Obesity Flashcards
State the proportion of obese, and overweight people in Scotland. Are these figures increasing/decreasing/constant ?
How many overweight or obese people are there in the world ?
29% obese
65% overweight (includes obese)
Increasing
> 2.1 billion people (30% of global population) are overweight or obese
Identify the three countries with the greatest rate of obesity.
Is the rate of increase in obesity greater or lesser than in other countries ?
USA
Mexico
England
3 countries with greatest rate of obesity, have greater increase in rate of obesity
Describe the economic costs of obesity.
- Global economic impact from obesity: $2.0 trillion, equivalent to global impact from smoking or armed violence, war and terrorism
- 2-7% of all health-care spending in developed economies
- Personal, social, economic costs partly because obesity leads to multiple chronic health conditions
- Decreased life expectancy (up to 20 yrs depending on severity of obesity)
Describe the role of the GP in obesity.
GPs important:
• More obese patients visit GPs frequently c.f. healthy weight counterparts
What can GPs do:
• Primary care practitioners - well placed to implement weight loss and obesity prevention programs opportunistically
• Interventions shown to be effective
– partnerships (e.g. between primary care practice and commercial weight loss organisation)
– communication based interventions
• NHS SIGN + NICE guidelines - doctors regularly screen for obesity
and recommend interventions to o/wt and obese patients within primary care
• Yet, weight discussion often unsuccessful and seldom occurs in primary care consultations
Explain why weight discussions are often unsuccessful and seldom occur in primary care consultations.
- Embarrassment -Lack of adequate training/support
- Dr doesn’t think patient has motivation
- Sensitive topic
When weight WAS discussed in primary care, who is it that raised the issue ?
In few times where weight was discussed,
it was practioner who raised the issue with patient
(often patient closing down the discussion)
Describe the impact of brief interventions for obesity in primary care.
- RCT showed that: Both advice only, and support (e.g. referral to weight management group) helped patients lose weight (however, support more so) (each patient was give 30 seconds of one of the two)
- So interventions are acceptable (according to patients) + useful
What is obesity ?
Excess adiposity
State formula for BMI. What is the main problem of BMI as a tool to estimate obesity ?
Body mass index (BMI) = Wt (kg)/ht (m)2
• Proxy measure (fat mass + fat-free mass) BUT still useful population level measure of o/wt and obesity across gender and age for adults
Identify the main measures used for obesity.
- BMI
- Waist circumference (reasonable indicator of intra- abdominal or visceral fat)
What are the NICE cut offs in terms of increased risk of health problems for waist circumference ?
NICE cut offs: males wc >94cm or females wc ≥ 80cm at ↑ed risk
health problems
What BMIs is obesity ? Overweight ?
Obesity is classified as BMI more or equal to 30kg/m2.
Class I is 30 to 34.9 kg/m2.
Class II is 35.0 to 39.9 kg/m2.
Class III is 40 and above.
Overweight is anything from 25 kg/m2 to above (includes pre-obesity and the three classes of obesity)
Identify co-morbidities of obesity.
Stroke Heart Disease Diabeters Cancer Psychological problems (depression, reduced self confidence anxiety, reduced quality of life, body dissatisfaction, may lead into eating disorders)
How is obesity defined in children ? WHa
• Arbitrary ref values (85th, 95th centiles for population), which vary worldwide
• IOTF: adult cut offs (BMI 25, 30) be linked to BMI centiles for children to provide child cut-offs (International standards, based on mean of international centiles)
‒ aim to define internationally acceptable cut off points for child obesity and overweight (helps compare different countries and come up with strategy applicable to all countries)
-e.g.
if 19.8 BMI as male aged 10 overweight child
• International cut offs reformulated to allow BMI to be expressed as a centile or SD score
- very minor changes in existing cut-offs
Draw a graph of BMI vs age for overweight, and obese males, and females respectively up to age 18. Explain the differences between males and females.
Refer to graph on page 3
More linear in males, more concave in females (probably due to early puberty)
What is the percentage of children at risk of overweight (including obesity) in Scotland?
Percentage of children at a health weight ?
72%
28%
What is the prevalence of child obesity in Scotland ?
13%
Identify possible consequences of childhood obesity.
- Pulmonary: Sleep apnoea; Asthma
- Orthopaedic: Ankle sprains; Increased risk of fractures
- Neurological: Idiopathic intracranial hypertension
- Gastroenterological: Cholelithiasis; Liver steatosis/non-alcoholic fatty liver
- Endocrine: Type 2 diabetes; Polycystic ovary syndrome
- Cardiovascular: Hypertension; Dyslipidaemia
- Psychological: Depression; Low self esteem
These are consequences we used to just see in adults, now in children as well.
