Table 1.
Questionnaire – please choose only one answer for each one of questions below
| Physiology |
| 1. Which of the following alternatives best characterizes people with obesity (BMI ≥ 30 kg/m2), compared to normal-weight individuals? |
| A. A lower resting metabolic rate (RMR) |
| B. Lower total energy expenditure (TEE) during physical activity given similar intensity and duration |
| C. A higher TEE |
| D. A decrease in carbohydrate metabolism |
| 2. Which of the following alternatives is correct in terms of TEE and RMR? |
| A. Degree of fat-free mass (FFM) is crucial for RMR |
| B. RMR is not affected by gender, age or BMI (kg/m2) |
| C. RMR accounts for approximately 50% of TEE in inactive individuals with obesity |
| D. Exercise-induced energy expenditure accounts for approximately 50% of TEE in an inactive individual with obesity |
| Etiology |
| 3. Which of the following alternatives is considered to be the main reasons for an increase in overweight and obesity? |
| A. Lack of self-control |
| B. Genetics |
| C. Genetic predisposition in addition to inactivity and overabundance of food |
| D. Increasing use of medications that can lead to weight gain |
| E. Endocrine causes |
| 4. Weight gain (WG) after a period of weight loss (WL), is one of the most profound challenges in obesity management. Which of the following alternatives represents the most likely contributor? |
| A. Reduction in motivation and lack of compliance |
| B. Reduction in RMR and a decrease in energy expenditure related to PA |
| C. Increase in hunger sensation and a decrease in satiety due to physiological adaptations to appetite control systems |
| D. Combination of A+B+C |
| Diagnosis |
| 5. Which diagnostic criterion regarding obesity represents the current standard? |
| A. BMI (kg/m2) |
| B. Presence of comorbidities |
| C. Body composition (fat-free mass vs. fat mass) |
| D. Amount of visceral adipose tissue (VAT) |
| 6. When diagnosing obesity in children, which of the following tools is considered to be the best one to use? |
| A. BMI curve |
| B. Waist-to-hip ratio |
| C. Iso-BMI curve |
| D. Percentiles |
| 7. Which of the patients would you most likely prioritize in terms of treatment for obesity? |
| A. Female 38 years old, BMI 50 kg/m2, mild hypertension, knee and lower back pain |
| B. Male 34 years old, BMI 35 kg/m2, diabetes type II, obstructive sleep apnea (OSAS) |
| C. Female 48 years old, BMI 32 kg/m2, physically active, minor joint discomforts |
| D. Male 36 years old, BMI 45 kg/m2, impaired fasting glucose, mild depression |
| Goals for Obesity Treatment |
| 8. Which alternative in terms of reduction in body weight is considered to give significant improvements in health? |
| A. 10–15 kg WL |
| B. 5–10% WL from baseline weight |
| C. A reduction in BMI category (e.g. from WHO class III to WHO class II) |
| D. A reduction in waist circumference (cm) by 10% |
| Conservative Treatment of Obesity |
| 9. What is considered to be the most optimal form for exercise in treating obesity? |
| A. 4 × 4 high-intensity interval training (HIIT) |
| B. Combined endurance and resistance exercise |
| C. Resistance exercise |
| D. Exercising in the moderate intensity zone/fat burning zone |
| 10. What is considered to be the most optimal strategy for lifestyle treatment of obesity? |
| A. Changing dietary habits |
| B. Combination of diet and exercise |
| C. Increasing physical activity levels (PALs) |
| D. Cognitive behavioral therapy (CBT) |
| E. Combination of diet, exercise and CBT |
| 11. When considering long-term weight reduction, which diet is believed to be the most effective one? |
| A. Low carbohydrate – high fat (LCHF) |
| B. Low fat |
| C. Mediterranean diet |
| D. Any diet can give the same weight reduction given equal negative energy balance and long term compliance |
| 12. Which of the following alternatives is considered to be the most appropriate recommendation when looking at conservative treatment of obesity? |
| A. A negative energy deficit of approximately 600 kcal/day |
| B. <20% of the energy in the diet comes from fat as a macronutrient |
| C. A weight loss of >1.0 kg/week |
| D. A diet very low in energy (<800 kcal/day) |
| Surgery (Non-Conservative Treatment of Obesity) |
| 13. Which of the following alternatives is the most correct one when looking at long-term outcomes of surgical treatment of obesity (gastric bypass, GBP)? |
| A. GBP improves the metabolic risk profile, but not primarily cardiovascular risk |
| B. Approximately 15% of patients experience suboptimal weight loss or significant weight regain |
| C. GBP does not produce a more significant WL after two years when compared to lifestyle treatment of obesity |
| D. Approximately 95% of patients who undergo GBP respond well when looking at WL |
| 14. Which of the following alternatives represents the most common complication experienced after GBP? |
| A. Hypertension |
| B. Dyslipidemia |
| C. Low levels of vitamin B12, vitamin D, calcium, and iron |
| D. Osteoporosis |
| Consequences of Obesity |
| 15. Which of the following alternatives are least associated with obesity? |
| A. DM2 |
| B. Osteoporosis |
| C. Male infertility |
| D. Non-alcoholic fatty liver disease (NAFLD) |
| Weight Loss Maintenance – Long-Term Perspective |
| 16. Which level of physical activity is recommended for individuals with obesity in order to maintain weight loss? |
| A. 30 min/day moderate intensity |
| B. Short 10 min bouts with high intensity 3 times/week |
| C. 45–60 min/day moderate intensity |
| D. 30 min HIIT 3 times/week |
| 17. On average, which percentage do individuals who have lost weight through lifestyle changes are able to maintain a clinically significant WL for at least 1 year? |
| A. 20% |
| B. <10% |
| C. 30% |
| D. >40% |
| 18. Which of the following alternatives is most associated with long-term WL maintenance? |
| A. A diet high in carbohydrates (≥55% of total energy intake) |
| B. Exercising at high intensity > 3 times/week |
| C. Eating breakfast > 5 days/week |
| D. Self-weighing ≥ 1 times/month |
| Subjective Questions |
| 19. Choose the alternative you agree the most with regarding possible reasons for you as a doctor feeling resistant to initialize treatment of obesity |
| A. There is not much I can accomplish during a 10-min consultation |
| B. Obesity is a very complex condition, so I prefer to focus on treating the comorbidities |
| C. There are few economic incentives in promoting public health/obesity prevention, and it is difficult charging fees for suggesting simple changes in diet and exercise routines |
| D. It is my duty to discuss weight issues with the patient, but long term follow-up and frequent consultations are beyond my capacity in busy surgery |
| E. I believe that most patients with obesity live in denial, and few methods are effective in maintaining weight, so I give them general advice and move on |
| 20. Choose the alternative you agree the most with regarding your role as a medical professional who treats patients with obesity |
| A. I trust my acquired knowledge from university education and I know how to treat this patient |
| B. I prefer to refer the patient to tertiary care/specialist health care services because I suggest that obesity is a self-inflicted condition and it is beyond my reach to treat |
| C. I can handle treating the medical aspects of comorbidities, but not the complexity of the lifestyle issues |
| D. I fear that I may create poor doctor-patient dynamics by bringing up weight and lifestyle issues. The subject of body weight is such a sensitive topic, and discussing it may make the patient reluctant to keep me as their GP |