diabetes

Question 16

Sibutramine

Answer 16

Sibutramine - inhibits noradrenaline and serotonin reuptake, promoting satiety

Question 17

Orlistat

Answer 17

Orlistat - lipase inhibitor, can cause steatorrhea

Question 18

Bariatric surgery criteria [3]

Answer 18

BMI > 35

BMI > 30 with poorly controlled type 2 diabetes

Obese Asian parents with type 2 diabetes

Question 19

Bariatric surgery outcomes

Answer 19

65% of type 2 diabetes go into remission 2 years post surgery

33% of these will re-develop it within 5 years

Hypertension

Dyslipidaemia

25% of patients will regain any lost weight within 10 years