Overweight and Obesity Flashcards
What are overweight and obesity?
Overweight and obesity are defined as abnormal or excessive fat accumulation that may impair health
How is overweight and obesity measured?
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
How accurate is BMI?
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
Why body shape matters
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
Overweight and obesity among adults
More than 6 out of 10 men are overweight or obese (63%)
More than 5 out of 10 women are overweight or obese (56%)
Overweight and obesity in the UK
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
Energy imbalance
The fundamental cause of obesity and overweight is an energy imbalance between calories consumed and calories expended over a prolonged period of time
What drives obesity?
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
Physical inactivity
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
Genetics
Majority polygenic trait plus environment
Very rarely single gene defects e.g. Prader-Willi syndrome, leptin deficiency
Medical conditions
Medical conditions that can cause weight gain include: Cushings syndrome, hypothyroidism, polycystic ovary syndrome, age
Social and economic influences
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
Premature death
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
Obesity related disease
Cardiovascular disease Type 2 diabetes Musculoskeletal disorders Some cancers Anxiety, depression and psychological damage Adverse outcomes in pregnancy
Economic costs of obesity
The cost to the NHS of treating obesity related conditions already exceeds £5 billion in England
Costs to wider society are approximately £20 billion
Benefits of modest weight loss
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
Role of the pharmacist
Need the skills to sensitively raise the issue of weight management
Explain risks
Encourage healthy lifestyles
Signposting to local services
Eight tips for healthy eating
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
OTC slimming products
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
Orlistat 60mg (OTC)
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
Enhanced community pharmacy services
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
Community pharmacy weight management services
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
If all else fails
Specialist obesity/bariatric clinic for multiple disciplinary care of severe and complex obesity
Expertise in multiple obesity-related disorders
Access to bariatric surgery
