Overweight and Obesity

Question 1

What are overweight and obesity?

Answer 1

Overweight and obesity are defined as abnormal or excessive fat accumulation that may impair health

Question 2

How is overweight and obesity measured?

Answer 2

BMI is a simple index of weight for height that is commonly used to classify weight in adults. 
<18.5 underweight
18.5-<25 healthy weight
>25 but <30 overweight
>30 obese

Question 3

How accurate is BMI?

Answer 3

BMI measures body weight not body aft
Measures may be skewed by high muscle mass
Different cut offs in different ethnic groups
Measures not appropriate for women who are breast feeding/ pregnant, or people who are very frail/ elderly
Need to take account of age, height and gender when using BMI in children and adolescents

Question 4

Why body shape matters

Answer 4

Indicates where fat is stored
Apple shape body known as abdominal or central obesity, may be more at risk of cardiovascular disease and type 2 diabetes

Question 5

Overweight and obesity among adults

Answer 5

More than 6 out of 10 men are overweight or obese (63%)

More than 5 out of 10 women are overweight or obese (56%)

Question 6

Overweight and obesity in the UK

Answer 6

Prevalence of obesity in adults has more than doubled in the last 25 years
Being overweight has become the norm and Britain is becoming an obese society
Over half of the UK adult population could be obese by 2050
Children are increasingly affected

Question 7

Energy imbalance

Answer 7

The fundamental cause of obesity and overweight is an energy imbalance between calories consumed and calories expended over a prolonged period of time

Question 8

What drives obesity?

Answer 8

Obesity is driven by changes in the physical, social and economic environment that make it easy to take in more calories than needed while making it harder to get enough physical activity to consume those extra calories

Question 9

Physical inactivity

Answer 9

Globally there has been an increase in physical inactivity due to increasingly sedentary nature of many forms of work, changing modes of transportation and increasing urbanisation

Question 10

Genetics

Answer 10

Majority polygenic trait plus environment

Very rarely single gene defects e.g. Prader-Willi syndrome, leptin deficiency

Question 11

Medical conditions

Answer 11

Medical conditions that can cause weight gain include: Cushings syndrome, hypothyroidism, polycystic ovary syndrome, age

Question 12

Social and economic influences

Answer 12

Generally rate of obesity are higher among those from poorer backgrounds and those experiencing greater levels of social deprivation
Pattern is clearer for women than men

Question 13

Premature death

Answer 13

Obesity is associated with premature death
It is estimated that on average obesity reduces life expectancy by between 3 and 13 years
In general the more severe the obesity and the earlier it develops, the greater the risk of premature death

Question 14

Obesity related disease

Answer 14

Cardiovascular disease
Type 2 diabetes
Musculoskeletal disorders
Some cancers
Anxiety, depression and psychological damage
Adverse outcomes in pregnancy

Question 15

Economic costs of obesity

Answer 15

The cost to the NHS of treating obesity related conditions already exceeds £5 billion in England
Costs to wider society are approximately £20 billion

Question 16

Benefits of modest weight loss

Answer 16

Evidence shows 5-10% weight loss has benefits including: decrease in total mortality, decrease risk of developing type 2 diabetes, decrease in obesity related cancers, decrease in blood pressure, blood lipid profile improves
Evidence shows 5-10kg weight loss can improve: back and joint pain, symptoms of breathlessness, sleep apnoea

Question 17

Role of the pharmacist

Answer 17

Need the skills to sensitively raise the issue of weight management
Explain risks
Encourage healthy lifestyles
Signposting to local services

Question 18

Eight tips for healthy eating

Answer 18

Base your meals on starchy foods
Eat lots of fruit and vegetables
Eat more fish including a portion of oily fish
Cut down on saturated fat and sugar
Eat less salt
Get active and be a healthy weight
Don't get thirsty
Don't skip breakfast

Question 19

OTC slimming products

Answer 19

Little robust evidence to support efficacy
Potential support to behavioral weight loss programmes
Not subject to same degree of safety and efficacy testing as licensed medicines
Potential risks e.g. adverse effects

Question 20

Orlistat 60mg (OTC)

Answer 20

Indicated for weight loss in adults over 18 years old who are overweight BMI > 28
Should be taken in conjunction with a mildly reduced calorie lower fat diet

Question 21

Enhanced community pharmacy services

Answer 21

Opportunities for weight management advice and information through many of the enhanced community pharmacy services e.g. 
Diabetes and cardiovascular services
Health screening and monitoring services
Smoking cessation services
Medication review services

Question 22

Community pharmacy weight management services

Answer 22

Initial assessment
Height and weight measurements
Information and goal setting
Follow-up, monitoring and support
May also include PGD for supply of orlistat, referral/ signposting

Question 23

If all else fails

Answer 23

Specialist obesity/bariatric clinic for multiple disciplinary care of severe and complex obesity
Expertise in multiple obesity-related disorders
Access to bariatric surgery