Obesity

• What is obesity?

  Harmful excess adiposity

  Results from consuming more energy than one needs

  BMI >/= 30
• What are the treatment options for obesity?

  Healthy eating

  Exercises

  Behavioural modification

  Pharmacotherapy

  • orlistat
  • liraglutide
  • semaglutide (GLP-1 receptor agonist)
  • tirzapetide (Mounjaro, GLP-1 & GIP receptor ci-agonist)

  Bariatric/Metabolic surgery
• NOTE: Using BMI can lead to overdiagnosis & underdiagnosis.

  Over -> people with lots of muscle may have a high BMI, so may be wrongly classed as obese

  Under -> people with lower/normal BMIs may have harmful excess adiposity
• What is orlistat?

  Gastric & pancreatic lipase inhibitor

  Decreases fat absorption

  Indications

  • BMI >/= 30
  • BMI >/= 28 with associated risk factors
• How long should semaglutide be used MAX?

  2 years
• Why is the BMI threshold 2.5 kg/m^2 lower for some ethnic groups?

  High adipose tissue in these groups

  South Asian, Chinese, other Asian, Middle Eastern, Black African or African-Caribbean
• What is the NICE criteria for bariatric surgery?

  BMI > 40

  BMI > 35 < 40 with a 'significant health condition that could improve with weight loss'

  BMI > 30 < 35 with recent onset T2DM

  NOTE: BMI criteria reduced by 2.5 for certain ethnic groups
• What are some common health conditions that can improve after bariatric surgery?

  CVD

  HTN

  Idiopathic intracranial HTN

  MASLD

  Obstructive sleep apnoea

  T2DM
• What are the benefits of bariatric surgery?

  Improve health & number of health conditions (T2DM, HTN, dyslipidaemia, asthma, MASLD, infertility etc.)

  Reduces cancers (esp in women)

  Increases quality & quantity if life
• What is the mortality in bariatric surgery?

  1/1000 30-day mortality
• How long do sleeve gastrectomy & bypasses take place?

  Sleeve gastrectomy = 45-50 mins

  Gastric bypass = 80-90 mins
• Fill in the blanks

  A) Sleeve gastrectomy

  B) One anastomosis gastric bypass

  C) Roux-en-Y gastric bypass

  
• Sleeve gastrectomy

  Irreversible

  Less supplement need compared to bypass

  1 day hospital stay

  Possible complications

  • GI leaks
  • bleeding
  • DVT/PE
  • acid reflux
  • sleeve twist/kinks
  • weight regain (higher than in bypass)
• One Anastomosis Gastric Bypass

  Weight loss is better for diabetes

  Hospital stay = 1 day

  Possible complications

  • GI leak
  • bleeding
  • DVT/PE
  • acid reflux (more than RYGB)
  • marginal ulceration (same as RYGB)
  • abdo pain (less than RYGB)
  • internal hernia (less than RYGB)
• Roux-en-Y Gastric Bypass

  Hospital stay = 1 day

  Possible complications

  • GI leaks
  • bleeding
  • obstruction
  • DVT/PE
  • dumping/reactive hypoglycaemia
  • internal hernia
  • marginal ulceration
  • abdominal pain
• Gastric banding is not commonly done much anymore.

  Lots of late complications/failure/explant
• What is gastric ballooning?

  Placement of a balloon within stomach

  Temporary procedure -> need to be removed

  Often used in obese pts with high surgical risks to get their weight down to perform bariatric surgery