42 | Nursing in Practice | Spring 2023
1
What is the approximate prevalence of obesity among adults in England ?
A 5 % B 10 % C 27 % D 33 %
2
Which of the following are caused or exacerbated by obesity ?
A Depression B Breast cancer C Subfertility D Stroke E All of the above
3
Which of the following statements are true about orlistat ?
A It works by increasing the metabolic rate
B It works by reducing fat absorption
C It can be bought over the counter
D Side-effects include faecal incontinence
E It is the most effective intervention that we have for obesity
QUICK QUIZ Weight loss
SCENARIO At the end of a smear appointment , your patient asks if she can discuss her weight . Her BMI is 42 and she says she has ‘ tried everything ’ – numerous diets , orlistat and various things bought online . She is worried about her health and wonders if the practice can help
1 2 3 4 5
4
Your patient has read in the media about an injectable drug for obesity , liraglutide , and wonders if she could have it on the NHS . Based on the information given so far , is she eligible for liraglutide on the NHS ?
A Yes B No
C Not enough information has been given to be able to answer this question
5
Your patient is treated with bariatric surgery . Which of the following is correct about the follow-up in primary care ?
A Patients should be followed up by secondary care for five years after surgery
B Patients will need annual bloods for life after bariatric surgery
C Patients who were using oral contraception may need to change to a different method after surgery
D All patients should take iron , B12 , thiamine and zinc supplements for life after bariatric surgery
By Dr Toni Hazell , a GP in north London
Answers . 1 A . Obesity is defined as a BMI ≥30 kg / m2 – 27 % of adults in England have obesity and this is predicted to rise to 35 % by 2030 . 1 2 E . Depression , breast cancer , subfertility and stroke may all be caused or exacerbated by obesity . Obesity is a leading cause of disability and death and can also cause or exacerbate diabetes , asthma , other cancers , osteoarthritis , sleep apnoea and gallbladder disease . 3 B , C , D . Bariatric surgery is the most effective treatment for obesity . Orlistat inhibits the enzyme lipase and stops the absorption of fats . 2 If too much fat is eaten , it will be excreted in stools , which can lead to faecal incontinence . Orlistat is usually prescribed at a dose of 120mg three times a day , but can be bought over the counter at half this dose . 4 C . Liraglutide is available on the NHS , via a Tier 3 weight-management service , if all of the following criteria have been met : • The patient has a BMI of ≥35 kg / m2 , or 32.5 kg / m2 if from an ethnic minority known to be at increased risk of the consequences of obesity • They have non-diabetic hyperglycaemia • They have a high risk of cardiovascular disease based on risk factors such as hypertension and hyperlipidaemia . Semaglutide is newly approved by NICE ( March 2023 ) – it is not yet available in the UK but when it is , the criteria will be : • Used for a maximum of two years within a specialist weight-management service • BMI criteria as for liraglutide • At least one weight-related comorbidity . It is therefore not possible to know if this patient is eligible for liraglutide without knowing her HbA1c , blood pressure and lipids . 5 B , C . There is a possibility that oral contraceptives will not be absorbed after bariatric surgery , so non-oral methods should be favoured . 4 Patients should be followed up for two years in secondary care 5 with regular blood tests during this time ; after discharge they should be done annually , with the precise tests depending on the type of surgery . All patients should take a multivitamin and three-monthly intramuscular B12 , with other supplementation according to the type of procedure .
References 1 NICE CKS . Obesity . 2022 . bit . ly / 3JakykV 2 Guerciolini R . Mode of action of orlistat . Int J Obes Relat Metab Disord 1997 Jun ; 21 Suppl 3 : S12-23 . 3 NICE TA664 . Liraglutide for managing overweight and obesity . 2020 . nice . org . uk / ta664 4 FSRH Clinical Guideline . Overweight , obesity and contraception . 2019 . bit . ly / 3LeaDxw 5 NICE QS127 . Obesity : clinical assessment and management . 2016 . bit . ly / 3JApKA3 6 BOMSS Guidelines on peri-operative and postoperative biochemical monitoring and micronutrient replacement for patients undergoing bariatric surgery . 2014 . bit . ly / 3TfecWi
ALAMY