1. Obesity Clinic. 11/10/04

2. Clinic comprises of: Consultant Consultant Dietician Dietician And scales that weight to 300kg (normal G.P scales go to 150kg) And scales that weight to 300kg (normal G.P scales go to 150kg) No psychologist attached at present 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 BMI >30……usually >35 Evidence of motivation Evidence of motivation Evidence of previous attempts to loose weight Evidence of previous attempts to loose weight Having seen a dietician 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 taken on for 2 years initially, and only kept longer if losing weight. Patients seen 3 monthly in clinic Patients seen 3 monthly in clinic Dietician may see more frequently, especially in beginning Dietician may see more frequently, especially in beginning Initial visit is an assessment by consultant and then dietician. Initial visit is an assessment by consultant and then dietician.

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

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

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

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

9. The Importance of Breakfast! Shown by 2 recent U.S Studies: 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 Diet Modification for 3 months Exercise Exercise Review after 3 months: 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 Sees each new patient after consultant assessment Offered some support Offered some support In depth food sheet of typical day In depth food sheet of typical day Plan agreed with patient of how to modify diet. 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. 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! 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! Anyone interested can arrange to go along….especially if thinking of setting up a GPwSI service!