Curriculum standards

Knowledge guides

LG 16: Disorders of weight

Key presentations and conditions

Advanced Trainees will have a comprehensive depth of knowledge of these presentations and conditions.

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Epidemiology, pathophysiology, and clinical sciences

Advanced Trainees will have a comprehensive depth of knowledge of the principles of the foundational sciences.

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Investigations, procedures, and clinical assessment tools

Advanced Trainees will know the scientific foundation of each investigation and procedure, including relevant anatomy and physiology. They will be able to interpret the reported results of each investigation or procedure.

Advanced Trainees will know how to explain the investigation or procedure to patients, families, and carers, and be able to explain procedural risk and obtain informed consent where applicable.

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Important specific issues

Advanced Trainees will identify important specialty-specific issues and the impact of these on diagnosis and management, and integrate these into care.

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Presentations

ADHD (untreated and treated)
Arthritis
Arthropathy
Autism (untreated and treated)
Corticosteroid treated conditions
Depression
Disorders of glucose metabolism:
- diabetes:
  - corticosteroid induced
  - type 1
  - type 2
Eating disorders
Exercise intolerance
Fatigue
Fatty liver disease
Hyperandrogenism
Hypoventilation syndrome
Infertility
Insulin resistance
Kidney disease with proteinuria
Male hypogonadism
Menstrual disturbance
Mood disorders (untreated and treated)
Obstructive or central sleep apnoea
Overweight/Obesity
Severe mental illness
Sexual dysfunction
Sleep apnoea
Weight gain:
- obesity
- overweight
- polycystic ovary syndrome (PCOS)
Underweight:
- electrolyte disturbances
- functional hypothalamic amenorrhoea
- nutritional deficiencies
- osteopenia
- osteoporosis
- stress fractures
Vascular disease:
- cardiovascular
- peripheral

Conditions

Endocrine consequences of underweight syndromes:
- electrolytes disorders
- fatty liver disease
- hypothalamic amenorrhoea
- subfertility
Overweight/Obesity:
- endocrine causes:
  - adrenal
  - Cushing syndrome
  - iatrogenic
  - other
  - pituitary
- energy overconsumption:
  - anxiety
  - binge eating disorders
  - drug-induced:
    - ADHD medications
    - anticonvulsants and other neuroleptics
    - antidepressants
    - antipsychotics
    - betablockers
    - corticosteroids
    - insulin
  - food and cooking literacy
  - food security
  - PTSD
- genetic causes:
  - monogenic
  - polygenic
  - Prader–Willi syndrome
- GH excess
- hypogonadism
- hypothalamic disease
- hypothyroidism
- menopause
- PCOS

For each presentation and condition, Advanced Trainees will know how to:

Synthesise

recognise the clinical presentation
identify relevant epidemiology, prevalence, pathophysiology, and clinical science
take a comprehensive clinical history
conduct an appropriate examination
establish a differential diagnosis
plan and arrange appropriate investigations
consider the impact of illness and disease on patients and their quality of life when developing a management plan

Manage

provide evidence-based management
prescribe therapies tailored to patients' needs and conditions
recognise potential complications of disease and its management, and initiate preventative strategies
involve multidisciplinary teams

Consider other factors

identify individual and social factors and the impact of these on diagnosis and management

Bidirectional relationship of the gastrointestinal tract and brain in appetite and intake control and satiety
Epidemiology and prevalence of overweight/obesity
Evidence basis for weight management strategies:
- physical, endocrine, and mental health consequences of overweight/obesity and similarly for the underweight syndromes
- psychosocial factors that contribute to obesity and to underweight syndromes
Evidence basis for weight regain avoidance in obesity
Neuroendocrine regulation of appetite
Principles of body composition and energy balance
Recommended nutritional, micronutrient, and energy intake according to life stage:
- athletes
- by age and in aging
- developmental stage
- menopause
- post-bariatric nutrition:
  - immediate
  - long-term
  - long-term nutritional evaluation and management
- preconception/pregnancy/lactation
- sex

Clinical assessment

Body composition, weight, height, and waist to hip ratio
Counselling and best evidence-based lifestyle advice for individuals, as part of weight management strategy
Edmonton obesity staging system
History taking and physical examination:
- obesity-focused
- underweight syndrome-focused
Screening for endocrine causes and consequences of weight derangement

Disease risk mitigation

Alcohol
Blood pressure control
Cancer, particularly:
- breast
- colon
- endometrial
- oesophageal
- prostate
Electrolyte derangement
Hepatosteatosis (including cirrhosis)
Hyperandrogenism
Hypoventilation syndrome
Infertility and hypogonadism
Obstructive and central sleep apnoea
Renal disease
Screening for:
- diabetes
- lipid derangement
Smoking and vaping

Lifestyle

Counselling and best evidence-based lifestyle advice for individuals, as part of weight management strategy:
- contraception and pre-conception planning
- exercise
- knowledge of dietary strategies for weight loss:
  - effectiveness
  - evidence
  - maintenance
  - manage patient medications safely
  - precautions
- normal growth and development
- nutrition:
  - individualised counselling
  - psychological strategies
- nutritional and supplementation management to avoid micronutrient deficiencies and bone loss
- refer to multidispliniary team members as required, including:
  - dieticians
  - exercise physiologists
  - psychiatrists
  - psychologists

Pharmacological therapy

Apply up to date, evidence-based best practice and clinical judgement to individualised medication management plans
Principles of pharmacology:
- drug distribution, metabolism, and excretion
- drug interactions, precautions, and contraindications
Pharmacological therapy available for overweight/obesity:
- contraindications and precautions
- expected effectiveness
- indications
- monitoring requirements – short, medium and long term

Procedures

Bariatric surgery referrals:
- awareness of the evidence basis of various procedures
- manage patient medication (specifically obesity and diabetes medications) and nutritional therapy perioperatively
- manage pre- and post-dietary therapy, with knowledge in safe use of VLED
- selective referral according to patient suitability
Long-term management of patients post-bariatric surgery:
- complication monitoring
- diuretic and antihypertensive medications
- micronutrient supplementation, where indicated
- weight regain mitigation with knowledge of effective nutritional, motivations and psychological strategies

General management considerations

Environmentally sustainable practices in clinical care
Impact of culture, health literacy, social, geographic and financial barriers to accessing:
- comprehensive anorexia nervosa care
- comprehensive obesity care
Impact of living with obesity, anorexia and/or bulimia or other disordered eating on an individual, their family, their life and their life stages, and the long-term management considerations
Impact of socioeconomic determinants of health on an individual’s health outcomes
Options for improving equitable access to comprehensive weight management care for individuals, such as:
- appropriate multicultural resources
- multidisciplinary involvement
- use of telehealth and other digital health tools

Health needs of specific groups

Older people:
- consequences of weight loss on musculoskeletal system
- weight loss in older persons to avoid sarcopenia and excess bone loss
Pre-conception, pregnancy, and lactation:
- knowledge of evidence for safe pre-conception weight
- recommendations for timing of conception after rapid weight loss, including from bariatric surgery
- safety of medications in pregnancy and breastfeeding
- utilise medications safely and withdraw these in a timeframe that is safe for pregnancy
People living with mental health disorders:
- evidence for early screening and intervention for improved cardiovascular outcomes
- impact of medications for mental health disorders on appetite, body composition, and ability to comply with lifestyle advice