1. Obesity and Health

2. Trends in obesity Why people become obese Are we succeeding in managing obesity? Other illnesses associated with obesity Good diet for a healthy life

3. Prevalence of Obesity (England) DoH (2002) Health Survey for England 2002 DH:England % population 0 5 10 15 20 25 1991199519982002 men women

4. 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

5. 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

6. What happens if you are Obese?  Die earlier  More likely to get Diabetes  More likely to have Coronary Heart disease  More likely to have increased blood pressure

7. Centiles of weight gain in adults 20 40 60 20 25 30 35 40 Healthy normal Tiredness Breathlessness Back pain Hirsutism Angina Diabetes Dyslipidaemia Hypertension Arthritis 10% Centile 20% 50% 20% Age (years) BMI (kg/m 2 2 ) )

8. Causes of Obesity No 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

9. 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.

10. Benefits from 10% Weight Loss Mortality>20% fall in total mortalityMortality>20% fall in total mortality >30% fall in DM related deaths >40% fall in obesity related deaths Blood pressurefall of 10 mmHg systolicBlood pressurefall of 10 mmHg systolic fall of 20 mmHg diastolic Diabetesfall of 50% in fasting glucoseDiabetesfall of 50% in fasting glucose 50% less likely to develop 50% less likely to develop Lipidsfall of 10% total cholesterolLipidsfall of 10% total cholesterol fall of 15% LDL fall of 30% triglycerides increase of 8% HDL

11. 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.

12. 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)

13. Diabetes 80% of people with Type II diabetes are overweight. Diet is a key factor in the management of diabetes.

14. Increased physical activity enhances weight maintenance 0 2 4 6 8 10 12 14 Treatment (weeks) Follow up (months) 4 8 8 18 Weight change from baseline (kg) Exercise Non-exercise Pavlou et al, Am J Clin Nutr 1989; 49:1110–1114

15. 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)

16. Eat right for a healthy heart

18. How to reduce Blood Pressure  Reduce sodium - salt  Natural potassium i.e. fruit and vegetables & unprocessed foods  Reduced weight  Adequate calcium intake

19. 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!)

21. Stage of Behaviour Change Making Changes Maintaining Changes Relapsing Thinking about change Preparing to Change Stable “safer” lifestyle Interested in changing “risky” lifestyle

22. 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

23. 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)