Tier 1 And 2 Weight Management

Question 1

Obesity statistics in the UK: overall prevalence, prevalence in children, prevalence of overweight and obesity in men and women

Answer 1

• overall: 26.2% obesity
• children: 28% overweight or obese p
• 41.2% of men are overweight, 31.3% of women are overweight
• 7/10 men are overweight or obese, compared to 6/10 women

Question 2

Waist circumference and CVD risk

Answer 2

• moderate risk: high SC fat around the midline
• high risk: high visceral fat around the midline
• why BIA and waist circumference measures need to be used in addition to BMI
• visceral adipose tissue correlates well with measures of waist circumference
• the greater the waist circumference the greater the risk of metabolic disease
• WHO cut-offs are 80cm for women and 94cm for men

Question 3

Meta-inflammation and ichemia in obese adipocytes

Answer 3

• blood supply doesnt match adipose expansion in obese people and tissue becomes hypoxic, leading to inflammatory cytokine/adipokine release, immune cell infiltration, insulin resistance, inflammation
• can lead to lipid accumulation and insulin resistance in the liver and the muscle

Question 4

Risk factors for obesity

Answer 4

• lower socioeconomic class

- having genetic variants which predispose to obesity in environment with high food provision

Question 5

Benefits of 10 kg weight loss

Answer 5

• 20-25% reduction in total mortality
• 30-40% reduction in deaths related to diabetes
• 40-50% reduction in obesity-related cancer deaths
• 10 mmHg reduction in DBP and SBP
• diabetes: 30-50% reduction in fasting glucose, 15% reduction in HbA1c
• 10% reduction in overall cholesterol, 15% reduction in LDL, 30% reduction in TG, 8% increase in HDL
• improved ovarian function, lung function, insulin sensitivity
• improved sleep apnoea, joint pain, reduced back pain

Question 6

Tier 1 weight management

Answer 6

• preventative strategies from a public health perspective to prevent obesity
• more so for those with a BMI of <25
• prevention and reinforcement of healthy eating and PA messages
• environmental and population-wide services and initiatives
• includes national campaigns
• CCGs are responsible for provision of community-based interventions which encourage healthy eating and PA
• self-directed weight management has been found to have minimal impact at 12 months, interactive programs may be more beneficial at managing weight
• public acceptability was greater for the least intrusive interventions i.e provision of information and services, but most effective were interventions which eliminated/restricted choice

Question 7

Tier 2 weight management

Answer 7

• for people with a BMI of 25-30
• assessed at GP and referred to multi-component weight management services
• i.e weight watchers or slimming world or digital interventions (encouraging diet, PA, self-regulation and CBT techniques)
• aim for 3% weight loss at 3 months, 5-10% at 6 months
• maintenance at 12 months
• local CCGs are responsible for commissioning of weight management services
• seem to be effective in the short term, but weight loss often not retained
• but commercial open-group programs are more effective that SoC
• referral for 52 weeks achieves greater weight loss than standard 12 week interventions, extended referral improves fasting glucose

Question 8

Obesity prevention strategies (agentic, agento-structural, structural, micro, macro)

Answer 8

• agentic: individuals required to make independent choices
• agento-structural: structural changes to facilitate healthier choices
• structural: structural arrangements altered to the extent that individual choice in a given context is removed
• micro: schools, work, clinical, home
• macro: national, state or community level

Question 9

Critical features of successful tier 2 interventions

Answer 9

1) supportive relationships between service users and providers
2) self-regulation and maintenance of a healthy weight depend on individual own ability of engage in activities such as exercise
3) relationships are an essential first step in a weight management journey

Question 10

Implications of weight bias: an unintended consequence of weight management

Answer 10

• stress: leading to binge eating, lower PA, physiological reactivity (increased levels of cortisol, CRP, HbA1c)= leads to weight gain and psychological distress
• healthcare quality: poorer treatment adherence, lower trust of HCP, avoidance of follow-up, poorer communication. Leads to poorer psychological health, including poorer glycemic control