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“Obesity occurs when a person puts on weight to the point that it seriously endangers health.”

Obesity NAO. Tackling obesity in England. Feb 2001 Department of Health. The healthy living social marketing initiative. March 2007. “Obesity occurs when a person puts on weight to the point that it seriously endangers health.”

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“Obesity occurs when a person puts on weight to the point that it seriously endangers health.”

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  1. ObesityNAO. Tackling obesity in England. Feb 2001Department of Health. The healthy living social marketing initiative. March 2007 “Obesity occurs when a person puts on weight to the point that it seriously endangers health.” “…the fundamental cause is consuming more calories than are expended in daily life.” Input > Output

  2. Scary facts about obesityNational Audit Office. Tackling obesity in England. 15th February 2001 The (NHS) Information Centre, Lifestyle statistics. Statistics on obesity, physical activity and diet: England, 2006Zaninotto P, et al; for the DH. Forecasting obesity to 2010, Aug 2006 • 1 in 4 adults is obese in England • Incidence of obesity continues to rise • If current trends continue, 33% men and 28% women will be obese in 2010 • Around 1/3 of boys and 1/3 of girls aged 2-15 years are either overweight or obese Tackling obesity is a national priority

  3. Obesity: why bother treating it?National Audit Office. Tackling obesity in England. 15th February 2001 • Virtually all obese people develop some associated physical symptoms by the age of 40 • The majority require medical intervention for diseases that develop as a result of obesity by the age of 60 • Even modest losses in weight can confer significant metabolic and vascular benefits. Losing weight is associated with a reduction in: • Mortality (all cause, cancer, CVD and diabetes-related) • The risk of developing type 2 diabetes • Hypertension • Cholesterol • Avenell A, et al. Health Technol Assess 2004;8(21):1-465

  4. Estimated metabolic and vascular benefits of losing 10% weight?Haslam D, et al. BMJ 2006;333:640-2

  5. NICE Clinical Guideline 43 Obesity. Dec 2006 Overweight 25-29.9kg/m2 Obesity I 30-34.9kg/m2 Obesity II 35-39.9kg/m2 Obesity III ≥40kg/m2 Multicomponent interventions are the Tx of choice

  6. Lifestyle interventionsNICE Clinical Guideline 43 Obesity. Dec 2006Lean MEJ, et al. BMJ 2005;330:1339-40 • The mainstay of treatment for most overweight/obese patients • Reduced calorie intake • For sustainable weight loss, recommend diets with 600kcal/day deficit or those that reduce calories by lowering fat content, in combination with expert support and intensive follow-up • Increased energy expenditure • Exercise is associated with improved CV risk factors, even if no weight is lost • The American message “Move a little more eat a little less” may have greater meaning and applicability for many • 90% of obesity in the USA could be abolished by: • walking an extra 2000 steps a day (about a mile) and • reducing dietary intake by ~100kcal per day

  7. Drug treatmentNICE. Clinical Guideline 43, Dec 2006 • Consider drug treatment only after dietary, exercise and behavioural approaches have been started and evaluated. • Consider for patients who have not reached their target weight loss or have reached a plateau on dietary, activity and behavioural changes alone. • Review regularly to monitor effectiveness, adverse effects and adherence. Reinforce lifestyle advice. orlistat sibutramine rimonabantq

  8. Evidence from drug trials • All drug trials limited by high drop-out rates (40-50%) • No long-term morbidity and mortality data(except decrease in type 2 diabetes incidence with orlistat) • Most trials look at weight loss (primary outcome) and various CV risk factors (secondary outcomes) e.g. lipids, BP, HbA1C etc. • Large head to head studies lacking • Longest studies - Orlistat 4 years (XENDOS – decrease in type 2 diabetes) - Sibutramine 2 years (not licensed >1 year) - Rimonabant 2 years (not licensed >2 years)

  9. Summary of drug treatmentsMeReC Bulletin 2008:18(5)

  10. The NPC’s 3 steps to non-obese heaven • Move a little more, eat a little less • walk an extra 2000 steps a day (about a mile) • reduce dietary intake by 100kcal per day (a couple of biscuits) • Targetthose at risk of developing obesity: • Social factors deprivation • Family history • Children who are obese • Lifestyle interventions but also drugs are an option in some people • Assess motivation • Produce a mean 3-5kg weight loss • 10% weight loss at 1 year achieved in about every 4 to 8 people who take anti-obesity drugs • Follow NICE obesity guideline

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