Title: Choosing Health Pharmacy Campaign Want to lose weight
1Choosing Health Pharmacy Campaign Want to lose
weight?
2We 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?
3What 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.
4Which 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
5What weight loss is necessary to achieve a
clinically significant health improvement?
6Approximately 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
7Which is the most effective weight loss
intervention?
- Diet alone
- Physical activity alone
- Diet and physical activity
- Behaviour change, diet and physical activity
8Out 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.
9If 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
10Population prevalence of CHD risk factors
Pop
Hypertension
Smoking
Cholesterol
Inactivity
11How 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
12How far would a 70kg person have to walk to burn
off the calories in large burger?
- ½ mile
- 2 miles
- 6½ miles
- 7 miles
13Aims
- 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
15Prevalence of obesity in England
SourceHealth Surveys for England 1993-98
16Raising 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
17What 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
18Key messages for Losing weight
19Studies 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
20Most 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?)
21Dietary advice
22(No Transcript)
23Key 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
24Physical activity advice
25Energy balance body weight
Obesity results from excess energy intake
relative to Energy Expenditure
26Definitions
- 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
27Can 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)
28Benefits 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
29Other 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) -
30Fatness 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
31Are 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 ?
32So why are we not exercising?
- Why are 60-70 of adults not exercising enough
to achieve the health benefits associated with
physical activity?
33Barriers
- 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
35What 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
36How 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)
37How 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
38Type
- Aerobic
- Flexibility
- Resistance Training
39Adherence 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
40Progression
- Start slowly, Increase frequency, then time
(duration), then intensity - Add different types for variety and interest
- Pedometers
41Literature 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
42What 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
43Pharmacotherapy
- 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
44More 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
45Contact details
- Weight Management Team
- Leeds
- North West House
- Leeds
-
- Emma.croft_at_nhs.net
- Pat.carter_at_nhs.net