Obesity and health
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Obesity and Health. Trends in obesity Why people become obese Are we succeeding in managing obesity? Other illnesses associated with obesity Good diet for a healthy life. men. 25. women. 20. 15. 10. 5. 0. 1991. 1995. 1998. 2002. Prevalence of Obesity (England). % population.

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Obesity and health

Obesity and Health


Obesity and health

  • Trends in obesity

  • Why people become obese

  • Are we succeeding in managing obesity?

  • Other illnesses associated with obesity

  • Good diet for a healthy life


Prevalence of obesity england

men

25

women

20

15

10

5

0

1991

1995

1998

2002

Prevalence of Obesity (England)

% population

DoH (2002) Health Survey for England 2002 DH:England


Looking at the trends

Nearly 1 in 4 obese

% overweight BMI >25

70% men

63% women

16% children obese

trebled in 10 years

projected to 2020:

1 in 3 adults obese

1 in 2 children obese

Looking at the trends


Effects on the nation

18 million sick days a year

30,000 premature deaths a year

40,000 lost years of working life

shorten life by 9 years

£ 1/2 billion a year in treatment costs to NHS (5% total NHS budget)

£ 2 billion a year on wider economy

Massive social burden

...‘the last remaining socially acceptable form of prejudice’

Psychological problems

Effects on the nation


What happens if you are obese

What happens if you are Obese?

  • Die earlier

  • More likely to get Diabetes

  • More likely to have Coronary Heart disease

  • More likely to have increased blood pressure


Obesity and health

Centiles of weight gain in adults

Centiles of weight gain in adults

Angina

Angina

BMI (kg/m

)

2

2

BMI (kg/m

)

Diabetes

Diabetes

40

40

Dyslipidaemia

Dyslipidaemia

Tiredness

Tiredness

Hypertension

Hypertension

Breathlessness

Breathlessness

10% Centile

10% Centile

Arthritis

Arthritis

35

35

Back pain

Back pain

Hirsutism

Hirsutism

20%

20%

30

30

50%

50%

25

25

20%

Healthy

Healthy

20

20

normal

normal

Age (years)

Age (years)

20

40

60

20

40

60


Causes of obesity

Causes of Obesity

No single reason – combination of many things:

  • Social & environmental problem, not a medical one

  • Reduction in physical activity/sedentary lifestyle

  • Changes in eating patterns

  • Other e.g. Psychological, metabolic, genetic etc.

  • Susceptible groups e.g. Social class, ethnic minorities, family overweight, women with children


Are we succeeding in managing obesity

Are we succeeding in managing obesity?

Most obese patients will not stay in treatment; of those that do most will not lose weight; and of those who do lose weight …

…most will regain it.


Benefits from 10 weight loss

Benefits from 10% Weight Loss

  • Mortality>20% fall in total mortality

    >30% fall in DM related deaths

    >40% fall in obesity related deaths

  • Blood pressurefall of 10 mmHg systolic

    fall of 20 mmHg diastolic

  • Diabetesfall of 50% in fasting glucose

    50% less likely to develop

  • Lipidsfall of 10% total cholesterol

    fall of 15% LDL

    fall of 30% triglycerides

    increase of 8% HDL


Effective treatment of obesity

Effective Treatment of Obesity

DIET & WEIGHT LOSS : A review of 86 RCT

  • An average weight loss of 8% can be obtained over 3 -12 months.

  • VLCD produce greater initial weight losses, but over the long term

    (>1 year) weight loss is not different from LCD.

    PHYSICAL ACTIVITY ON WEIGHT LOSS: A review of 23 RCT

  • Physical activity results in moderate weight loss, independently increases cardiorespiratory fitness and decreases CVD risk.

  • Physical activity is an important predictor of weight maintenance.


Chd risk in people who are obese

CHD risk in people who are obese?

  • Main cause of excess mortality among obese people is CHD (National Audit Office, 2001; BNF 1999)

     UK obesity epidemic is threatening to reverse the current decline in deaths from CHD. (BHF, 2004)


Diabetes

Diabetes

  • 80% of people with Type II diabetes are overweight.

  • Diet is a key factor in the management of diabetes.


Increased physical activity enhances weight maintenance

Increased physical activity enhances weight maintenance

0

2

Non-exercise

4

6

Weight change from baseline (kg)

8

10

Exercise

12

14

8

18

4

8

Treatment (weeks) Follow up (months)

Pavlou et al, Am J Clin Nutr 1989; 49:1110–1114


Chd risk in people with diabetes

CHD risk in people with diabetes

Increased risk 2-5 fold - Why?

  LDL cholesterol/  HDL cholesterol

 Hypertension

 Hyperglycaemia

 Smoking

(Ref’s: DOH, 2000; Turner, 1998; Lehto 1996, Kussisto,1994; Morgan, 2000)


Eat right for a healthy heart

Eat right for a healthy heart


How to reduce blood pressure

How to reduce Blood Pressure

 Reduce sodium - salt

 Natural potassium i.e. fruit and vegetables & unprocessed foods

 Reduced weight

 Adequate calcium intake


How to reduce lipids

How to reduce lipids

  • Replacement of saturated fats with unsaturated

  • Ideally mono-unsaturated olive/rapeseed oil

  • Soluble fibre e.g. oats, fruit & veg

  • Soy protein (47g/d!)


Stage of behaviour change

Stage of Behaviour Change

Stable “safer” lifestyle

Making Changes

Maintaining Changes

Preparing to Change

Thinking about change

Relapsing

Interested in changing

“risky” lifestyle


What s happening in birmingham

Counterweight

practice nurse training

Dietitians

groups

individual

CBT

Exercise on Prescription

Foodnet project

CFW

Obesity strategy-pan Birmingham

Linking with Public Health in each PCT

Walk 2000

What’s happening in Birmingham?


Key contacts resources

British Dietetic Association www.bdaweightwise.com

National Obesity Forum (NOF) www.nationalobesityforum.co.uk

Association for the Study of Obesity (ASO) www.aso.org.uk

Counterweight Programme www.counterweight.org

Paula Noble Birmingham & Solihull area 07971 221663

Managing obesity in healthcare www.talkinglife.co.uk

Dympna Pearson

Food & Health Guidelines (Local intranet: services & localities)

Key contacts/resources


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