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Obesity and Life expectancy. January 2003 Life Table analysis of Framingham Data Obese at 40 live 6 to 7 years less than normal Overweight at 40 live 3 years less than normal Obese smoker live 14 years less than normal. Obesity Accounts for. 5% of heart attacks and strokes

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obesity and life expectancy
Obesity and Life expectancy
  • January 2003 Life Table analysis of Framingham Data
  • Obese at 40 live 6 to 7 years less than normal
  • Overweight at 40 live 3 years less than normalObese smoker live 14 years less than normal
obesity accounts for
Obesity Accounts for
    • 5% of heart attacks and strokes
    • 10% cases of osteoarthritis
    • 20% cases of hypertenstion
    • 40% of cancers
    • 80% cases of Type 2 diabetes.
  • There is limited data on the cost of obesity but evidence suggests that the direct cost accounts for 5 to 7% of total health care expenditure (WHO,1998).
what is obesity
What is Obesity?
  • Defined by World Health Organisation using body mass index (BMI) (Weight in Kg divided by height in meters squared)
  • 5’4” Normal 65kgs (10 stone 3 lbs) Obese 78kgs (12 stone 2 lbs)
  • 5’10” Normal 78kgs (12 stone 2 lbs) Obese 94kgs (14 stone 10 lbs)
relationship of bmi to excess mortality

Bray GA. Overweight is risking fate. Definition, classification,

prevalence and risks. Ann NY Acad Sci 1987;499:14-28.

Relationship of BMI to Excess Mortality

300

Age at Issue

20-29

250

30-39

200

150

Mortality Ratio

100

High

Moderate

Low

Risk

Risk

Risk

50

0

15

20

25

30

35

40

Body Mass Index (kg/[m2])

current prevalence data in ireland
Current Prevalence data in Ireland
  • Female: 33% Overweight 26% Obese (13% self report)
  • Male: 45% Overweight 24% Obese (16% self report)
  • Children: 20% Overweight or obese(5-12 yo)Slan 2007 Independently Measured
grades of bmi kg m2
Grades of BMI Kg/M2
  • BMI 19-25 -Normal
  • BMI 25-30 -OverweightObesity
  • BMI 30-35 -Grade 1
  • BMI 35-40 -Grade 2 BMI >40 -Grade 3(Morbid) Overweight or obese USA 71%, UK 65%

USA 5% have BMI > 40 Ireland 2% have BMI > 40

grades of bmi kg m21
Grades of BMI Kg/M2
  • BMI 19-25 -Normal
  • BMI 25-30 -OverweightObesity
  • BMI 30-35 -Grade 1
  • BMI 35-40 -Grade 2 BMI >40 -Grade 3(Morbid) Overweight or obese USA 71%, UK 65%

USA 5% have BMI > 40 Ireland 2% have BMI > 40

normal weight finishes at
Normal weight finishes at
  • BMI 25 Male 12st 2lbs 78Kgs

Female 10st 3lbs 65 kgs

bmi ranges
BMI ranges

BMI 1

BMI 2

bmi range 20 to 251
BMI range <20 to 25

BMI 19

Guess 20

BMI 25

Guess 23

slide15

BMI 4

BMI 3

bmi range 40 to 45
BMI range 40 to 45

BMI 44

BMI 40

bmi range 40 to 451
BMI range 40 to 45

BMI 44

Guess 35

BMI 40

Guess 32

slide18

BMI 5

BMI 6

bmi range 50 to 55
BMI range 50 to 55

BMI 51

BMI 52

bmi range 50 to 551
BMI range 50 to 55

BMI 51

Guess 43

BMI 52

Guess 42

slide21

BMI 7

BMI 8

bmi range 70 to 751
BMI range 70 to >75

BMI 72

Guess 50

BMI 76

severe grade 3 obesity
Severe (Grade 3) Obesity
  • BMI 40 --- Male 20st 128kgsFemale 16st 10lbs 108kgs
current prevalence data adult
Current Prevalence data (Adult)
  • Female: 33% Overweight 26% Obese (13% self report)
  • Male: 45% Overweight 24% Obese (16% self report)Slan 2007 Independently Measured
obesity is associated with
Obesity is associated with
  • Diabetes
  • Cancer
  • Sleep Apnoea
  • Osteoarthritis
  • Fatty liver disease
  • Psoriasis
  • Dementia
  • Cardiovascular Disease
  • Death from H1N1 (Swine Flu)
excess weight is a major risk factor for diabetes in us adults 2001 n 195 005
Excess weight is a MAJOR risk factor for diabetes in US adults, 2001 (n=195, 005)

Prevalence of diabetes (%)

30

25.6

20

14.9

10

7.3

4.1

0

Normal

OverweightBMI 25-29.9

ObeseBMI 30-39.9

ObeseBMI 40

Mokdad et al. JAMA 2003; 289: 76-9

obesity also reduces survival in certain cancers
Obesity also reduces survival in certain cancers
  • Colon
  • Breast
  • Endometrium
  • Prostate
  • Ovary
increased risk of dementia
Increased risk of dementia
  • BMI and increased risk of dementia – analysis of prospective cohort study (Whitmer et al. 2005)
    • Increased risk of dimentia in later years for those overweight / obese in mid-life
    • Increased risk for
      • Males
      • Females
obese patient with acute abdomen
Obese patient with Acute abdomen
  • 30% chance of atelecasis/pneumonia
  • 2.8 times more likely than non obese
overweight and obesity following road accidents
Overweight and obesity following Road Accidents
  • Study of 1,615 CrashesCrash factor adjusted odds for dying 2.08 for overweight 3.17 for obese

Injury severity adjusted odds for dying 1.87 for overweight 3.89 for obese

Ryb J.Trauma 2008(64)406-411 CIREN study

role of weight and seatbelts
Role of weight and seatbelts
  • Seatbelts decrease risk of death and intraabdominal injury in obese and non obeseLack of seatbelt increases risk of death 9.7 fold in obese 5.2 fold in non obese

Zarzaur & Marshall J Trauma 2008(64)412-417

a lot of equipment
A lot of equipment
  • Has upper weight limit of ~ 150kgsTrolleysBedsTheatre TablesRadiology – equipment and quality
radiology equipment in ireland
Radiology Equipment in Ireland
  • Audit of 40 hospitals
  • CT, MRI, Fluoroscopy
  • Weight Limit
  • Aperture Diameter
slide47

Bagel

Cheeseburger

20 Years Ago

Today

20 Years Ago

Today

Chips

20 Years Ago

Today

350 calories

333 calories

590 calories

140 calories

210 calories

610 calories

slide52

International Pediatric

Association

FISPGHAN

childhood obesity in ireland
Childhood Obesity in Ireland
  • 30% overweight and 14.7% obese overall
  • 12% obese 7 year olds
  • 20% obese aged 9-10 years

Slan Survey 2007

do obese children become obese adults
Do obese children become obese adults?
  • 30% of adult obesity begins in childhood so many adults were not obese childrenand not all obese children will stay obese
  • 1/3 obese preschoolers = obese adults (26-41%)
  • All ages risk twice as high for obese as non-obese (range 2-6.5 fold risk) Serdula,Preventative Medicine 1993:22;167-177
  • Parental obesity > doubles the risk of adult obesity in both obese and non-obese children < 10 yearsWhittaker NEJM 1997;337(13):869-73
treatment options for obesity
Treatment Options for Obesity
  • Diet & Lifestyle changes
  • Pharmacotherapy
  • Surgery
nothing works without diet lifestyle change
Nothing works without diet/lifestyle change
  • Diet – 500 kcalorie deficit/day healthy eating priciples
  • Activity - No consensus 1 hour daily every day
  • No treatment works without this
who would you rather be
Who would you rather be?
  • Man on Left = Driver
  • Man on Right = Conductor
physical activity at work
Physical Activity at Work
  • Prof. Jerry Morris,
    • Physical Activity Epidemiology
    • Lancet 1953
  • 31,000 London Transport Workers
    • Drivers and Conductors
    • London Double Decker Bus
  • Drivers had higher rates of Coronary Occlusion (heart attacks) and higher early mortality than conductors
results
Results

Morris JN et al., Lancet 1953

cardiorespiratory fitness and incident metabolic syndrome 9007 men and 1491 women acls 1979 2003
Cardiorespiratory Fitness and Incident Metabolic Syndrome, 9007 men and 1491 womenACLS, 1979 - 2003

All p <0.001

Age adjusted rate/ 1000 person years

Cardiorespiratory fitness tertile

LaMonte, M. et al, 2005 Circulation

obesity
Obesity
  • Pandemic in Adults and Children
  • Tracks to adulthood strongly from kids
  • Is preventable
  • Is treatable
malnutrition in hospitals
Malnutrition in Hospitals

“Food is your medicine - hence let your medicine be your food”

Hippocrates, circa 400 BC

malnutrition in hospitals1
Malnutrition in Hospitals
  • Malnutrition risk has been identified in 20% - 60% of hospital admissions to medical, surgical, elderly and orthopaedic wards.
  • Further, hospitalization with surgery or other medical treatments often result in additional weight loss.
  • It has been reported as undiagnosed in up to 70% of cases.
malnutrition in hospitals2
Malnutrition in Hospitals
  • Under-nutrition is associated with
    • Impairment of body systems including muscle weakness, immune system and gut function
    • Delayed wound healing
    • Apathy and depression
    • Reduction of appetite and ability to eat
    • Increased mortality rates
which patients are at risk
Which patients are at risk?
  • Elderly
  • Cancer
  • Trauma/ sepsis
  • Chronic disease states
  • Pre and post operative
  • Obese as well as normal weight
  • Alcohol dependent
malnutrition in hospitals3
Malnutrition in Hospitals
  • There are many cost benefits in treating and preventing under-nutrition including
    • Reduced length of stay as inpatient
    • Reduced costs per stay
    • Reduced mortality
  • Benefits are seen the earlier under-nutrition is recognised and treated
slide72
MUST
  • ‘Malnutrition Universal Screening Tool’
  • Allows health care professionals to easily identify those at risk of malnutrition in a rapid and consistent manner.
  • This best targets appropriate nutrition therapy.
slide73
MUST
  • A screening tool should be used within the hospital to identify patients at risk of malnutrition
  • Within 48 hours of admission
  • Once weekly thereafter
  • Need to act on results of the screening tool
  • Should be included in nursing handover
slide74
MUST
  • Quick and easy to complete
  • Universal- suitable for all patients
  • Facilitates continuity of care
  • Evidence- based
  • Precedes nutritional assessment
  • Ensures appropriate referrals
slide75
MUST

Take a look at the format of the MUST screening tool………..

the 5 steps of must
The 5 steps of ‘MUST’
  • Steps 1-3: Take 3 measurements and score them against the scale provided
      • BMI
      • Weight loss
      • Acute disease effect
  • Step 4: Add scores together to identify overall risk of malnutrition
  • Step 5: Form appropriate care plan in line with local policy
what do you need to measure
Weight:

Only 25% of patients are weighed on admission. (McWhirter & Pennington, 1994)

Very difficult to assess nutritional status without weight

Height:

Measure with stadometer (height measure)

Self reported or Ulna Length

BMI: Weight / Height2

Normal range = 20-25 kg/m2

Below 20 kg/m2 possible malnutrition

Below 18.5 kg/m2 likely malnutrition

NB. A word of warning  Obese patients can still be at risk of malnutrition if they lose weight rapidly i.e. lose lean body mass

What do you need to measure?
step 1
Step 1
  • Weigh the patient
step 11
Step 1
  • Measure the patients height using the stadometer – height measure
step 1 if you can t measure height
Step 1 – if you can’t measure height….

Estimated height from ulna length

step 2 must and weight loss
Step 2 - ‘MUST’ and weight loss
  • Unintentional weight loss over a period of 3-6 months is an indicator of acute or recent-onset malnutrition
  • If previous weight is unavailable, subjective criteria include:
      • Clothes and/or jewellery having become loose
      • History of reduced food intake, reduced appetite, and swallowing problems
      • Over 3–6+ months, underlying disease of psychosocial or physical disability  weight loss
step 3 acute disease effect
STEP 3 Acute disease effect
  • Most likely to apply to patients in hospital
  • Applies to patients who have had or are likely to have no nutritional intake for more than five days
  • ‘MUST’ Score: Add 2 if acute disease effect applies
step 4 overall risk of malnutrition
STEP 4 - Overall risk of malnutrition
  • Total of scores from steps 1, 2 and 3
  • Document score
step 5 nutrition care plan
STEP 5 Nutrition Care Plan
  • Low risk of malnutrition
    • Repeat screening weekly
  • Medium and high risk of malnutrition
    • Nutritional intervention – refer to dietitian
    • Repeat screening weekly
need to
Need to
  • Screen in all healthcare institutions
  • Get the surgeons on board
  • Manage obesity in hopsital – huge missed opportunity
10 key characteristics of good nutritional care in hospitals
10 Key Characteristics of goodnutritional care in hospitals
  • All patients are screened on admission to identify the patients who are malnourished or at of becoming malnourished. All patients are re-screened weekly.
  • All patients have a care plan which identifies their nutritional care needs and how they are to be met.
10 key characteristics of good nutritional care in hospitals1
10 Key Characteristics of goodnutritional care in hospitals
  • The hospital includes specific guidance on food services and nutritional care in its Clinical Paths
  • Patients are involved in the planning and monitoring arrangements for food service provision.
  • The ward implements Protected Mealtimes to provide an environment conducive to patients enjoying and being able to eat their food.
10 key characteristics of good nutritional care in hospitals2
10 Key Characteristics of goodnutritional care in hospitals
  • All staff have the appropriate skills and competencies needed to ensure that patient’s nutritional needs are met.
  • All staff receive regular training on nutritional care and management.
  • Hospital facilities are designed to be flexible and patient centred with the aim of providing and delivering an excellent experience of food service and nutritional care 24 hours a day, every day.
10 key characteristics of good nutritional care in hospitals3
10 Key Characteristics of goodnutritional care in hospitals
  • The hospital has a policy for food service and nutritional care which is patient centred and performance managed in line with home country governance frameworks.
  • Food service and nutritional care is delivered to the patient safely.
  • The hospital supports a multi-disciplinary approach to nutritional care and values the contribution of all staff groups working in partnership with patients and users.