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1 Clinical Weight Management Guidelines of New Zealand Communicating the Key Messages to Frontline Healthcare Workers Weight Management for Adults, Children.

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Presentation on theme: "1 Clinical Weight Management Guidelines of New Zealand Communicating the Key Messages to Frontline Healthcare Workers Weight Management for Adults, Children."— Presentation transcript:

1 1 Clinical Weight Management Guidelines of New Zealand Communicating the Key Messages to Frontline Healthcare Workers Weight Management for Adults, Children and Young People o ple Sharlaine Chee-Keil Rebecca Ruwhiu-Collins Nigel Chee Acknowledgement: Dr Hayden McRobbie MB ChB (Otago) PhD (London) Inspiring Limited Faculty of Health and Environmental Sciences, Auckland University of Technology Wolfson Institute of Preventive Medicine, Queen Mary University of London

2 2 Implementation of the Clinical Weight Management Guidelines of New Zealand Training outcomes To communicate the key messages of the Guidelines for weight management (national consistency) To apply a brief intervention process to give advice based on current evidence Ability to identify the treatment options available based on the evidence and when they are appropriate © Inspiring Limited All rights reserved.

3 3 Ministry of Health The aim of the Guidelines is to provide evidence-based guidance for weight management. The Guidelines can be used in primary care and community-based initiatives Ministry of Health, Clinical Trials Research Unit Clinical Guidelines for Weight Management in New Zealand Adults. Wellington: Ministry of Health Ministry of Health, Clinical Trials Research Unit Clinical Guidelines for Weight Management in New Zealand Children and Young People. Wellington: Ministry of Health

4 4 Our weight problem

5 5 A significant number of New Zealanders are overweight or obese What percentage of New Zealand adults are obese?

6 6 Our weight problem 25% of all adults in New Zealand are classified as obese, and many more are overweight 43% of Maori adults in New Zealand are obese 65% of Pacific Island adults in New Zealand are obese South Asian population groups in New Zealand are also more likely to be overweight or obese. © Inspiring Limited All rights reserved.

7 7 Our weight problem What percentage of children in New Zealand are obese? 8% of children in New Zealand are obese

8 8 What does this mean for New Zealand? There are significant health risks associated with being overweight or obese such as: –increased risk of CVD –Type 2 diabetes –some cancers –asthma –sleep apnoea –impaired fertility –musculoskeletal problems Other consequences include a reduced quality of life, a reduced capacity for healthy social interaction and the feeling of isolation due to social stigma Most recent health impact estimates found high BMI accounted for approximately 3200 deaths (1997).

9 9 Benefits of effective weight management

10 10 Why we need to act now Benefits of effective weight management for children and adults Activity

11 11 Why we need to act now What are the benefits of effective weight management for children and adults? Reduced risk and delay of the onset of Type 2 diabetes Adults A reduction in blood pressure, blood glucose and LDL cholesterol Reduction in chances of passing weight problems onto children and family Reduced risk of early mortality Children Reduced risk of obesity- related illness in adulthood Greater liveliness and healthier lifestyle from a young age Stronger development of social skills from a young age Breaking the cycle of poor weight management in New Zealanders

12 12 What does the evidence tell us The Four-step process

13 13 The Guidelines Algorithms Note: Printable Algorithm’s in QRC in the FAB E-Learning Tool

14 14

15 15 STEP 1 Engage and raise awareness

16 16 Checkpoint: How to approach weight management Which of the following patients should you be engaging in a discussion about weight and raising awareness with? Choose the best answer. A.Maori, Pacific, and South Asian patients (consumers) B.Those patients (consumers) that come in wanting to address their weight. C.Those patients (consumers) who are visibly overweight. D.All patients (consumers).

17 17 Step 1: Engage and raise awareness Starting the conversation Step 1 is to engage and raise awareness. For many healthcare workers starting the conversation about weight can be the hardest step. Activity What are some examples of how you would approach starting the conversation? Adults Children

18 18 Step 1: Engage and raise awareness Measurement Body mass index (BMI) provides a good indirect measure of the fat tissue (or adiposity) in an individual. Use BMI to classify overweight and obesity as part of routine clinical practice Waist circumference provides additional information, especially if excess intra-abdominal fat.

19 19 Body Mass Index BMI Categories Normal weight: 18.5 – 24.9 kg/m2 Overweight: 25 – 29.9 kg/m2 Obese: More that 30 kg/m2 BMI = Weight (kg) __________ Height (m2) Note: BMI Calculator in the FAB E-Learning Tool

20 20 Step 1: Engage and raise awareness BMI Measurement BMI is an indicator of risk. It does not: distinguish between fat and lean mass account for ethnic differences (people with similar BMIs of different ethnicities may have different levels of fat tissues) measure actual body fat or provide information about distribution of body fat account for people with smaller stature and with a BMI < 25, but with a large waist (indicating abdominal fatness)

21 21 Step 1: Engage and raise awareness Waist Measurement A waist circumference of more than 94cm in men and 80 cm in women may indicate increased health risks due to weight Measure waist circumference at the mid point between the lowest rib and iliac crest

22 22 Step 1: Engage and raise awareness Other Measurements Examples could include recording clothing size Measurements can act as motivators once a person starts losing weight.

23 23 STEP 2 Identify need and context for action

24 24 Step 2: Identify need and context for action Identify the need and motivation for action Step 2 is to motivate clients to start a change in their behavior Find out about their lifestyle (or affirm a decision they have already made to make a change) Give brief advice, encouragement and allow the person to choose how to act.

25 25 Step 2: Identify need and context for action Personalising your advice Identify key motivators Give some brief personal advice that aligns with what is important to them People are motivated to make a change when they: –understand the situation they are in –can see the benefit in changing –feel as if change is achievable

26 26 Personalising advice Frontline Healthcare Workers Clinic Setting (GP) Clinic Setting (nurse) Green prescription Fitness consultant Dietitian Community health worker Physiotherapist

27 27 STEP 3 Determine options for action

28 28 Step 3: Determine options for action What is available Once you have gathered facts and given brief advice, determining an option for action differs from case to case No option is a quick fix. All require long-term commitment, and an understanding that it is healthiest to lose weight slowly over time No matter what, everyone should be given advice about FAB

29 29 Step 3: Determine options for action What is available The FAB approach is the most effective non surgical approach to healthy weight management. It involves three lifestyle interventions in combination: 1 Changes to Food and diet 2 Increasing physical Activity 3 Using Behavioural strategies to support weight loss and maintenance.

30 30 Step 3: Determine options for action What treatment options are available Pharmacotherapy Weight loss medicines (anti-obesity drugs) used in combination with FAB can lead to increased long-term weight loss Only drug the Guideline recommends is Orlistat (Xenical). Gastrointestinal side effects. Reassess at 3 months if not lost at least 5% of inial body weight They are an option when other methods of weight loss have failed, and can be used in clients with a BMI of 30 or more.

31 31 Step 3: Determine options for action Bariatric Surgery Bariatric surgery is not an alternative to a better lifestyle, but can be considered for people with a BMI greater than 40 Comorbidities or for those who have other medical problems, for example diabetes, anti-obesity medicines and surgery can be considered at a lower BMI of 35 Bariatric surgery is substantially more effective than non-surgical interventions in people with morbid obesity.

32 32 Step 3: Determine options for action FAB Regardless of BMI and history, the FAB trio of lifestyle interventions is appropriate for everyone FAB is the most effective non-surgical and non- drug related method for long-term weight loss For FAB to be successful, all three interventions must be used in combination.

33 33 Step 3: Determine options for action FAB - Food Small changes to eating habits can make a difference Take lifestyle, and preferences into consideration when suggesting dietary changes Modification changes could include: reducing portion size, reduce sugar intake, food groups, read food labels The overall aim is to reduce total energy intake.

34 34 Step 3: Determine options for action FAB - Activity PA with diet results in an average increased weight loss of 1.4kg at 12 months Goal of PA (in the Guidelines) is to increase energy expenditure and resting metabolic rate Increased activity in combination with food (diet) and behavioral support will achieve long-term weight loss Activity should be increased in small achievable increments (snacktivity). Target to aim for is 60 minutes of moderate- intensity activity per day Sense of what this means - the indicators of a brisk walk (e.g. puffing, a slight sweat). If there is the need for support with physical activity exercise on prescription (Green Prescription) is a good option.

35 35 Step 3: Determine options for action FAB - Behaviour Behaviour support involves strategies to reinforce changes. The goal is to alter habits. Encourage small sustainable behavioral changes Behavior change can be the difficult intervention to implement. Can increase weight loss by 2-8 kg at 12 months. Social support from others Self monitoring (food and activity diary) Stimulus control (removing temptation, limit exposure to high risk situations) Contingency management (planned use of non- food rewards) Cognitive restructuring (realistic goals, help change self defeating thoughts that undermine weight-loss efforts.

36 36 Step 3: Determine options for action Checkpoint Dave has a BMI of 29. What options for action do you think would suit Dave best? A.Making small changes to his diet, starting with 5–10 minutes more exercise a day, and removing temptation by packing a lunch each day could be a good start B.Weight loss drugs will be the best intervention for Dave C.Weight loss drugs in conjunction with the three FAB interventions is the best course of action for Dave D.Discussing bariatric surgery with Dave.

37 37 Step 3: Determine options for action Checkpoint Answer Dave has a BMI of 29. What options for action do you think would suit Dave best? A.Making small changes to his diet, starting with 5–10 minutes more exercise a day, and removing temptation by packing a lunch each day could be a good start

38 38 Step 3: Determine options for action Checkpoint Dave mentions that he saw an advert for weight loss drugs and wanted to get some more information about them. What would be the best advice to give Dave? A.I don’t know anything about weight loss drugs and so cannot advise you B.Weight loss drugs are not a quick fix for losing weight and you will still need to make changes to your lifestyle. The first port of call I think is to have a go at making some small changes to your diet, physical activity, and behaviours – you might be surprised on what you can achieve C.Yes I can get a prescription for you, its probably what you need to lose the weight that you’re carrying D.I would not recommend that you use Xenical as its associated with serious side effects. You just need a bit of willpower to succeed in losing weight.

39 39 Step 3: Determine options for action Checkpoint Answer What would be the best advice to give Dave? B. Weight loss drugs are not a quick fix for losing weight and you will still need to make changes to your lifestyle. The first port of call I think is to have a go at making some small changes to your diet, physical activity, and behaviours – you might be surprised on what you can achieve.

40 40 STEP 4 Arrange ongoing support and contact

41 41 Step 4: Arrange ongoing support and contact Who else can help As a healthcare worker, you are one part of the formula Reinforce lifestiyle change through regular brief contact (cinical, family/whanau, community) Refer to other health groups to support change

42 42 Step 4: Arrange ongoing support and contact Who can help Your Client Healthcare workers Whanau Other health groups There are many specialists, organisations and health groups that can help. Refer to existing physical activity programmes (such as Green prescription), church groups or marae also offer support. Use the Finding FAB Services directory on the MoH HIIRC website (July 2011).

43 43 FOUR-STEP PROCESS Children and Young people

44 44 The Facts Children and Young people Requires a different approach. Overweight or obese children and young people are at greater risk of obesity in adulthood. Emphasis on slowing weight gain – as opposed to weight loss. Focus on behaviour change. US Centres for Disease Control and Prevention BMI for age and sex percentile charts to assess BMI BMI in the 85 th percentile or higher can be classified as overweight BMI in the 95 th percentile or higher can be classified as obese

45 45 Step 2: Identify the need and motivation for action Children and Young people Explain to parents/whanau the risks in later life. E.g. diabetes and CVD Modelling behaviours support behaviour change Comprehensive lifestyle approach – whanau FAB

46 46 Step 3: Determine some options for action Children and Young people The FAB trio of interventions are most appropriate It’s vital to allow children to grow into their weight through healthier eating and activity patterns. This includes at least 60 minutes of moderate-intensity to vigorous aerobic activity each day Pharmaceuticals (anti-obesity drugs) are not be used in children and young people. Exception ONLY where BMI > 95 th centile AND FAB has not controlled weight gain. If medication is necessary use Orlistat only (under specialist supervision) Surgery is NOT recommended

47 47 Step 4: Arrange ongoing contact and support Children and Young people Maintain contact and monitor their progress. If appropriate advise parents to have a brief conversation with teachers, other whanau or community members they spend time with about encouraging lifestyle change Recommend FAB options and involve parents in taking responsibility. This will be the key to long-term behavior change.

48 48 Children and Young people Checkpoint How much physical activity should Dave’s children be encouraged to do as part of the FAB intervention? A.At least 30 minutes of moderate physical activity each day B.At least 60 minutes of moderate-intense to vigorous physical activity each day C.Focus on fun, not time, and make sure they are active at least once a week D.At least 60 minutes of moderate to vigorous physical activity a week

49 49 Children and Young people Checkpoint Answer How much physical activity should Dave’s children be encouraged to do as part of the FAB intervention? B.At least 60 minutes of moderate-intense to vigorous physical activity each day.

50 50 Children and Young people Checkpoint What is the best way to implement behavioural change in Dave’s children when it comes to managing their weight? Choose the best answer. A.Be frank with them about their problem, and let them know the consequences of an unhealthy lifestyle B.Talk to them one-on-one so they aren’t embarrassed C.Involve the whole family, and focus on positive changes for the future, rather than weight issues now D.All of the above

51 51 Children and Young people Checkpoint Answer What is the best way to implement behavioural change in Dave’s children and young people when it comes to managing their weight? Choose the best answer. C.Involve the whole family, and focus on positive changes for the future, rather than weight issues now.

52 52 New FAB tools FAB E-Learning tool (printable tools, RNZCGP approaved CME points) Available: - July 2011 Finding FAB Services Directory Weight Management Website https://weightmanagement.hiirc.org.nz

53 53

54 54 New FAB tools Social Media – Twitter, Facebook Keep up to date with new research, events, and tools posted on the Weight Management website on Facebook or Twitter 'Like' the Facebook page or 'Follow' the Twitter feed. Facebook: search for "Weight Management New Zealand” blications/JPHC/March- 2011/JPHCGuidelinesSummaryJullMarch11.pd f

55 55 THANK YOU


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