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:
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:
- 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
