1. Obesity
Eppie Habashi

2. Classification
Obesity is excess body fat and is due to an imbalance between energy intake and expenditure – can be caused by lifestyle, genetics, drugs, medical problems BMI – Overweight – Obesity I – Obesity II Obesity III

3. HUGE Problem 26% of adults in the UK are obese
68% of men and 58% of women are overweight
Associated with many chronic diseases, many of the complications reduced with weightloss
Associated with cancers
Psychological problems

4. Table 1 . Classification of cardiovascular and metabolic disease risk by waist circumference in people who are overweight or in obesity class I.
Cardiovascular and metabolic disease risk relative to normal weight and waist circumference
BMI
Low§
High§
Very high§
Overweight (BMI 25–29.9)
No increased risk
Increased risk
High risk
Obesity I (BMI 30–34.9)
Very high risk
§ For men, waist circumference < 94 cm (37 inches) is low, 94–102 cm (37–40 inches) is high, and > 102 cm (approx 40 inches) is very high.§ For women, waist circumference < 80 cm (31.5 inches) is low, 80–88 cm (31.5–34.5 inches) is high, and > 88 cm (approx 34.5 inches) is very high.
Data from: [NICE, 2006b; SIGN, 2010]

5. Lifestyle Factors Food intake Physical Inactivity
Social and psychological factors
Economic factors

6. Genetics
Genes thought to contribute 25-40% of the difference in adiposity between people
Possibly related to the hypothalamus being insensitive to leptin

7. Medical Conditions
Hypothyroid Cushings PCOS Growth hormone deficiency Hypothalamic damage Genetic conditions eg Prader-Willi

8. Medications Insulin Oral hypoglycaemics Antidepressants
Anticonvulsants
Antipsychotics
Lithium
Steroids
Beta blockers
Pizotifen

9. Management Broach the subject with sensitivity
Explain risks of being overweight
Benefits of moderate weightloss
Enquire into medical problems that contribute to or are complications of weight FH DH SH

10. Investigations Check glucose and lipids
Consider other tests – TFT, LFT etc

11. Assess readiness to lose weight
Concerned about weight?
Believe they can lose it?
How important?
Is it affecting your life?
What would you have to change?
Barriers to lifestyle change? Knowledge, cost, time, taste, disability, self-esteem
If not keen, explore why, discuss benefits of even 10% weightloss

12. Table 1 . The benefits of a 10 kg weight loss in a person with obesity.
 Aspect
Benefit
Mortality
20–25% reduction in total mortality30–40% reduction in deaths related to diabetes40–50% reduction in obesity-related cancer deaths
Blood pressure (in people who are hypertensive)
10 mmHg reduction in both systolic and diastolic values
Diabetes (in people who are newly diagnosed)
30–50% reduction in fasting glucose15% reduction in HbA1c
Lipids
10% reduction in total cholesterol15% reduction of low density lipoprotein cholesterol (LDL-C)30% reduction in triglycerides8% increase in high density lipoprotein cholesterol (HDL-C)
Other benefits
Improved lung function, insulin sensitivity, and ovarian functionReduced back pain, joint pain, breathlessness, and sleep apnoea

13. Dietary Advice DH website – “your weight your health”
Sustainable and balanced diet
5 portions of fruit and veg/day
High fibre
Moderate amount of dairy, low fat
Moderate amount of protein
Low fat, low sugar
Reduce alcohol
Lean ways of cooking

14. Exercise Advice According to individual fitness
At least 5 x 30minutes per week
Build up the intensity
May find group program beneficial
Health benefits, not just weight loss

15. Orlistat Age 18-75 with BMI at least 30 or 28 with co-morbidities
Contraindicated if cholestasis or malabsorption
Adverse effects : GI, ADEK, rare hepatitis, drug interactions
Only continue beyond 3 months if 5% weight loss, no restriction on length of treatment
120mg with meals upto tds
Caution in pregnancy, contraindicated in breast feeding

16. Surgery 1st line if BMI>50
If BMI > 40 and unable to achieve and maintain clinically significant weight loss for at least 6 months Or
If BMI > 35 and has other disease that could be improved by weight loss (and meets above criteria)

17. Summary
Multiple factors
Huge effects
Lifestyle
Orlistat
Surgery