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