Obesity and Weight Management: Epidemiology, Risks, and Intervention Strategies

Learning Outcomes

Understand the degree of the problem of obesity in the western world Understand the risks of obesity and the benefits of weight loss and achieving and maintenance of an appropriate weight target

• Use appropriate techniques to measure and categorise a person's standard/level of obesity

Understand the UK weight management structure and NICE approach

Weight Management Consultation

Undertaking a weight management consultation Tackling the obesity problem in the future

Obesity and Weight Management

Directed Private Study

1. Patient.info article that is easy to read and covers every aspect of including drug treatments, the stepwise approach to management, risks, medicines that aggravate weight gain - taking an assessment of a patient, behavioural interventions and more ... MUST READ
2. NHS choices article called Britain: the fat man of Europe - covers epidemiology, health consequences and what the UK government are doing about it

Influence of Race, Ethnicity, and Culture on Childhood Obesity: Implications for Prevention and Treatment

CPE- Essential Service Tier 4 (PH) opportunistic healthy lifestyle advice, Rx linked intervention- HT/ T2DM; Campaign based service- PQS.

Self Directed Learning

1. http://patient.info/doctor /obesity-in-adults
2. https://www.nice.org.uk/ guidance/cg189
3. https://www.nutrition.org .uk/healthy-sustainable- diets/

Check out Pre- WorkContent

Epidemiology

Epidemiology - Study/ analysis of the distribution patterns of health and a disease of a define population. -I- understand the problem of Obesity and the real situation the world is in.

Part of NHS Long Term plan to provide a targeted support (T2DM/ HT). Has significant impact on improving health, reducing inequalities and reduce cost.

Double funded NHS Diabetes Prevention Prog using Digital Weight Management to widen patient choice and target inequality.

• Epidemiology and cost
• Causes
• Health consequences

Categorising bodyweight and calculating BMI

• Current structure of management of obesity in the UK and understand NICE guidance

The WM consultation

• Recommending change

'Obesity is not a lifestyle choice caused by individual greed, but a disease caused by health inequalities, genetic influences and social factors.' Professor Andrew Goddard, RCP presidentEPIDEMIOLOGY

Cost of Obesity

Most adults in the UK are overweight or obese Men are fatter than women Britain is 'the fat man of Europe' Bankrupt the NHS Health and wellbeing Lifestyle @ Unfair fight

Identifying risk factors for disease and targets for preventive healthcare- strategic plan 61.7% are overweight or obese 67% of men and 57% of women are overweight or obese Epidemiology- trend is increase in obesity for both men & women. UK being highest prevalence in Europe.

COST £5bn a year NHS spend on obesity related diseases like stroke and diabetes (10% of NHS budget spent on T2DM) Annual cost to government around £6.5M, increase to £50B by 2050. 5x more likely to have a stroke or a heart attack Complications such a blindness and amputation Government can afford to spend £14m on anti-obesity marketing and programmes vs food industry that spends more than £1bn a year on marketing

Causes of Obesity

Simplistic model is that obesity is caused by a greater energy intake than energy expenditure; however weight is more complex than energy input and output and the causes are multifactorial- variety of elements.

Biology Economic Food intake Physical Activity Environmental

Biology and Genetics

Biology- there are number genes (possibly several hundred) that affect one's susceptibility to become overweight. Obesity caused by these inherited genetic factors control Adipose Tissue metabolism. Free Fatty Acids & insulin play a part. Genes are thought to contribute to 25-40% of the variation in adiposity between people. Only in rare exceptions could a single gene mutation result in severe morbid obesity. KRS2 is one gene that has recently been identified as being implicated in obesity and metabolic rate. DNA sequencing in over 2,000 obese individuals identified multiple mutations of the KRS2 gene, and mutation carriers exhibited severe insulin resistance and a reduced metabolic rate. It may be that modulation of KSR2- mediated effects may have the potential to have therapeutic implications for obesity

Food Intake Factors

Food intake: Total energy intake from food and drink is on a downward trend from 2009; however, intake is still 5% higher than the estimated average requirement. - larger portion sizes, perception - its not all 'adults eating fried chicken and chips' but actually a government study shows that 75% of children aged 4-18 months were getting more calories than they needed from formula and solid food. 70%-90% of excess weight is put on before primary school. - HUNGER IS IN THE MIND - brain tells you to stop not your stomach - study at Birmingham university - 2 lunches with a group of amnesiacs and a group of people with no memory problems - Packaging, largely affordable fast food/sugary drinks/food, snacking culture

Environmental Factors

Obesogenic environment- which is "the sum of influences that the surrounding opportunities or conditions increasing obesity in individuals and populations" Obesogenic environments are the collective/group physical, economic, policy, social and cultural factors that promote obesity. For example, they may have a high concentration of fast food outlets and encourage driving over walking. Recommend change School food & exercise programmes Informative campaigns - 'no sweet checkouts' Public health strategies - town planning - convenience store planning

Physical Activity and Economy

Physical Activity: clear association between 30mins a day and BMI. Fewer manual jobs, improvements in transport, increasing car ownership and the introduction of labour saving technologies. Economy Economic, food companies pay a premium to have their merchandise on end displays that count for 30% of supermarket sales - perhaps we're not in as much control of our shopping as we'd like. Greater reliance on processed foods and eating out.

Risks of Obesity in Minority Ethnic Groups

KEY POINTS RELEVANT TO MINORITY ETHNIC GROUPS

Disease Risks

DISEASE CARDIOVASCULAR RISK Highest prevalence in men of Irish ethnicity Lowest prevalence in men from Black African ethnic group and women from Bangladeshi ethnic group Higher risk at a lower BMI in many Asian groups compared to White population CORONARY HEART DISEASE Highest prevalence in men from Indian and Pakistani groups Lowest prevalence in men from Black African and Chinese groups Mortality rates high for those dying in England and Wales but born in South Asia HYPERTENSION Prevalence three to four times higher in Black African population than in White population Adolescents from Indian ethnic group at greater risk than White adolescents at lower BMI South Asian and Chinese populations at elevated risk compared to European populations even if BMI is low STROKE Chinese and Black populations at increased risk Highest prevalence in men of Black Caribbean ethnicity Highest prevalence in women from Bangladeshi and Pakistani groups Mortality rates lower for Black population than the general population

Risk of T2DM is 6X higher in Ethically diverse groups Indian/Asian ethnic groups - at a higher risk in almost all categories Black African - lowest CV and CHD but high in all other categories Chinese - low CHD but high in all other categories White/European populations - lower than other ethnic groups in general WHY? - Diet - Genetic predisposition

METABOLIC SYNDROME More prevalent in South Asian and Black African populations TYPE II DIABETES Men from Bangladeshi population almost four times as likely as the general population Men from Pakistani and Indian populations almost three times as likely as the general population

Health Consequences of Obesity

Cancers and Cardiovascular Disorders

Breast Colon Endometrial Ovarian Prostate Rectal Infertility Kidney disease Complications during pregnancy and birth Cancers Heart failure Hypertension Ischaemic heart disease Ischaemic stroke

Miscellaneous Disorders

Miscellaneous disorders Cardiovascular disorders Dementia Depression Intracranial hypertension Neurological/ psychosocial Obesity related health problems

Respiratory and Musculoskeletal Disorders

Asthma Chronic obstrucitve pulmonary disease (COPD) Obstructive sleep apnea Respiratory disorders Obesity is shortening our lives: Obesity cuts life expectancy by 2-4 years Morbid obesity cuts life expectancy by a decade! Gout Osteoarthitis Lower back pain

Gastrointestinal Disorders

Gallstones Gastro-oesophageal reflux disease Pancreatitis Liver disease Type II diabetes Gastrointestinal disorders Musculoskeletal

Benefit of Weight Loss

Benefit of weight loss Risk of obesity Motivation of losing weight

Relative Increase Risk of Diseases in Obesity

Benefit of weight loss Risk of obesity Relative increase risk of diseases in obesity

Improved Health Outcomes

Benefit of weight loss · Improved lipid profiles. . Reduced disability from osteoarthritis. . Lower all-cause mortality as well as specifically lower diabetes-related mortality and cancer- related mortality. · Reduced risk of diabetes. · Improved diabetic control. · Reduced blood pressure. · Improved lung function in people with asthma. Risk of obesity

Categorise Bodyweight

Metric System and BMI Classification

Metric System: • 5 Weight (in kilograms) BMI = Height 2 (in meters) . Determines the degree of overweight/obesity in adults and associated health risk · PROBLEM: not applicable to all

The National Institute for Health and Care Excellence (NICE) recommends the use of body mass index (BMI) to assess overweight and obese individuals. WHO international BMI classification - a person is considered obese when their BMI reaches or exceeds 30kg/m2

Problems with Using BMI

PROBLEM WITH USING BMI muscle: fat - A person who is very muscular will have a great weight in muscles and bone to support the muscles and so may have a high BMI without an excess of fat. Makes no mention of body fat - In BAME groups, risk factors are of concern at a lower BMI. - Risk of type 2 diabetes is <6X higher. - In the elderly, it may underestimate body fat in older persons and others who have lost muscle, low mortality is in the group with a BMI of 25-30 rather than 20-25 (higher morbidity) due to respiratory.