L10- Obesity and nutrition Flashcards
definition of obesity
an abnormal or excessive fat accumulation that presents a health risk
obese BMI
> 30
very obese BMI
> 40
underweight BMI
<18.5
most of the worlds populations live in countries where obesity
kills more than underweight
obesity is not distributed equally
• Ethnicity • Sex • Local inequalities • Deprivation levels - Local inequalities: Inequality gap between those in deprived and affluent areas- obesity higher in deprived regions
what can obesity contribute towards
- Cancers
- Mortality
- CVD
- Liver
- Repro complications
- Osteoarthritis and back pain
- T2D
- Asthma
- Depression and anxiety
- Sleep apnoea
- Huge cost to the NHS- 5.1 billion
obesity is not as simple as
energy in energy out
how many causes of obesity
108 (>300 interactions)
national obesity plan focuses on
- sugar reduction
- local communities
- schools
- retail
- labelling
sugar reduction
o Use of tax system
o Ban to end the sale of energy drinks
schools
o Physical activity
o Education
retail
o Prices
o Location e.g. checkout
labelling
e.g. nutrients
the single most important intervention is to understand that there is
no single most important intervention
weight loss required for therapeutic benefit e.g.
diabetes, hypertension, sleep apnoea, osteoarthritis, stress, PCOS
how many tiers of obesity services
4 tiers
tier 1
primary activity, population level public health prevention, identifying those at risk, referring into appropriate interventions
commissioned by local authorities
example of tier 1 approach
for healthy population inc skill based e.g. cook and eat sessions
community based approaches becoming important
tier 2
community based weight management services
tier 2 commissioned by
local authority- weight management services for those without complex needs
tier 3
specialised weight management services for people with severe and complex obesity
tier 3 commissioned by
CCGs
patients with complex needs- includes dietetic and psychological support
- gateway to tier 4
tier 4
bariatric surgery
tier 4 commissioned by
CCGs
- bariatric surgery- limited capacity
studies show weight loss is largely about
diet in the short term but requires physical activity to be sustained
example of very effective intervention
bariatric surgefry
bariatric surgery
limited capacity in NHS
long term weight loss
ghrelin
appetite stimulating
PYY and GLP1
satiety hormones
challenge of weight loss
weight-maintenance
example of drug used to treat obesity
orlistat
orlistat mode of action
energy wastage- adjunct to diet for obesity, including weight loss and maintenance
other obesity drugs suppress
appetite
T@DM remission
Bariatric surgery
low carb]low calories diet
what is the role of the doctor
- Brief advice
- ‘While you’re here, I just wanted to talk about your weight’ - Weight stigma
- Listen
- Know your limits
- Dietitians
is obesity a disease
- Will it reduce stigma or increased it?
- Workplace protection
- Do we need a medical model?
- Genetics: increased genetic variants and increased risk of obesity
- Obesity descries a collection of 60+ disorders?
- DO we need a medical model?
malnutrition
- 3 million people adults are affected o 30^ hospital admissions o 35% care home admissions o 15% outpatient attendances o 10% GP presentations - £20 billion per year on the NHS
