1. Anna Cowell James O’Connell Aintree Weight Management Team
Rethinking Obesity
Anna Cowell
James O’Connell
Aintree Weight Management Team

2. Aims & Objectives To Provide an update on current obesity statistics.
To consider reasons for obesity epidemic.
To consider what works and what doesn’t at primary care level.
To provide an update on Bariatric surgery as a treatment option for obesity.

3. Obesity statistics (2015/16)
58% of women and 68% of men were overweight or obese.
Obesity prevalence increased from 15% in to 27% in 2015.
Over 1 in 5 children in Reception, and over 1 in 3 children in Year 6 were measured as obese or overweight.
525,000 admissions in NHS hospitals where obesity was recorded as a factor.
Obesity costs the NHS £6,000,000,000 per year.

4. How Do We Treat Obesity?

5. Weight Stigma
Children with obesity experience a 63% higher chance of being bullied.
54% of adults stigmatised by colleagues.
69% of adults experiences of stigmatisation from health care professionals.
All party parliamentary group report May 2018
88% of people with obesity have been stigmatised, criticised or abused as a result of their obesity.
94% believe that there is not enough understanding about the causes of obesity amongst the public, politicians and other stakeholders.
More than one third of people with obesity have not accessed any lifestyle or prevention services.
42% of people with obesity did not feel comfortable talking to their GP about their obesity.

6. Current Approach Obesity
Eat Less Move More

8. Student Population Body image, new relationships?
First time away from home
New city
Isolated
Stress – assessments exams, Job vs study balance

9. The 5A’s
ASK
ASSESS
ADVISE
AGREE
ASSIST

10. Resources

11. Summary Challenge weight stigma
Try to be non judgemental when dealing with weight issues
Eat less move more advice doesn’t work
Weight is a complex issue
Use compassion and empathy
Set goals away from weight
Know your local services
Refer to specialist services when appropriate
‘if you want things to change, you first have to change YOU’

12. Bariatric surgery

13. Bariatric Surgery Criteria
Surgery will only be considered as a treatment option for people with morbid obesity providing all of the following criteria are fulfilled:
BMI of 40kg/m² or more, or between 35 kg/m² and 40kg/m2 in the presence of other significant diseases.
The individual has attended a local specialist obesity service (non surgical Tier 3 / 4) for approx. 12 months.
The service will be led by a professional with a specialist interest in obesity and include a physician, specialist dietician, nurse, psychologist and physical exercise therapist, all of whom must also have a specialist interest in obesity.
There must be a formalised MDT led processes for the screening of co-morbidities and the detection of other significant diseases.
For patients with BMI > 50 duration may be less time with Tier 3.

14. NHS Surgical Options

15. Roux-en-Y Gastric Bypass
Multifunctional mechanism:
Restriction
Malabsorption
Gut hormones - decreased hunger
and increased satiety
Dumping syndrome

16. Sleeve Gastrectomy Growing in popularity over last 5 years
Originally 1st of 2 stage plan
2nd stage usually RYGB
75-80% stomach removed
Restriction and hormonal changes

17. 2 stage surgery …
12-24
months

18. Excess Weight Loss 1 year data Excess Weight Loss example:
Operation Weight: 170kg
Operation BMI: 52
BMI 25 Weight: 81kg
Excess Weight: 89kg
If achieved 70% EWL weight would be 108kg, with a BMI of 33
RCT
Observational
Gastric Band
33%
34%
Sleeve
70%
51%
Gastric Bypass
72%
63%
Limited long term data – observational studies 57% band and 64% with a gastric bypass at 5 years.
The Effectiveness and Risks of Bariatric Surgery
An Updated Systematic Review and Meta-analysis, , JAMA

19. Review of the key results from the Swedish Obese Subjects (SOS) trial - a prospective controlled intervention study of bariatric surgery. Journal Intern Med

20. Benefits of surgery Diabetes Remission
Obstructive sleep apnoea - recommended retest after months
Hypertension – gradual dose reduction
Cholesterol – dose reduction / discontinued
Depression – weight related may improve, established clinical depression may not.
May improve fertility
Partial = HbA1c <48 1 year duration with no medication
Complete = HbA1c <42 1 year duration with no medication
Prolonged = as complete but for 5 years.

21. Common issues after surgery
Hair thinning
General dizziness
Ulcers – risk increased further if smoking
Gallstones
Body dysmorphia
Excess skin
Vitamin and mineral deficiencies

22. References

23. Any Questions ?