10-minute clinic show notes Weight Management.
Obesity is a medical condition characterized by excessive accumulation of body fat, to the point where it may have adverse effects on health and its incidence is steadily rising in both young and adult. It’s typically measured using the body mass index but this has limitations and may not always be an accurate representation as to a level of obesity.
While genetics and hormonal factors play a role in obesity, lifestyle choices such as diet, physical activity level, and environmental factors also significantly contribute to its development. In recent years, the prevalence of obesity has been on the rise globally, leading to serious health concerns such as an increased risk of heart disease, type 2 diabetes, certain types of cancer, and other health problems. In this podcast we take an overview on the rise of obesity, the management options we have in general practice, and the impact of newer injectable drugs for weight loss that many patients are now requesting.
References:
Overview | Obesity: identification, assessment and management | Guidance | NICE
Global burden of obesity in 2005 and projections to 2030 – PubMed (nih.gov)
Overview | Liraglutide for managing overweight and obesity | Guidance | NICE
1 Recommendations | Semaglutide for managing overweight and obesity | Guidance | NICE
Mounjaro can now be prescribed to people with type 2 diabetes
Resources:
Obesity – Treatment – NHS (www.nhs.uk)
Weight loss and diabetes | Diabetes UK
NHS England » The NHS Digital Weight Management Programme
12 Week Weight Management Programme | NHS inform
Take home points:
- 64% of adults in England are currently overweight or obese (26% obese, 38% overweight). 23% of children aged 10-11 are obese, 20% over the age of 5 are overweight or obese.
- 70% of black adults are obese or overweight, 65% of white British, 37% Chinese
- Obesity is a global and complex health concern that reduces life expectancy and is a significant risk factor in multiple chronic diseases such as T2D, CVD, liver disease, 12 types of cancer (the 2nd biggest cause), respiratory disease and mental health
- Britons spend more on confectionary annually (£3.9bn) than fruit and veg (£2.2bn)
- Use BMI with care – it is not a direct measure of central adiposity (caution if high muscle mass)
- People with a South Asian, Chinese, other Asian, Middle Eastern, Black African or African-Caribbean family background are prone to central adiposity and their cardio-metabolic risk occurs at a lower BMI, so use lower BMI thresholds as a practical measure of overweight and obesity
- Encourage adults with a body mass index (BMI) below 35 kg/m2 to measure their own waist-to-height ratio to assess central adiposity (the accumulation of excess fat in the abdominal area)
- When talking to a person about their waist-to-height ratio, explain that they should try to keep their waist size to half their height (so a waist-to-height ratio of under 0.5)
- Consider referral to tier 3 services if the underlying causes of overweight or obesity need to be assessed, the person has complex disease states or needs that cannot be managed adequately in tier 2 (for example, the additional support needs of people with learning disabilities), conventional treatment has been unsuccessful, drug treatment is being considered for a person with a BMI of more than 50 kg/m2 and if surgery is being considered.
- Bariatric surgery is an effective intervention for people with obesity and type 2 diabetes, with studies showing it can bring about remission in 30-60% of cases, and that this can be maintained for many years
- The main requirement of a dietary approach to weight loss is that total energy intake should be less than energy expenditure.
- Only consider very-low-calorie diets, as part of a multicomponent weight management strategy, for people who are living with obesity and who have a clinically assessed need to rapidly lose weight
- Consider pharmacological treatment only after dietary, exercise and behavioural approaches have been started and evaluated
- The co-prescribing of orlistat with other drugs aimed at weight reduction is not recommended
- Glucagon-like Peptide 1 Receptor agonists such as semaglutide and liraglutide may be considered as weekly injections to assist weight loss as part of a specialist weight management service
- Semaglutide is licensed under the brand names Wegovy, Ozempic and Rybelsus, which are recommended by NICE and available on the NHS for managing blood glucose levels in people with type 2 diabetes. Of these three, only Wegovy is recommended for weight management in people with or without type 2 diabetes.
- Mounjaro, the brand name for tirzepatide, has just received draft approval for helping people living with obesity to lose weight on the NHS.
- There is now a black market in counterfeit weight loss drugs claiming to be GLP-1 agonists