Obesity Flashcards
Part 1 of 3
What is obesity?
An excessive accumulation of body fat which has a significant detrimental effect on health
Especially central obesity
Energy Balance to maintain body weight
To maintain body weight
The Intake of energy (must equal) = Expenditure of energy
However, if intake is higher than expenditure weight will be gained
If you eat more of the following energy nutrients than you burn off they will be converted to body fat
Apple v Pear
Apple
Fat is deposited centrally around the stomach area
Commonly seen in men and women once they have reached the menopause
Pear
Fat laid down around the thighs, bottom and hips
Typical distribution seen in women
The apple distribution increases the risk of heart disease
Causes of obesity
Genetics
Does run in families
See evidence in adopted children/twins and the biological parents
Extensive research is been conducted to determine the ‘obesity causing gene(s)’
But question the cause! (sometimes you need to question the cause)
Examples of genetic diseases that can cause obesity:-
Prader Willi Syndrome
Cushings Syndrome
Low Metabolic Rate
Affects a very small %
Hypothyroidism slows metabolism
More causes of obesity
Lifestyle – major cause
Combination of:-
Poor diet
Lack of physical activity
Sedentary lifestyle
Possible Influences:-
Advertising of foods high in fat, sugar and salt
Wide availability of cheap foods high in fat & sugar
Reliance on convenience foods
Increase in eating away from home
Increase in portion sizes
Sedentary life styles
Use of cars, computers etc
More labour saving devices
Medical reasons for weight gain
Underactive thyroid
Diabetes treatment
Ageing
Cushing syndrome
Stress, anxiety, low mood
Tiredness
Fluid retention
Polycystic ovary syndrome
Corticosteroids
Drugs which cause weight gain
Oral hypoglycemic agents - Sulphonylureas, pioglitazone, insulin
Antidepressants - Paroxetine, amitriptyline, mirtazepine
Anticonvulsants - Gabapentin, carbamazepine
Antipsychotics - Olanzapine, risperidone, lithium
Corticosteroids - Prednisolone
Oral contraceptives
Beta blockers - Atenolol, metoprolol
Pizotifen
Antihistamines - Cetirizine, fexofenadine
How to categorise body weight
Categorised using Body Mass Index (BMI)
BMI calculated using an individual’s total weight (kg) relative to their height (m)
BMI:
Determines the degree of obesity in adults and is associated with health risk
Makes no specific measurement of body fat so it is possible for an adult to have a high BMI but relatively low body fat mass e.g. athletes who are very muscular
BMI = Weight (kg) ➗ height (㎡)
Waist Circumference
Provides information about the distribution of body fat
Patients with a central distribution of body fat have an increased cardiovascular risk and more likely to have insulin resistance
Low waist circumference:
Men ≤ 94cm
Women ≤ 80cm
High waist circumference:
Men 94 - 102cm
Women 80 - 88cm
Very high waist circumference:
Men ≥ 102cm
Women ≥ 88cm
Consequences of obesity
Stroke
Cardiovascular disease
Respiratory disease
Hormonal imbalances
Osteoarthritis
Cancer
Diabetes
Hyperuricemia and gout
Gallbladder disease
Non-alcoholic fatty liver disease
Medicines to support weight loss - how does orlistat work
Orlistat works by preventingaround a third of the fat from the food you eat being absorbed
The undigested fat isn’t absorbed into your body and is passed out with your faeces (stools)
This will help you avoid gaining weight, but won’t necessarily cause you to lose weight
Used in conjunction with a low calorie diet
Available OTC as Alli (60mg) under the supervision of a pharmacist
BMI must be ≥ 28
Only recommended NHS treatment
Cycle of Change
Pre-contemplative stage - No intention to change, or unaware of the problem
Contemplative stage - Aware a problem exists but no commitment to action or change
Preparation/determination stage - Intent on taking action to address the problem
Action stage - Active modification of behaviour
Maintenance stage - Action to sustain changes. New behaviours replace the older ones
Relapse stage - Fall back into old patterns of behaviour
Structure of weight management in the UK
Step 1 - Primary care and community advice
Brief interventions by all healthcare professionals
Unpaid service but a role which must be undertaken by all HCP’s
Step 2 - Primary care with community inventions
More in-depth consultations offered in the community by trained HCP’s
Patients can self-refer into the programmes
Local authorities commission the services e.g. community pharmacy weight management services
Weight Watchers, Slimming World, Lipotrim
Step 3 - A primary/community care based multidisciplinary team
Specialist community weight management services are provided for severe and complex obesity
Patients have to be referred:
Underlying causes of obesity need to be assessed
Patient has complex disease states
Conventional treatment has been unsuccessful
Drug treatment or surgery is being considered for a patient with a BMI of ≥ 50
Commissioned by the Local Authority
Step 4 - Specialised complex obesity services (including bariatric surgery)
Specialised bariatric medical and surgery multidisciplinary teams with pre-op assessments and surgery care is provided, which is commissioned centrally by NHS England
Bariatric surgery
Makes changes to a patient’s digestive system
Most common types:
gastric band – a band is placed around the stomach, so you don’t need to eat as much to feel full
gastric bypass – the top part of the stomach is joined to the small intestine, so you feel fuller sooner and don’t absorb as many calories from food
sleeve gastrectomy – some of the stomach is removed, so you can’t eat as much as you could before and you’ll feel full sooner
Where are community pharmacy placed in the weight management structure?
Placed within Step 2
Department of Health White Paper - Healthy lives, healthy people - our strategy for public health in England. The government recognised that community pharmacies are a valuable and trusted public health resource with millions of contacts with the public each day.
Pharmacies have a real potential to effectively improve the health and wellbeing of the public and reduce health inequalities. They can help reduce the costs of treating the consequences of obesity such as expensive coronary heart disease, cancer and diabetes
How do I deliver a successful NHS service? environment and printed materials
The Physical Environment
The room used should be easily accessible and private
Are there enough chairs?
Are the chairs suitable for obese patients?
Ideally the chairs should have no arms
Printed materials
Appropriate literature should be available which includes information on benefits in weight loss, information on local services, diet and exercise
How do I deliver a successful NHS service? pt 2 equipment - tools - service specification
Equipment
Adequate and regularly calibrated weight and height scales
Weighing scales should be able to measure in excess of 150kg with a wide base
Tools
Forms for patients details
Copies of food and physical activity diaries
Activities which can be undertaken during the consultation such as food portion size pictograms
Service Specification
Produced by your local commissioner
Will contain: details of why the service is needed, the scope of the service, exclusion criteria, the finance arrangement and the monitoring and evaluation criteria
It may also contain a list of resources and/or equipment you require
NHS weight management service - the initial consultation
The initial Consultation
Check the patient’s suitability using the criteria in the service specification
Explain what the programme involves
Assess the patient’s willingness to change using the cycle of change model
Collect the patient’s details as per service specification
Explain the benefits of weight loss and the health risks of obesity
Take accurate weight and height measurements and calculate BMI
Take an accurate waist measurement and explain the importance to the patient
Discuss current lifestyle
Agree realistic, achievable goals and lifestyle changes for the next 6 months
Provide information on other support groups available
NHS Weight Management Service - follow up and support consultation
Discuss the patient’s experience and progress since the last consultation
Encouraging praise and success of achievements
Discuss obstacles and challenges and discuss solutions together
Taking and reviewing the patient’s weight, height and waist measurements
Review the need to refer to other HCP’s
Exploring additional ideas to improve eating habits or increase physical activity
Setting new goals where old ones have been achieved
Resolving individual difficulties with the programme such as poor attendance or participation
NHS weight management service - the final consultation
Measuring and recording the patient’s end measurements
Reflecting on the success since the previous session and the success since starting the programme
Discussing ongoing future realistic goals
Ensure the patient is aware that they can return for further support if needed
Provide further information and literature
Complete the necessary paperwork to record outcome data as per the service specification
NHS Weight Management Service - outcomes and evaluation
The overall aim is to support weight loss and improve public health
The service specification will indicate what outcome data is required and how the service is evaluated
The average lifestyle weight management service results in 3% weight loss from baseline weight
Weightwatchers
Easily accessible information provided in a format appropriate to the service user to enable clients to understand and assess their own BMI scores, waist circumference and body composition
Develop detailed and specific action plans for each client to include:
Information about healthy eating recommendations
Local physical activity opportunities
Goal setting
Diary monitoring
Focus interventions on activities that are sustainable and fit easily into everyday life
Slimming World
The theory behind the plan is simple – to lose weight you need to take in fewer calories than you use up
Achieves this reduction in calories by encouraging dieters to freely eat foods that are lower in calories but high in nutrients such as pasta, lean meat, rice, fish, fruit and veg, whilst limiting calorie-packed foods that are nutrient-poor such as biscuits and alcohol
Attend a weekly meeting and have a weigh-in
Lipotrim
Uses a nutrient complete Total Food Replacement formula which is designed to safely maximise the Calorie Gap
Calorie Gap = the difference between the calories you use and the calories you eat
Provides all of the essential nutrients your body needs in a day
