Obesitythe Health Time Bomb
Speaker name, affiliation,etc
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Definition
• Obesity is an excess of body fat frequently resulting
in a significant impairment of health and longevity.
• BMI offers a reasonable measure with which to
assess fat and the standards used to identify
overweight and obesity should agree with the
standards used to identify grade 1 and grade 2
overweight (BMI of 25 and 30, respectively) in adults.
• BMI calculated by dividing individuals weight by
height in meters squared.(kg/m )
• Waist Circumference:
Risk for Women >32” and Men >37”
2
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BMI
Classification
BMI
(kg/m2)
Risk of Co-morbidities
Underweight
<18.5
Low (Risks are increased in
other areas)
Desirable
18.524.9
Average
Overweight
25.029.9
Mildly Increased
Obese
>30.0
Class 1 Obesity
30.034.9
Moderate
Class 11 Obesity
35.039.9
Severe
Class 111 (morbid
obesity)
>40.0
Very severe
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National Audit Office
Obesity
• Increases with age
• More prevalent among lower socio-economic
and lower income groups, with particular
strong social gradient towards women.
• More prevalent among certain ethnic groups,
particularly among Afro-Caribbean and
Pakistani women
• Is a problem across all regions in England but
shows some regional variations.
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Why is reducing obesity important?
• In 2006 it was anticipated that obesity will
soon surpass smoking as the greatest cause
of premature life loss in England.
• Obesity will bring levels of sickness that will
put enormous strain on health services
• By 2010 the costs of obesity to the NHS will
increase to £3.7 billion a year.
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Why is reducing obesity important?
• WHO predicts 1/3rd increase in loss of
healthy life because of being
obese/overweight.
• Proportion of population of England who
obese has grown by 400% in the last 25
years.
• In England, 24% of the adult population are
now obese.
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Why is reducing obesity important?
Obesity is a known risk factor for
• Type 2 Diabetes
• Coronary Heart Disease
• Metabolic Syndrome
• Cancer: especially Breast and Colon
• Psychological ill health
• Osteoarthritis
• Hypertension
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Greatly increased
(relative risk much
greater than 3)
Moderately increased Slightly increased
(relative risk 1-2)
( relative risk 2-3)
Type 2 diabetes
Coronary Heart
Disease
Cancer (Breast cancer
in postmenopausal
women, endometrial
cancer, colon cancer)
Gallbladder disease
Hypertension
Reproductive hormone
abnormalities
Dyslipidaemia
Osteoarthritis (Knees)
Polycystic ovary
syndrome
Insulin resistance
Hyperuricaemia and
gout
Impaired fertility
Breathlessness
Low back pain
Sleep apnoea
Anaesthetic risk
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Foetal defect
associated with
maternal obesity
Epidemiology – population impact
• Prevalence of Obesity in Great Britain is
three times greater than 20 years ago.
• 30,000 deaths were attributable to
obesity during 1998 in England.
• Equivalent to 9 years lost life for each
individual
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Prevalence of Obesity in Men in England 19802002
(Source: Health Survey for England 2002)
Percentage
50
40
Healthy Weight
30
Overweight
20
Obese
10
Mobidly Obese
0
1980
1993
2000
Year
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2002
Prevelence of Obesity in Women in England 19802002
(Source: Health Survey for England 2002)
Percentage
50
40
Healthy Weight
30
Overweight
20
Obese
10
Mobidly Obese
0
1980
1993
2000
Year
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2002
Causes of Obesity
• Increase too rapid to indicate that
genetic factors are primary cause
• Reflects change in eating patterns and
levels of physical activity
• Over consumption of energy relative to
need
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Groups at Risk
•
•
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Children
Racial and Ethnic Groups
Lower Socio Economic groups
Women
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Children
• Population target: To halt the rise in obesity
of 11 year olds by 2011.
• Worldwide 22 million children under the
age of 5yrs are obese and 122 million
overweight.
• Nearly 30% of children aged 2 to 15 were
classed as overweight or obese in 2006.
• Conservative estimates indicate that without
any intervention one fifth of boys and one
third of girls will be obese by 2020.
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Racial & Ethnic Influences
• Pakistani, Indian and Bangladeshi men in England
have relatively low levels of obesity measured by
BMI.
• However, 41% of Indian men are classed as centrally
obese compared to 28% of men in the general
population.
• In 2004, Black Caribbean and Irish men had the
highest prevalence of obesity (25% each). For
women, obesity prevalence was higher for Black
African (38%), Black Caribbean (32%) and Pakistani
ethnic groups (28%) and lower for Chinese women
(8%), than for women in the general population.
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Racial & Ethnic Influences
• In South Asia, approximately, 20% of
the population is diabetic and 25%
glucose intolerant.
• In England, children who are Asian are
four times more likely to be obese than
those who are white.
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Inequalities
• Large social class differences, particularly for
women.
• In 2003, prevalence of obesity among women
was lower in managerial and professional
households (18.7%) and in intermediate
households (19.6%) than in routine and
manual households (29.0%)
• Difference in dietary consumption not clear,
although there appears to be some
differences.
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Women
At risk times;
• Puberty / Menstruation
• Childbirth
• Menopause
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Public Health Interventions
Prevention and treatment of obesity:
1. Prevention of developing obesity
2. Correction of existing obesity
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Interventions
Obesity is a complex condition that has contributing
factors at four different levels.
• Individual: Food Consumption, Levels of Exercise
• Inter-personal: Parental and Personal Beliefs and
Behaviours
• Organisational: School Dinners, Healthy Workplace
Policies
• Governmental: Guidance/ Policy, Funding, Food
labelling, Advertising
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Prevention of developing obesity
• Some evidence to suggest that school based
programmes that promote physical activity,
modification of dietary intake and the
targeting of sedentary behaviours may help to
reduce obesity in children, particularly girls.
• A systematic review concludes that
compulsory rather than voluntary aerobic
exercise is causally related to the reduction in
adiposity in children.
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Prevention of developing obesity
• Applying this to the family situation with
parental support, maybe beneficial.
• Some evidence to suggest that parents as
change agents for their children is
successful.
• Evidence to suggest that parents
underestimate the weight of their children
and therefore do not recognise the risk.
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Health benefit of modest (10%)
weight loss
Mortality
20-25% fall in overall mortality
30-40% fall in diabetes related deaths
40-50% fall in obesity-related cancer deaths
Diabetes
Up to 50% fall in fasting blood glucose
Reduces risk of developing diabetes by over 50%
Fall of 10% total cholesterol, 15% LDL and 30% TG
Increase of 8% HDL
10 mmHg fall in diastolic and systolic pressures
Lipids
Blood
Pressure
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Individual approaches to health
promotion: Aims
Medical
To identify those at risk
Behaviour
Change
To encourage individuals to take
responsibility for their own health
and choose healthier lifestyles
To increase knowledge and
skills about healthier lifestyles
To work with clients to meet their perceived
needs
Educational
Empowerment
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Individual approaches to health
promotion: Methods
Medical
Primary health care consultant.
e.g. Weight, BMI, waist circumference
measurement. Identify co-morbidities.
Behaviour
change
Persuasion through one to one advice and
information. Discuss the risks and benefits of a
modest weight loss.
Educational
Provide information, backed up by support.
Identify how ready the patient is to change.
Exploration of attitudes and lifestyle.
Empowerment
Refer to another member of the team for
support or specialist. Provide regular
monitoring, set goals, use self help material.
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Individual approaches to
health promotion:
Professional / Client relationship
Medical
Expert led. Passive, conforming client. Evidence
would suggest patients are more motivated to
lose weight if they are advised to do so by health
professional
Behaviour
change
Expert led. Dependant client.
Beware of “victim blaming”.
Educational
May be expert led, involves client in negotiation of
issue for discussion. Voluntarism
Empowerment
Health promoter is facilitator, client becomes
empowered.
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Professional practice
Take care with ethics - ask yourself
• Is my communication style, method and
content appropriate?
• Am I acting in the best interests of the
client and/or their family?
• What harm could I cause- eg reduce
self esteem, blame, arouse fear, anxiety
or guilt feelings
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Beattie’s Model
Mode of intervention
Authoritative
Health
Persuasion
Mode of thought
Objective knowledge
Legislative
Action
Mode of intervention
Individual
Personal
Counselling
Collective
Community
Development
Mode of intervention
Mode of thought
Negotiated
Participatory, subjective knowledge
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Stages of Change Model
Attitude
Development
Commitment:
Ready to
Change
Pre-contemplation:
Not interested
in changing
‘risky’ lifestyle
Exit:
Maintaining ‘safer’
lifestyle
Action:
Making
changes
Contemplation:
Thinking about
change
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Maintenance:
Maintaining
change
Relapse:
Relapsing
Back
Behaviour
Development
First steps in tackling obesity
For the Client:
• Personal acknowledgement of excess weight and an
understanding of its health consequences are essential.
• Willing to explore of current lifestyle and attitudes.
For the Health Professional:
• Explore what is modifiable given the context
/circumstances.
• Respond appropriately with informed evidenced based
interventions
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First steps in tackling obesity
• Encourage healthy eating
• Increase physical activity
• Provide brief behavioural advice.
E.g. keep a food diary
• Aim for 5-10% weight loss
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Evidence-Based Treatment Goals
Individual Aims:
• To reduce BMI to less than or equal to 25
• To reduce waist circumference to below:
– 37” for men
– 33” for women
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Healthy Eating
• Eat five or more portions of fruit a day
• Base meals on starchy foods, such as
wholemeal bread, pasta, rice, cereal or potato
• Reduce intake of foods high in fat and food
high in sugars
• Use cooking methods which reduce fat, such
as grilling
• Reduce alcohol intake (high in calories)
• Consume less high fat/sugar snacks
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Changes required by Individuals
Action
Target per day
Increase avg.
5 portions
intake of fruit and
veg
Increase avg.
18gms
intake of dietary
fibre
Reduce the avg. 6gms
intake of salt
©LTPHN 2008
Current Average
2.8 portions
13.8gms
9.5gms
Changes required by Individuals
Action
Target Per day
Current Average
Reduce the avg.
intake of
saturated fat
11% of food
energy
35.3% of food
intake
Maintain total
intake of fat
35%
35.3%
Reduce the avg.
intake of sugar to
food energy
12.7%
©LTPHN 2008
Physical exercise
• Children and Young People should
achieve a total of at least 60 minutes of
at least moderate-intensity physical
activity each day.
• Twice a week this activity should
include activities which improve bone
health.
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Physical exercise
• For general health adults should achieve a
total of at least 30 minutes a day of at least
moderate-intensity physical activity on five or
more days a week.
• Can be broken down into 10 minute chunks.
• A stepwise increase in activity is
recommended, such as walk to work, use the
stairs, etc.
• 60-90 minutes per day is recommended for
weight loss and maintenance.
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Physical exercise
• Advice should be combined with
decreasing sedentary behaviour.
• Older adults should keep moving and
retain their mobility through daily
activity.
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Brief Behavioural Advice
• Plan for action (start date, what action will be
taken)
• Regularly monitor diet and activity levels
• Set goals (specific and manageable)
• Use stimulus control (avoid tempting
situations)
• Reward achievements
• Seek support from friends and family
• Use self-help materials on cognitive
behavioural treatment
©LTPHN 2008
Management of Overweight and
Obesity
First approach should be non
pharmacological
• Dietary advice, physical activity,
psychological therapies.
If at increased risk and other attempts
have not been successful, consider
• Pharmacology
• Surgery
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Pharmacological Intervention
• Pharmacotherapy may be helpful for eligible
high-risk patients. Medication should be used
only in the context of a treatment program
that includes the elements described
previously—diet, physical activity changes,
and behavior therapy.
• NICE Guidance on obesity in adults and
children
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Pharmacological Interventions
• Orlistat: inhibits the action of pancreatic
lipase enzymes in the gastrointestinal system
and needs to be used in conjunction with low
fat eating plan.
• Sibutramine: is a satiety enhancer which
works on the central nervous system by
altering the chemical messages that control
how a person feels and thinks about food.
Needs to be used in conjunction with a
healthy eating plan.
©LTPHN 2008
Maintenance
• Individuals who have successfully lost
weight are prone to relapse.
• Continued support should be available.
• Limited evidence on the positive effects
of self help peer groups with therapist
led booster sessions.
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Further resources
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Department of Health
NICE guidance on Obesity
National obesity observatory for England
Foresight Report 2007
Tackling Obesities: Future Choices - Key Messages
Nuffield Council on Bioethics Report 2007
Obesity White Paper DH 2008
National Child Measurement Programme 2006/07 Results
FPH Obesity Toolkit - Lightening the load, tackling overweight and obesity
The information Centre for Health & Social Care
Statistics on Obesity, Physical Activity and Diet, England 2008
The NHS Information Centre
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