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Obesity PowerPoint Presentation

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Description : The facts and figures relating to obesity...The health problems obesity can cause

Tags : Obesity,obesity symptoms,obesity treatment,Overweight,Obesity and overweight

Published on : Nov 05, 2023 | Views : 959 | Downloads : 4

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Slide 1-

Goring and Woodcote Medical Practice Patient Participation Group (PPG) Obesity and Self-Care 4 November 2017 Slide 1 Open Meeting
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Agenda PPG Notices: OCCG Primary Care Meeting – George Hotel Wallingford, 28 Nov 1830-2000 Online access to medical records –help with the “Patient Access” programme Obesity – the Primary Care perspective – Dr Andy Goode Obesity Treatments – Mr Greg Jones Questions Slide 2
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Goring & Woodcote Medical Practice PPG Open Meeting 4 November 2017 OBESITY Presented by Dr Andy Goode
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OBESITY What we are going to cover… The facts and figures relating to obesity The health problems obesity can cause How the Practice team can help patients who want to tackle their obesity problem What secondary care can offer – eg bariatric surgery
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Obesity – the facts Obesity represents the greatest threat to health in the developed world, with poor diet contributing to more disease than physical inactivity, smoking and alcohol combined. Obesity rates have almost doubled in the last 20 years! It is suggested that by 2050 obesity will have an annual cost to the nation of nearly £50 billion pounds. The majority of the obese adult population do not identify themselves as either obese or even very overweight.
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What is Obesity ? Overweight and obesity are terms that refer to an excess of body fat and they usually relate to increased weight-for-height. The most common method of measuring obesity is the Body Mass Index (BMI). In adults, a BMI of 25kg/m² to 29.9kg/m² means that person is considered to be overweight, a BMI of 30kg/m² or higher means that person is considered to be obese. This is a crude tool.
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(NICE) recommends the use of BMI in conjunction with waist circumference as the method of measuring overweight and obesity and determining health risks. In order to measure abdominal obesity, waist circumference is measured, and categorised into desirable, high and very high, by sex-specific thresholds. Men Desirable = Less than 94 cms (<37”) High = Between 94-102 cms (37”-40”) Very high = More than 102 cms (>40”) Women Desirable = Less than 80 cms (<31”) High = Between 80-88 cms (31”-34”) Very high = More than 88 cms (>34”)
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Obesity prevalence varies with age for both males and females, with the highest obesity levels in the 55-64 age group. Adult obesity: Prevalence
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OBESITY STATISTICS In 2015, 58% of women and 68% of men were overweight or obese. Obesity prevalence increased from 15% in 1993 to 27% in 2015. In 2015/16, over 1 in 5 children in Reception, and over 1 in 3 children in Year 6 were measured as obese or overweight.
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Prevalence of morbid obesity (a BMI of 40+) has more than tripled since 1993, and reached 2% of men and 4% of women in 2015.
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In 2015/16 there were 525,000 admissions in NHS hospitals where obesity was recorded as a contributory factor.
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Health problems related to obesity Hypertension High blood pressure is twice as common among obese adults as among those of a normal weight (43% of obese men and 37% of obese women, compared with 21% of men and 18% of women with BMI within the normal range).
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Health problems related to obesity Diabetes Number of people diagnosed with diabetes has increased by 60% in the last decade. Prevalence of diabetes (diagnosed and undiagnosed) among adults with desirable and very high waist circumference was 2% and 11% respectively.
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Pre-diabetes Higher risk of going on to develop diabetes than the background population. A warning alarm. Opportunity to reduce risk and change before diabetes develops. Medication can help with this but weight loss through lifestyle change really helps.
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Obesity – other health risks Heart disease & stroke Some cancers Depression & stress Arthritis Breathing problems, such as asthma and sleep apnoea (when a person stops breathing for short episodes during sleep)
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Weight loss – not a simple solution? It is widely recognised that obesity and tackling weight loss can also be heavily linked to psychological problems affecting a patient. Depression Obesity At the Practice, we can help and support patients and refer them for specialist opinion as appropriate.
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How can patients help themselves - diet? 26% of adults ate the recommended 5 or more portions of fruit and vegetables a day in 2015. Women (27%) were more likely to do so than men (24%). Poor diet and nutrition are recognised as major contributory risk factors for ill health and premature death.
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How can patients help themselves – diet Start a diet – which one ? – how big is a normal portion ? 5:2 diet, Paelo diet, Cambridge diet, South Beach diet See our portion size plates at the Practice Join a slimming group - which one ? Weightwatchers, Slimming World OR Come to the Practice and see Nicky our HCA who has a special interest in supporting patients through weight loss
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How can patients help themselves – activity ? In 2015/16, 26% of adults were classified as inactive (fewer than 30 minutes physical activity a week). Less active and less fit people have a greater risk of developing high blood pressure. Physical activity can reduce your risk for type 2 diabetes. Studies show that physically active people are less likely to develop coronary heart disease than those who are inactive.
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How can patients help themselves – activity Join a local Gym or exercise at home! Go for a walk! Walking is simple, free, and one of the easiest ways to get more active, lose weight and become healthier. You don't have to walk for hours. A brisk 10-minute daily walk has lots of health benefits and counts towards your recommended 150 minutes of weekly exercise Join the local Goring Gap Health Walks! Go for a swim! Join a dance class! Anything to get you moving and hopefully having fun!
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How can we help patients in primary care Help and support patients who want to lose weight and become more active Monitor their progress Refer patients to weight loss and activity programmes
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Medication Orilstat Can only be continued if causing weight loss Affects absorption of fat from the gut Causes diarrhoea GLP-1 agonist Medication (injection) that we can use in diabetic patients to improve blood glucose control and fortuitously causes some weight loss in certain patients.
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Options in secondary care We can refer patients to secondary care so that they can discuss options such as weight loss surgery, also called bariatric or metabolic surgery, which is sometimes used as a treatment for people who are very obese. It can lead to significant weight loss and help improve many obesity-related conditions, such as type 2 diabetes or high blood pressure. But it's a major operation and in most cases should only be considered after trying to lose weight through a healthy diet and exercise.
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What are the Treatments for Obesity Mr Greg Jones Consultant Upper GI & Bariatric Surgeon Royal Berkshire NHS Foundation Trust
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What I will cover Secondary care treatment options Non-surgical weight loss Bariatric surgery Secondary treatment options for diabetics What surgery involves Outcomes from surgery
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Model of Care in the UK Tier 4 - Specialised Complex Obesity Services (including bariatric surgery) Tier 3 - Multi-disciplinary team obesity service to provide an intensive level of input to patients. Tier 2 - Primary Care with Community Interventions Tier 1 - Primary Care and Community Advice
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BMI
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BMI
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Tier 3 weight loss Up to 77,000 people in West Berkshire. Not currently available Who gets priority?
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BMI
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Tier 3 referral BMI > 50 (consider surgery as primary therapy) BMI > 40 BMI > 35 + Obesity related co-morbidity BMI 30 – 34.9 with recent onset type 2 diabetes Lower BMI in recent onset diabetes in Asian population
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Obesity related disease
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Obesity related disease
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Obesity related disease
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Obesity related disease
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Obesity related disease
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Obesity related disease Diabetes High blood pressure Heart disease Sleep apnoea Arthritis High cholesterol Polycystic Ovaries Asthma
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Tier 3 weight loss Dietician Psychologist Physician / GP Trainer
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Tier 3 results Also: Increase in exercise Increase in quality of life Improvement in diabetes More likely to have their “5 a day”
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Tier 3 results BUT: Weight regain at 2-4 years Not available locally MOST health gains with 10% weight loss Results are around 8% weight loss
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BMI
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Tier 3 for Type 2 diabetics Structured programme 1. Active loss – 800KCal food eplacement 2. Re-introduction 3. Sustain For BMI 28-35 Type 2 DM Dr Theingi Aung - RBH
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Tier 4 Royal Berkshire Hospital BMI > 50 (consider surgery as primary therapy) BMI > 40 BMI > 35 + Obesity related co-morbidity BMI 30 – 34.9 with recent onset type 2 diabetes Lower BMI in recent onset diabetes in Asian population
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Time line of assessment of RBH Obesity pathway for surgery
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Royal Berkshire Hospital Surgical Team: 3 consultant surgeons supported by 8 junior doctors Consultants: See each others patients Before and after surgery Operate on patients seen by other consultant May operate together
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Stomach and intestinal tract
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Operations Intra-Gastric Balloon Gastric Band Sleeve Gastrectomy Gastric Bypass
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Gastric Balloon
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Gastric Balloon Day case procedure Endoscopy - camera passed down gullet into stomach General Anaesthetic Balloon is size of 2 cans of Coke
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Gastric Balloon 20-30% excess weight loss at 6 months Need to be removed / replaced after 6 months Feeling sick and vomiting common early on after the procedure.
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Gastric Band
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Gastric Band Arrive morning of Surgery General Anaesthetic 5 small cuts (0.5-1cm)– KEYHOLE surgery Takes 1 hour Day surgery
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Works by Dividing the stomach with inflatable band Adjustable to reach goal Restricts amount you can eat Stimulates nerves telling the brain you are full
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Benefits Safest, simplest procedure Day case surgery “reversible” 50-60% excess weight loss No major nutritional problems Good long term evidence that it works
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Problems Least amount of excess weight loss Less effect on other medical problems Less likely to cure/benefit diabetes May take some time to achieve best fill of the band Band slippage/erosion Further surgery 30%
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Gastric Bypass
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Gastric bypass Arrive morning of surgery General Anaesthetic 5 small (1cm) cuts – KEYHOLE surgery Takes 1.5 hours 2 nights stay, 60% have 1 night stay 2 week liquid diet
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Robotic Gastric Bypass Royal Berkshire – only place in the UK
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Works by Reducing the stomach to the size of your thumb. Reducing the amount you can eat Separating most of the stomach from food Changes the hunger hormones so you feel less hungry Re-arranging the small bowel Changes the hunger hormones so you feel full These hormone changes help cure diabetes
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Benefits Most excess weight loss (70-80%) Best for helping other medical problems Highest cure for diabetes Long term evidence (20 years)
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Problems More early complications than Band (although very few) Longest operation Re-arrangment of Anatomy Small risk of leak Nutritional supplements (tablet and injection) and blood tests required.
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Sleeve Gastrectomy
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Sleeve Gastrectomy
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Sleeve Gastrectomy Arrive morning of surgery General Anaesthetic 5 small (1cm) cuts – KEYHOLE surgery Takes 1 hour 2 nights stay Water day of operation Liquids day after surgery
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Works by Reduces amount you can eat as stomach is now one 5th of its original size Removes the part of stomach from food that triggers hormone release Changes the hunger hormones so you feel less hungry Food enters the small bowel quicker Changes the hunger hormones so you feel full These hormone changes help cure diabetes
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Benefits Weight loss starts from time of surgery Loose 50-70% of excess weight over 2 years Cure or reduce need for diabetes medicines No re-arrangement of anatomy Less complicated than bypass
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Problems Not reversible Risk of weight regain if “stretching of sleeve” 15% do not loose expected weight Leak Heart burn Newer procedure, only have 10 year data
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UK Outcomes
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UK Diabetes
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Diabetes Prevention
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Risk of Dying
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Day to day living Improves activity and exercise Most able to walk 3 flights of stairs Back to work Back to hobbies
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14% of deaths from cancer in men & 20% of deaths in women are due to overweight and obesity Hospital visits for all cause cancer 1 in 50 Bariatric surgery patients 1 in 12 similar non-surgery patients Breast cancer even more reduced. Cancer
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Quality of life Looked at for 25 years after bypass Improvement seen from 5-25 years
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Summary Surgery Safe Best weight loss results Best results for other medical problems Keyhole surgery Non-Surgical Limited Long term results not impressive
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Referrals NHS – Royal Berkshire Hospital Consult your GP for referral Private – Spire Dunedin Same Surgeons and team 0118 958 7676 DunedinHospBariatrics@spirehealthcare.com
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Questions? Slide 79