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)

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

% population

0

5

10

15

20

25

1991 1995 1998 2002

men

women

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

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

What happens if you are Obese?

Die earlierMore likely to get DiabetesMore likely to have Coronary Heart

diseaseMore likely to have increased blood

pressure

Centiles of weight gain in adultsCentiles of weight gain in adults

2020 4040 6060

2020

2525

3030

3535

4040

HealthyHealthynormalnormal

TirednessTirednessBreathlessnessBreathlessnessBack painBack painHirsutismHirsutism

AnginaAnginaDiabetesDiabetesDyslipidaemiaDyslipidaemiaHypertensionHypertensionArthritisArthritis 10% Centile10% Centile

20%20%

50%50%

20%

Age (years)Age (years)

BMI (kg/mBMI (kg/m22))

Causes of ObesityNo 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?

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 LossBenefits from 10% Weight Loss

• MortalityMortality >20% fall in total mortality>20% fall in total mortality>30% fall in DM >30% fall in DM

related deathsrelated deaths>40% fall in obesity related deaths>40% fall in obesity related deaths

• Blood pressureBlood pressure fall of 10 mmHg systolicfall of 10 mmHg systolicfall of 20 mmHg diastolicfall of 20 mmHg diastolic

• DiabetesDiabetes fall of 50% in fasting glucosefall of 50% in fasting glucose 50% less likely to develop50% less likely to develop

• LipidsLipids fall of 10% total cholesterolfall of 10% total cholesterolfall of 15% LDLfall of 15% LDLfall of 30% triglyceridesfall of 30% triglyceridesincrease of 8% HDLincrease of 8% HDL

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?

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

• 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

0

2

4

6

8

10

12

14

Treatment (weeks) Follow up (months)

4 8 8 18

Wei

gh

t ch

ang

e fr

om

bas

elin

e (k

g)

Exercise

Non-exercise

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

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

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

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

Making Changes

Maintaining Changes

RelapsingThinking about change

Preparing to Change

Stable “safer” lifestyle

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

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)