Obesity

Question 1

How is obesity defined?

Answer 1

A chronic, progressive, relapsing, multifactorial, neurobehavioral disease in which excess body fat causes adipose tissue dysfunction and abnormal physical forces, leading to adverse metabolic, biomechanical, and psychosocial health consequences.

Question 2

What are the key diagnostic criteria for obesity?

Answer 2

• Excessive body fat as measured by reliable methods
• Caused by genetic, developmental, environmental, or medical factors
• Leads to structural or functional abnormalities increasing morbidity and mortality

Question 3

What is adiposopathy?

Answer 3

Dysfunction of adipose tissue endocrine and immune function leading to metabolic disease (“sick fat disease”).

Question 4

What is fat mass disease?

Answer 4

Physical stress or damage caused by excessive fat mass on other body tissues.

Question 5

Are the health effects of obesity just co-morbidities or risk factors?

Answer 5

No — they are direct adverse consequences of excess body fat.

Question 6

How is BMI calculated?

Answer 6

BMI = weight (kg) ÷ height (m²)

Question 7

What are advantages of using BMI?

Answer 7

• Correlates with metabolic and fat mass disease in populations
• Commonly used, reproducible, low cost
• Adequate for epidemiological studies and general screening

Question 8

What are disadvantages of using BMI?

Answer 8

• May not correlate with disease in individuals
• Does not account for muscle mass
• Same cutoffs for all sexes and ethnicities
• Should not be the sole measure of obesity

Question 9

What key aspects should be covered in the history of an obese patient?

Answer 9

• Medication history
• Family history
• Socioeconomic and cultural background
• Nutritional intake and eating behavior (food diary)

Question 10

What should be assessed on physical examination?

Answer 10

• Vital signs - height, weight, waist circumference, BP, pulse
• General physical examination for comorbidities

Question 11

What defines a very low-calorie diet (VLCD)?

Answer 11

Less than 800 kcal/day, using formulated meal replacements under medical supervision.

Question 12

How do VLCDs compare to standard low-calorie diets?

Answer 12

Cause more rapid weight loss due to lower energy intake.

Question 13

What metabolic improvements can VLCDs produce?

Answer 13

• Reduced fasting glucose, insulin, triglycerides
• Modest increase in HDL
• Modest decrease in LDL
• Reduced blood pressure

Question 14

What are risks of VLCDs?

Answer 14

Fatigue, nausea, constipation, diarrhoea, cold intolerance, increased gallstones, and possible weight regain.

Question 15

What must be assessed before starting an exercise program?

Answer 15

• Current activity level
• Readiness to exercise
• Patient expectations and goals
• Need for medical testing
• Formal exercise prescription (FITTTE: Frequency, Intensity, Time, Type, Training, Enjoyment)

Question 16

What are the 5 A’s of obesity management?

Answer 16

1. Ask – permission to discuss weight
2. Assess – BMI, waist circumference, obesity stage
3. Advise – on health risks and long-term strategies
4. Agree – on realistic goals and behavioral changes
5. Arrange/Assist – address barriers, provide resources, follow-up

Question 17

What class of medication is Orlistat?

Answer 17

Gastrointestinal lipase inhibitor.

Question 18

What is Orlistat’s mechanism of action?

Answer 18

Impairs gastrointestinal fat absorption.

Question 19

What are potential adverse effects of Orlistat?

Answer 19

• Oily rectal discharge
• Flatus with discharge
• Increased defecation
• Fecal incontinence
• Gallstone risk
• Urinary oxalate risk
• Rare liver injury
• Reduced absorption of fat-soluble vitamins (A, D, E, K)

Question 20

What class of drug is Liraglutide?

Answer 20

GLP-1 (glucagon-like peptide-1) receptor agonist.

Question 21

How is Liraglutide administered?

Answer 21

Subcutaneous injection via prefilled multi-dose pen.

Question 22

What is the recommended maintenance dose of Liraglutide for obesity?

Answer 22

3 mg daily, at any time of day, regardless of meals.

Question 23

What is the Liraglutide dose escalation schedule?

Answer 23

• Week 1 - 0.6 mg/day
• Week 2 - 1.2 mg/day
• Week 3 - 1.8 mg/day
• Week 4+ - 3 mg/day

Question 24

When should bariatric surgery be considered?

Answer 24

In potential candidates with severe obesity, after multidisciplinary assessment and failure of conservative therapy (specific criteria not provided in notes).

Question 25

What is the most optimal bariatric procedure to perform?

Answer 25

Vertical sleeve gastrectomy.

Question 26

What are the two main disease mechanisms of obesity?

Answer 26

1. Adiposopathy (“sick fat”) – endocrine and immune dysfunction of adipose tissue. 2. Fat mass disease – physical/mechanical stress from excessive body fat.

Question 27

What are some contributing factors to obesity?

Answer 27

Genetic/developmental errors, infections, hypothalamic injury, medications, energy imbalance, and environmental factors.

Question 28

What are the metabolic, biomechanical, and psychosocial consequences of obesity?

Answer 28

- Increased morbidity and mortality due to metabolic syndrome - joint disease - mental health burden.

Question 29

What is the primary goal of obesity treatment?

Answer 29

Long-term weight management through combined nutritional, behavioral, pharmacological, and surgical strategies.