Choosing Health Pharmacy Campaign Want to lose weight

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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

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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.

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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

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What weight loss is necessary to achieve a
clinically significant health improvement?

• 5
• 10
• 5 kg
• 10 kg

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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.
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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

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Population prevalence of CHD risk factors
Pop
Hypertension
Smoking
Cholesterol
Inactivity
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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

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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

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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

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• 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

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Prevalence of obesity in England
SourceHealth Surveys for England 1993-98
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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

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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

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Key messages for Losing weight
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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

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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?)

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Dietary advice
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(No Transcript)
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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

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Physical activity advice
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Energy balance body weight
Obesity results from excess energy intake
relative to Energy Expenditure
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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

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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)

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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

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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)

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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

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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 ?

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So why are we not exercising?

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

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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

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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

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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

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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)

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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

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Type

• Aerobic
• Flexibility
• Resistance Training

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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

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Progression

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

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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

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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

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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

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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

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Contact details

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