1. PRACTICAL METHODS FOR THE MANAGEMENT & PREVENTION OF OBESITY By Sandra Ayisi Addo, M.Sc NUTRILINE (Weight Loss & Nutrition Centre) MWIA African & Near East Regional Conference July 8-10, 2015

2. Obesity

3. Obesity signage in Accra reads:

4. Content Clinical management: Assessment & Evaluation of the obese Treatment methods for the obese Prevention methods for obesity A Nutriline weight loss success story

5. Assessment of the obese individual

6. An indirect indicator of body fatness Establishes degree of obesity and disease risk Possible limitations for the muscular, elderly Body Mass Index (BMI) assessment BMI = weight (kg)/height(m) 2 BMIClassification < 18.5Underweight 18.5 – 24.9 Healthy weight 25 – 29.9 Overweight >30 Obese height(m) Weigth (kg) What is your BMI?

7. Waist circumference: independent risk predictor CVD risk factors: absolute risk Comorbidities: absolute risk Patient’s readiness: improves success Other assessments

8. Tools for assessment

9. Medical History Nutrition History 24 Hour Recall

10. Evaluation of status

11. Evaluation Overweight with comorbidities- treatment Obese with or without comorbidities- treatment Mildly overweight if motivated- treatment

12. Evaluation High waist circumference with overweight or obesity- treatment Normal weight/mild overweight (not motivated)- Prevention of weight regain and healthy lifestyle counselling

13. Treatment methods - Lifestyle approach (Diet, PA, BCT) - Pharmacotherapy - Surgery

14. Weight change Energy intake (food) Energy expenditure (metabolism, activity) Weight change = Intake – Expenditure (the science is simple, the doing it isn’t !)

15. Lifestyle approach: Diet Structured personalized meal plan Portion control Oil control Diet quality Satiety issues Alcohol water intake

16. Lifestyle approach: Physical activity Less weight loss Prevents weight regain Improves overall fitness

17. Lifestyle approach: Behaviour change therapy Skills for overcoming barriers  self-monitoring  stimulus control  problem solving  rewards

18. Patient centred partnership Agree on desired weight goal/rate of loss Agree on behaviour change goals Exercise 30 mins/3x per week Do not eat while watching tv if it promotes over eating Meet with that friend at a non-eating place if association with that friend promotes over eating Weekly review visits by patient

19. Maintenance program 80% of those who lose weight are likely to regain slowly Involves continued contact with Nutrition professional (short & long term) Successful if regain is less than 3kg in 2 years

20. Pharmacotherapy- 2 nd tier of treatment Recommended if low response with Diet/PA/BCT An adjunct to Diet, PA, BCT Not for cosmetic weight loss

21. Surgery – 3 rd tier of treatment Recommended if all methods fail BMI ≥ 40 or ≥ 35 with comorbidities Complications with 1-4% mortality rate Two types: Limits gastric volume (banded gastroplasty) Limits gastric volume plus alteration in digestion (roux-en-Y gastric bypass )

22. Prevention of obesity

23. Public health approach to prevention National level Institutional level Family level

24. Family Level A family based approach for long term effectiveness

25. Role of mother and the family Mother nurtures foetus & feeds her household The family is the primary source of influence and social learning that shapes eating habits and PA of children Family interventions affect the society, nation and world

26. An obese person increases risk of obesity of those close to him/her

27. Family based programs Maternal factors: Gestational weight gain/smoking habits Sound breastfeeding & weaning practices Parental involvement: Reduce screen time Dining dynamics with parental modeling Improve sleep Food environment Feeding control

28. Promotion of marriage & economic empowerment Working mothers to uphold their role as carers of the home Family based programs

29. At Nutriline NOW: Obesity treatment Obesity prevention: Our clients apply principles at home Prevention of excessive gestational weight gain FUTURE: Comprehensive family based program

30. Thank you