Obesity has long been touted as a public health emergency, but unlike ebola or AIDS, it is one which does not show the severity of its effects in the acute setting. The erosive effect of obesity on health means it is usually brushed aside in favour of treating acute ailments and the ‘presenting complaint’. 

As healthcare advocates, it is important we all remember our goal of health improvement which includes promotion of a healthy lifestyle. Unfortunately, with the increasing prevalence of high BMIs what we now consider to be normal is in fact not. To put it in context, here is a quick recap of the latest figures regarding the prevalence of obesity in Ireland:

• 80% of those > 50 years are overweight/obese

• 37% of all adults are overweight

• 26.5% of females < 20 years are overweight/obese

• 26.6% of males < 20 years are overweight/obese

• 19% of nine-year-olds are overweight, 7% of which are obese.^1,2

With prevalence rates so high it is understandable that our definition of  ‘normal’ would shift. Recently the Lancet conducted a study which found that obesity can reduce a person’s life by up to eight years. What wasn’t as well publicised in the media was the loss of healthy years, which in the worst case can result in a loss of up to 19 years of healthy living (defined as free of obesity-associated cardiovascular disease and diabetes).³

A further study conducted by the Lancet has found that each 5kg/m2 increase in BMI was almost linearly associated with cancers of the uterus, gallbladder, kidney, cervix, thyroid, colon and leukemia.⁴ As such, similar to dealing with a patient’s smoking, a patient’s weight should be addressed at every opportunity with implementation of a firm plan.

As this is primarily a lifestyle problem it can be extremely difficult to treat and if treated successfully, results can be close to impossible to maintain. Lifestyle changes comprise the three following which should be used in combination: diet, exercise and behavioural treatment. It is important to set realistic goals from the outset which in light of current studies seems to be a 5-10% decrease in bodyweight.

Diet should focus on calorie reduction. The first step is to reduce overall calorie intake without deprivation of nutrients. A good starting point involves removing alcohol, sugar-containing beverages and sweets because these rarely contain adequate amounts of other nutrients. It is important when choosing a diet with the patient that their preferences are taken into account. If they are supportive of the choice they are more likely to stick to it.

Exercise is not very efficient at contributing to weight loss but is still an essential part of maintaining any loss. Its true benefit lies in improved functionality and increased insulin sensitivity. 

It is important when recommending exercise to quantify the amount and intensity. Ideally, it should be > 30 minutes per day at 70% of the patient’s maximum heart rate. When choosing an activity, consider patient preference and ability. Apps such as Strava or MapMyRun can be used by patients with smartphones to monitor their personal progress. As their fitness improves they should be told to keep reaching their target heart rate by increasing the intensity of their activity.

Behavioural strategies include self-monitoring (diaries and self-weighing), controlling or modification of stimuli for eating, realistic goal setting, meal planning and education and social support

Involving family members or spouses is important in supporting weight loss as this will help to achieve goals. Once goals are achieved it is important that these lifestyle changes are still adhered to, this will help maintain any weight loss that was achieved. 

It is also important to be aware of current strategies in place for dealing with the obesity epidemic. The HSE has focused on preventing childhood obesity while for the most part ignoring those who are currently affected. There is no combative strategy in place for dealing with this problem. If anything, it seems the HSE has abandoned any hope of dealing with this crisis. 

Bariatric surgeries were cancelled in 2014. It is one of the few surgeries which saves money in the long-term and has a cure rate for new onset type 2 diabetes in the region of 80%. Even ignoring this type of decision, the information made available online by the HSE is focused on childhood obesity and making a search on ‘adult obesity HSE’ doesn’t provide information for patients wishing to tackle the problem on their own or simply looking for advice in regards to their weight. 

For this reason we as healthcare professionals, must as individuals, make a push towards promotion of a healthy lifestyle.

References

1. Gakidou E et al. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: a systematic analysis for the Global Burden of Disease Study 2013. The Lancet, 2014, Aug 30;384(9945):766-81
2. Growing Up in Ireland, Overweight and Obesity among 9 year olds, Government Publications Dublin, 2011
3. Grover SA, et al. Years of life lost and healthy life-years lost from diabetes and cardiovascular disease in overweight and obese people: a modelling study. Lancet Diabetes Endocrinol. 2014 Dec 4
4. Bhaskaran K, et al. Body-mass index and risk of 22 specific cancers: a population-based cohort study of 5·24 million UK adults. Lancet. 2014 Aug 30;384(9945):755-65.