Curriculum standards

Knowledge guides

LG15: Disorders of body 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

Overweight or obese

Acanthosis nigricans / Insulin resistance / T2DM
Binge eating disorders
Central hypoventilation
Depression and other mental health issues
Developmental delay
Early onset obesity
Hyperphagia
Hypotonia
Microphallus
Neonatal hypoglycaemia
Obstructive sleep apnoea
Oligomenorrhoea
Poor infant feeding
Premature adrenarche / precocious puberty
Prolonged jaundice
Weight gain:
- obesity
- overweight

Underweight

Delayed puberty
Depression / Mental health issues
Eating disorders
Faltering weight
Fractures / Osteopenia
Malabsorption
Oligomenorrhoea / Primary or secondary amenorrhoea
Refeeding syndrome

Conditions

Overweight or obese

Disorders of the leptin signalling pathway:
- leptin deficiency
- leptin resistance
- MC4R mutations
- POMC deficiency
- proprotein convertase 1 (PC1) deficiency
Endocrine causes:
- Cushing disease
- growth hormone deficiency
- hypogonadism
- hypothyroidism
Exogenous obesity
Hypothalamic disease:
- PWS
- ROHHAD
Syndromic / Genetic causes, such as:
- Albright's hereditary osteodystrophy
- Bardet–Biedl syndrome
- osteodystrophy
- PWS

Complications of overweight / obese

Dyslipidaemia
Fatty liver disease
Hypertension
Insulin resistance / T2DM
Polycystic ovary syndrome
Psychological

Underweight

Eating disorders
Malabsorption:
- coeliac disease
- cystic fibrosis
- inflammatory bowel disease
Malnutrition:
- neglect
- restricted diets due to autism / sensory processing issues
- restricted diets due to multiple allergies

Complications of underweight

Amenorrhoea
Nutrient deficiencies
Osteoporosis
Refeeding syndrome

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 and anorexia / underweight syndromes:
- evidence basis for weight management strategies
- evidence basis for weight regain avoidance in obesity
- 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
Neuroendocrine regulation of appetite
Principles of body composition and energy balance
Recommended nutritional, micronutrient, and energy intake according to life stage:
- athletes
- post-surgical
- sex, age, and pubertal stage

Cardiovascular risk mitigation

Alcohol
Blood pressure management
Electrolyte derangement
Kidney disease
Non-alcoholic liver disease (NAFLD)
Screening for:
- diabetes
- lipid derangement
- obstructive sleep apnoea and central apnoea
Smoking / vaping

Clinical assessment

BMI, body composition, height, weight, and plot on appropriate centile charts / assess SDS, waist circumference, waist-to-height ratio
History taking and physical examination:
- clinical screening for factors that may predict endogenous obesity
- obesity-focused
- underweight syndrome-focused
Screening for endocrine causes and consequences of weight derangement

Lifestyle

Assessment of sleep hygiene and screening for obstructive sleep apnoea
Counselling and best evidence-based lifestyle advice for individuals, as part of weight management strategy:
- dietary strategies for weight loss
- effectiveness
- evidence
- exercise – knowledge of relevant guidelines related to children
- maintenance
- manage patient medications safely
- menstrual issues
- normal growth and development
- nutrition, including use, prescription, and monitoring of VLEDs
- nutritional and supplementation management to avoid micronutrient deficiencies and bone loss
- precautions

Pharmacological therapy

Pharmacological therapy available for overweight / obesity:
- contraindications and precautions
- expected effectiveness
- indications
- monitoring requirements – short-, medium-, and long-term
Principles of pharmacology:
- drug distribution, metabolism, and excretion
- drug interactions, precautions, and contraindications

Procedures

Bariatric surgery referrals:
- awareness of the evidence basis of various procedures
- long-term management of people post-bariatric surgery:
  - complication monitoring
  - micronutrient supplementation, where indicated
  - weight regain mitigation with knowledge of effective motivational, nutritional, and psychological strategies
- manage patient medication, specifically obesity and diabetes medications, perioperatively
- selective referral according to patient suitability

General management considerations

Environmentally sustainable practices in clinical care
Impact of culture and health literacy, and social, geographic, and financial barriers, to accessing:
- comprehensive eating disorder care
- comprehensive obesity care
Impact of living with obesity or disordered eating on an individual, their family, their life, their psychological health, 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:
- multidisciplinary involvement
- resources appropriate to patients’ language and cultural needs
- use of telehealth and other digital health tools

Health needs of specific groups

Arrange appropriate referrals for management of associated conditions, including but not limited to:
- behavioural disorders
- orthopaedic (e.g., spinal)
- psychosis
- surgery
Consider lifestyle measures in obesity prevention and management, such as:
- dietary
- environmental modifications
- physical activity
Developmental delay
Evidence for early screening and intervention for improved cardiovascular outcomes
Impact of medications for mental health disorders on ability to comply with lifestyle advice, appetite, and body composition
Management of hypothalamic / pituitary dysfunction, including but not limited to:
- growth hormone therapy
- hypogonadism, including pubertal induction and hormone replacement
- management of central hypothyroidism
People living with mental health disorders
Prader-Willi syndrome