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GEM - obesity including reference to NICE guidance

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Obesity is a risk factor for a variety of medical problems, including type 2 diabetes, hypertension, hyperlipidaemia, coronary heart disease, stroke, osteoarthritis, gout, sleep apnoea, gallstones, and cancer of the breast, prostate and colon. People who are overweight have a higher all-cause mortality than average, which increases with greater obesity. The prevalence of obesity in children and adults is increasing in the UK and elsewhere across all gender, age, race and ethnicity groups.

  • 1 in 5 adults are obese
  • prevalence of obesity has trebled over the last 20 years
  • nearly two thirds of men and over half of women are overweight or obese
  • deaths linked to obesity shorten life by 9 years on average

This GEM cannot cover the whole 'knowledge base' of the nMRCGP exam. However this GEM seeks to highlight important areas of knowledge for the primary care clinician (GP or GP registrar).

  • How is obesity graded?
  • How does waist circumference influence clinical assessment of obesity?
  • what about the relationship between cardiovascular disease and obesity?
  • significance of abdominal obesity
    • the significance of waist circumference in assessing associated risk of obesity related disorders has been examined in various studies.
      • one measure relating the waist circumference has been the waist hip ratio. The waist hip ratio is a measurement relating waist and hip measurements
        • measurement of waist circumference - measured between the lower border of the ribs, and the iliac crest in a horizontal plane
        • measurement of hip circumference - measured at the widest point over the buttocks
        • WHR obtained by dividing the mean waist circumference by the mean hip-circumference
        • men with a WHR 0.90-0.99 and women with a WHR 0.80-0.84 were classified as overweight
        • men with a WHR 1.00 and women with a WHR 0.85 were classified as obese
        • there is study evidence of increased cardiovascular risk associated with central obesity
    • the significance of abdominal obesity (and therefore waist measurement) has also been recognised in the IDF classification for metabolic syndrome. What is metabolic syndrome?
    • low levels of HDL are associated with obesity. What are other causes of low HDL that the clinician should consider?
    • what is visceral fat? How does visceral fat relate to hyperinsulinaemic states?
    • with respect to NICE guidance
      • NICE have emphasised the importance of waist circumference in terms of management options for patients with obesity
      • conservative management
        • what is the general dietary advice
          • is a diet of less than 600kcal advised, in general, for adults with obesity?
          • is a low carbohydrate diet advised?
          • what is the difference in kcal intake between a low calorie diet and a very low calorie diet?
          • GPN reference
        • exercise in the obese patient
          • what exercise is recommended?
          • how often should the obese patient exercise?
          • what about obese children?
          • GPN reference
      • active management of obesity
        • when is pharmacological treatment of obesity indicated? GPN reference
        • regarding pharmacological treatment
          • orlistat
            • what is the NICE guidance re: initiation and monitoring of treatment?
            • regarding adverse effects of orlistat, faecal incontinence occurs in

              • approximately 20% of patients
              • approximately 10% of patients
              • approximately 50% of patients
              • GPN reference
      • surgical treatment for obesity
        • what is the NICE criteria for surgical treatment of obesity
        • when is surgery indicated as a first-line active treatment option

Additonal references:


  1. Royal College of General Practitioners. Curriculum Statement 15.6 Metabolic problems.

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