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
