1. Obesity Clinic.

2. Clinic comprises of: Consultant Dietician
And scales that weight to 300kg (normal G.P scales go to 150kg)
No psychologist attached at present
Mr May, upper GI cancer surgeon sees patients considered for surgery when all else has failed, and usually BMI >40

3. Referral Criteria BMI >30……usually >35 Evidence of motivation
Evidence of previous attempts to loose weight
Having seen a dietician
Children are not seen in clinic under 16 years, and there is no dedicated paediatric service

4. Outline.
Patients taken on for 2 years initially, and only kept longer if losing weight.
Patients seen 3 monthly in clinic
Dietician may see more frequently, especially in beginning
Initial visit is an assessment by consultant and then dietician.

5. Typical Questions Asked in History.
Where you overweight as a child?
When did you start to put on weight?
What is your lightest adult weight?
What things have you already tried?
What medications have you tried?
How is your weight affecting your health?
How is your general health?
Sob, snoring, sleep apnoea/daytime sleeping, thyroid, ammenorrhea

6. Typical Questions Asked in History.
Are your family overweight?
Do you eat 3 meals a day?
Any particular food cravings/weaknesses?
What snacks?
What exercise do you do?
WHY DO YOU WANT TO LOOSE WEIGHT?
Have you got a target in mind – and what timescale?

7. Examination. Many have acanthosis nigracans around neck and axilla
Pulse, resting tremor, thyroid
BMI
Waist : Hip ratio

8. Investigations.
Bloods – FBC, U+E, Chol, TFT, LFT, Haematinics, Testosterone, +/- FSH, LH,
+/- ECG

9. The Importance of Breakfast!
Shown by 2 recent U.S Studies:
Calories taken earlier in the day are easier to burn off than those taken later.
People who eat breakfast are less likely to become obese.

10. Management. Diet Modification for 3 months Exercise
Review after 3 months:
If losing weight, continue
If stable consider orlistat (need <30% fat diet to work) or sibutamine
If gaining weight – reassess and re-iterate.

11. Dietician Sees each new patient after consultant assessment
Offered some support
In depth food sheet of typical day
Plan agreed with patient of how to modify diet.
Tailored to each patient fat/calorie/protein reduction accordingly

12. The Future.
The clinic has not been formally assessed, so success rate is unknown at present.
Dr Whitelaw hope to expand the service, bringing in a psychologist and ENT support……funding!
Anyone interested can arrange to go along….especially if thinking of setting up a GPwSI service!