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Obesity

Epidemiology

In the UK, around 23% of people are obese and 44% of men and 34% of women are overweight - meaning that more than half the UK is overweight or obese!

Obesity is one of the biggest health challenges we face. The Government is committed to taking action to reverse the rising tide of obesity. Almost 1 in 4 adults in England are currently obese, and if we carry on as we are by 2050, 9 in 10 adults will be overweight or obese. The cost of overweight and obese individuals to the NHS is estimated to be £4.2 billion and is forecasted to more than double by 2050. The cost to the wider economy is £16 billion, and this is predicted to rise to £50 billion per year by 2050 if left unchecked.

In January 2008 the Government published 'Healthy Weight, Healthy Lives: A Cross-Government Strategy for England'. £372 million has been made available to implement the strategy, which sets out how the Government will enable everyone in society to maintain a healthy weight.

Why is this important - risks associated with weight gain

Increased Health Risk of Premature Death

According to CDC researchers, an estimated 300,000American deaths a year are related to obesity, but see note, below. The risk of premature death rises with increasing weight. Even moderate weight gain (10 to 20 pounds for a person of average height) increases the risk of death, particularly among adults aged 30 to 64 years. Individuals who are obese (BMI greater than 30) have a 50 to 100 percent increased risk of premature death from all causes, compared to individuals with a healthy weight.

Increased Health Risk of Heart Disease

The risk of heart attack, congestive heart failure, sudden cardiac death, angina or chest pain is increased in persons who are overweight or obese. High blood pressure is twice as common in adults who are obese than in those who are at a healthy weight. Obesity is associated with high triglycerides and decreased HDL cholesterol.

Increased Health Risk of Stroke

Atherosclerosis, or narrowing of the arteries, which may lead to the formation of an arterial blood clot, is an important pre-condition of many strokes. Atherosclerosis is accelerated by high blood pressure, smoking, high cholesterol and lack of exercise. Obesity, especially morbid obesity is frequently associated with a high-fat diet, raised blood pressure and lack of exercise. Thus obesity is now considered an important secondary risk factor for strokes.

Increased Health Risk of Type 2 Diabetes

A weight increase of 11-18 pounds raises a person's risk of developing type 2 diabetes to twice that of individuals who have not gained weight. Over 80 percent of people with diabetes are overweight or obese. This may account for the newly invented word, "diabesity"®, which signifies the close association between obesity and diabetes.

Increased Health Risk of Cancers

Obesity is associated with an increased risk for some types of cancer including endometrial (cancer of the lining of the uterus), colon, gall bladder, prostate, kidney, and post-menopausal breast cancer. Women gaining more than 20 pounds from age 18 to midlife double their risk of post-menopausal breast cancer, compared to women whose weight remains stable.

Increased Health Risk of Fatty Liver Disease

The main cause of non alcoholic fatty liver disease is insulin resistance, a metabolic disorder in which cells become insensitive to the effect of insulin. One of the most common risk factors for insulin resistance is obesity, especially central abdominal obesity. Studies indicate a correlation between body mass index (BMI) and the degree of liver damage. The higher the BMI the worse the liver disease.

Obesity is a Risk Factor For Chronic Venous Insufficiency

Although obesity is not a direct cause of chronic venous insufficiency, it is an important risk factor. This is because obesity, especially morbid obesity, leads to raised blood pressure, a sedentary lifestyle and musculoskeletal problems (hampering mobility and use of leg muscles), all of which are contributory factors in the development of chronic venous insufficiency. Obese patients also have an increased health risk of other vascular disorders (eg. lower-limb ischemia), caused by inadequate blood flow to the extremities.

Increased Health Risk of Gallbladder Disease

The risk of gallstones is approximately 3 times greater for obese patients than in non-obese people. Indeed, the risk of sympomatic gallstones appears to correlate with a rise in body mass index (BMI).

Increased Health Risk of Breathing Problems

Obstructive sleep apnea (that is, interrupted breathing during sleeping) is more common in obese persons. Obesity is associated with a higher prevalence of asthma and severe bronchitis, as well as obesity hypoventilation syndrome and respiratory insufficiency.

Obesity and Deep Vein Thrombosis

Risk factors for deep vein thrombosis include prior history of the disease, vascular damage, hypertension and predisposition to blood clotting. Although obesity (BMI 30+) has traditionally been recognised as a risk factor for deep vein thrombosis and pulmonary embolism, experts now consider that the evidence supporting this association is inadequate, as much depends on other factors such as history, illness, immobility, and age.

Increased Health Risk of Arthritis

musculoskeletal disorders, including osteoarthritis, are much more prevalent among obese patients, especially patients diagnosed with severe clinical or mobid obesity. Health studies show that obesity is a strong predictor for symptoms of osteoarthritis, especially in the knees. The risk of osteoarthritis increases with every 2-pound gain in weight.

Increased Health Risks For Expectant Mother and Baby

Obesity has a strong detrimental effect on the health of both mother and new-born baby, both during and after pregnancy. Obesity while pregnant is associated with a higher risk of death in both the baby and the mother. It also raises the risk of high blood pressure in the Mom, by 10 times. Obesity during pregnancy is also associated with an increased risk of birth defects, such as spina bifida. Obesity-related health problems occurring after childbirth include higher risk of wound and endometrial infection, endometritis and urinary tract infection.

Medical causes

Common ones:

  • Poor diet
  • Sedentary Lifestyle
  • Genetics

Pathological:

Iatrogenic:

How would you manage it - investigate, treat, advise (what is the evidence base)

Investigations Clearly, you firstly try to rule out the clinical conditions:

  • 24 urine cortisol for Cushings
  • TFTs
  • Growth hormone levels

Treatment There is an awesome article here about the evidence behind different therapies.

  • Dieting
  • Increased Exercise
  • Medications (orlistat can be prescribed, but they must lose 2.5 kilos on their own first, to demonstrate their ability to stick to a diet, and have a BMI over 30 - or 28 if other risk factors like diabetes).
  • Surgery, such as gastric banding or gastric bypass can help, but has its risks, and they must have a bmi over 40.

How would you bring up the subject of obesity with a patient

  • Gently
  • With tact
  • Talk about how we can solve the problem together, rather than tell them they have to do it.

What is impaired fasting glycaemia (look at case) and why is it important

Indicated body's glucose tolerance is raised, and means they might be on the way to or actually do have diabetes - a level above 7 indicates dm type 2