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Choosing Health Pharmacy Campaign Want to lose weight

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Title: Choosing Health Pharmacy Campaign Want to lose weight


1
Choosing Health Pharmacy Campaign Want to lose
weight?
  • Emma Croft Pat Carter

2
We know we are in the grips of a world wide
obesity epidemic, but on a scale of European-wide
obesity prevalence, where would the UK be ranked?
  • 3rd

3
What percentage of men, women and children in
England, are overweight or obese?
  • Overweight and obese men 65.3 / obese men 22
  • Overweight and obese women 55.5 / obese
  • women 23
  • Children increasing faster than adults
  • National average 14.7
  • Yorks and Humberside 11.4
  • 41.6 of young adult males (16-24 years old) in
  • this region are overweight or obese, 25 higher
  • than the national average.

4
Which part of the country has the highest
prevalence of obese men? Is it West Midlands,
Yorks and Humber, London, or the North West?
  • London 17.8England 22.2
  • West Midlands 22.5
  • North West 23
  • Yorks Humber 24.6

5
What weight loss is necessary to achieve a
clinically significant health improvement?
  • 5
  • 10
  • 5 kg
  • 10 kg

6
Approximately how many calories a day would you
have to reduce intake by to achieve a 1lb weight
loss in a week?
  • 200 Kcals
  • 400 Kcals
  • 600 Kcals
  • 800 Kcals

7
Which is the most effective weight loss
intervention?
  • Diet alone
  • Physical activity alone
  • Diet and physical activity
  • Behaviour change, diet and physical activity

8
Out of the following diets, which do you believe
to be the most effective?
  • Slim Fast
  • Atkins Diet
  • Rosemary Conely
  • Weight Watchers

After 1 month Atkins produced the greatest mean
weight loss, however after 6 months there was no
significant difference between the 4 diets.
Rosemary Connelly had best results although not
significantly.
9
If we could reduce just one of the following
health risks for the entire population of the UK,
which one would have the most impact on coronary
heart disease statistics?
  • Smoking
  • Inactivity
  • High Cholestrol
  • Hypertension
  • Obesity
  • Diabetes

10
Population prevalence of CHD risk factors
Pop
Hypertension
Smoking
Cholesterol
Inactivity
11
How long would a 70 kg person have to walk at 3
mph to burn the calories in a glass of wine?
  • 15 mins
  • 40 mins
  • 2 hours
  • 4 hours

12
How far would a 70kg person have to walk to burn
off the calories in large burger?
  • ½ mile
  • 2 miles
  • 6½ miles
  • 7 miles

13
Aims
  • Address issues arising from the 2006 obesity
    campaign.
  • Be more confident in how to raise weight as an
    issue
  • Increase knowledge around evidence based messages
    for promoting weight loss.
  • Give you information on where to signpost people
    for weight management support

14
  • 28,000 heart attacks attributable to obesity
  • 6 of all deaths attributable to obesity
  • Direct costs to NHS at least 0.5 billion
  • Indirect costs to UK economy at least 2 billion
  • 80 of costs arising from CHD, hypertension and
    type 2 diabetes

15
Prevalence of obesity in England
SourceHealth Surveys for England 1993-98
16
Raising the issue
  • Share positive experiences
  • Use campaign materials to create interactive
    eye-catching displays
  • Target those collecting weight loss medication
  • Target people buying weight loss products
  • If comfortable raise with those with long term
    conditions as a way to improve management

17
What to do next
  • Give brief key evidence based messages
  • Have evidence based literature available
  • Signpost on to primary care, local groups
    (voluntary and commercial), leisure services

18
Key messages for Losing weight
19
Studies have shown that those who lose weight and
keep it off have similar habits
  • Eat a regular breakfast
  • Exercise regularly
  • Reduce the content of fat in their diet
  • Self monitor their lifestyle (food, exercise,
    behaviour)
  • Receive support (friends, family, health
    professional)
  • Increase their intake of fruit and vegetables
  • Reduce sedentary behaviour (eg TV watching)
  • Reduce the amount of food eaten outside of the
    home
  • Consistent eating pattern (weekdays and
    weekends)
  • Eat regular meals

20
Most relapsers
  • Did not exercise to lose weight
  • Used fad diets or fasted
  • Skipped breakfast and ate more snacks, especially
    confectionary
  • Felt deprived most of the time and banned their
    favourite foods
  • Regained weight when they stopped their diet
    regime
  • Ate unconsciously in response to problems /
    emotions
  • Didnt seek help / support from others
  • Buried their head in the sand (what problem?)

21
Dietary advice
22
(No Transcript)
23
Key dietary messages for losing weight
  • Eat a balanced diet
  • Eat regular meals including breakfast
  • Eat 5 portions of fruit and vegetables
  • Reduce amount of fatty sugary processed foods
    eaten

24
Physical activity advice
25
Energy balance body weight
Obesity results from excess energy intake
relative to Energy Expenditure
26
Definitions
  • Physical Activity any bodily movement that
    utilises muscle actions and requires a measurable
    increase in energy
  • Exercise subset of physical activity that is
    structured and targeted at improving physical
    fitness

27
Can physical activity work for the overweight and
obese?
  • Individuals are more likely to lose weight if
    physical activity is involved in the programme of
    weight loss.
  • Successful weight loss maintenance is associated
    with increased physical activity
  • (NWCR, 1994)

28
Benefits of exercise to the overweight and obese
  • Increased energy expenditure
  • Maintain/increase muscle mass ? Maintain/Increase
    metabolic rate
  • Maintenance of physical activity may be one of
    the best predictors of long term weight
    maintenance
  • Some evidence suggests exercise may
    preferentially reduce central obesity and
    associated disease risk
  • Exercise is known to improve psychological
    well-being ? may improve adherence to behavioural
    changes and help control energy intake

29
Other Benefits independent of weight loss
  • Exercise reduces disease risk - CHD, stroke, type
    2 diabetes, colon and breast cancers,
    osteoporosis and depression
  • Inactive and unfit people have almost double the
    risk of dying from CHD. Physical Activity is also
    an independent protective factor against CHD
    (DOH, 2005 )
  • The risk of developing Type 2 diabetes is
    increased by 30-40 in sedentary people,
    compared with people who are regularly physically
    active (DOH 2002)
  • Exercise improves diabetes control
  • Lowers (or maintains) blood pressure
  • Improves blood lipid profile (by raising HDL and
    lowering total cholesterol)
  • Can lower resting heart rate
  • Increased physical work capacity (activities of
    daily living)
  • Sleep better
  • Increased mobility and flexibility
  • Prevents falls and reduces injuries (improves
    balance and strength)

30
Fatness vs Fitness
  • Some evidence suggests fitness rather than
    fatness may be a more important predictor of
    mortality than weight
  • Broader perspective to weight management should
    consider treatment outcomes of improved health
    and fitness as well as weight loss

31
Are you doing enough?
  • Does anyone know the government recommendations
    for general health and well-being ?
  • Does anyone think they are doing enough physical
    activity to benefit their health ?

32
So why are we not exercising?
  • Why are 60-70 of adults not exercising enough
    to achieve the health benefits associated with
    physical activity?

33
Barriers
  • Usual barriers
  • Time, lack of knowledge of benefits, lack of
    social support, religion, age, hard work, access,
    cost etc
  • Physical
  • Obesity - discomfort
  • Often unfit
  • Co-morbidities CHD, diabetes etc
  • Psychological/Social
  • Fear breathlessness, embarrassment, worry about
    injury
  • Lack of specialist classes / advice
  • Physiological
  • Reduced capacity for exercise low fitness
  • Often co-morbidities

34
The Obesogenic environment
  • it will be a daunting task to change the
    course of nations that have progressively become
    quite comfortable with an effortless lifestyle in
    which individual consumption is almost
    unlimited. (Bouchard Blair, 1999)
  • A major barrier for obese people is exercise
    tolerance and adherence
  • Vicious circle Excess weight ? reduced activity
    levels ? further weight gain

35
What are the Guidelines?
  • FITTA
  • F requency - Minimum 5x week
  • I ntensity - Moderate
  • T ype - Walking/cycling etc
  • T ime (duration)- 30mins 10min warm up
    10min cool down
  • Intermittent exercise if 30mins not tolerated.
  • A dherance - Follow up / monitor /support

36
How Long? (Time Frequency)
  • Is 30 minutes/day, 5x week enough?
  • Maintenance of weight loss
  • Physical activity levels of 1500-2000 kcal / week
    associated with improved maintenance of lost body
    weight (HDA, 2003).
  • Prevention of weight regain requires 60-90
    minutes of moderate intensity activity or lesser
    amounts of vigorous activity (Saris et al,
    2003).
  • Prevention of Obesity
  • 45-60mins of moderate intensity physical
    activity a day is necessary to prevent obesity
    (DOH, 2005)

37
How hard? (Intensity)
  • Moderate intensity What does it mean?
  • How to monitor - One persons brisk is another
    persons fast or slow
  • Rate of perceived exertion (RPE) - feeling
    puffed, getting warm, able to speak in short
    sentences
  • Heart rate (drugs and disease may affect this
    use RPE as well)
  • Calorie expenditure e.g. Walking at 3mph (1.5
    miles 30 minutes)
  • 50 kg person for 30 mins 83 kcal
  • 100 kg person for 30 mins 165 kcal
  • (www.caloriesperhour.com)
  • So, 100kg person doing 30 mins/day x 5 days
  • For 1 week 825Kcal
  • For one year 42,900kcal
  • Could lead to 10 11 lbs of fat loss over 1 year

38
Type
  • Aerobic
  • Flexibility
  • Resistance Training

39
Adherence Addressing Obesity
  • What can you do to help get people active and
    stay active?
  • Sufficient evidence to recommend the use of brief
    interventions in primary care
  • Opportunistic advice
  • Discussion, negotiation and encouragement
  • Ranging from basic advice to individually-focused
    (NICE, 2006)
  • Promote regular walking and cycling
  • Written info on benefits and local opportunities

40
Progression
  • Start slowly, Increase frequency, then time
    (duration), then intensity
  • Add different types for variety and interest
  • Pedometers

41
Literature for the public
  • Why Weight Matters
  • Your Weight Your Health
  • Available to order on DOH website
  • Balance of good health
  • Food labelling info
  • Available from food standards agency
  • More websites detailed in the campaign guidance

42
What support is available
  • Commercial slimming groups
  • Primary care
  • Various programmes for long term conditions most
    of which have a weight management element.
  • Weight management services in some parts of the
    city
  • Programmes run in leisure centres
  • Walking groups

43
Pharmacotherapy
  • Xenical (Orlistat) MAP (Medical Action Plan)
  • Reductil (Sibutramine)- Change for life programme
  • Acomplia (Rimonabant)- Its what you gain
    programme
  • All patients prescribed these medications should
    be encouraged to access these support resources
  • All patients receiving these medications should
    be receiving concomitant diet and activity advice
    and regular weight monitoring

44
More information
  • NICE Guidance on the prevention , identification
    ,assessment and management of overweight and
    obesity in adults and children.
  • DOH Your Weight your Health Series
  • Choosing Health Food and Physical Activity Action
    plans

45
Contact details
  • Weight Management Team
  • Leeds
  • North West House
  • Leeds
  • Emma.croft_at_nhs.net
  • Pat.carter_at_nhs.net
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