Time to tackle obesity
The prevalence of overweight and obese adults in England has trebled in the past 25 years.
In 2004 two-thirds of adults, almost 24 million, were classed as either overweight or obese.1 In children aged two to 15 the prevalence of obesity was 18 per cent in 2004, with a further 15 per cent of children classed as being overweight.2
In terms of the range and seriousness of associated chronic conditions, obesity is more harmful to health than smoking, heavy drinking or poverty.3 The life expectancy of obese patients is shortened by an average of around seven years – more if the onset of obesity is early or the condition is severe.4
Obese patients are twice as likely to die from heart disease.5 Severely obese men and women are 52 per cent and 62 per cent, respectively, more likely to die from cancer.6
The association of central obesity with the metabolic syndrome is well recognised. Obesity is also associated with an increased risk of type 2 diabetes, gallbladder disease, sleep apnoea, CHD, stroke, osteoarthritis, hyperuricaemia and gout, colon cancer, endometrial cancer, post-menopausal breast cancer, reduced fertility, low back pain and anaesthetic risks. Children may be affected by emotional problems resulting from poor self-image and psychosocial dysfunction caused by taunting.
The NICE guidance on the prevention and treatment of overweight and obesity, published last month, will help primary care teams to offer effective prevention and treatment to their patients.7
A ‘typical' practice with a list size of 6,000 will have around 1,000 adult patients who are obese, 50 adults who are severely obese, and approximately 200 children aged two to 15 who are obese. Because of the physical, psychological, social and financial costs associated with obesity, it makes sense to reduce its impact - modest weight loss of only 5 to 10 per cent can result in significant benefits to health.8
The NICE?guidance encourages discussing weight, diet and activity in situations when weight gain is more likely, such as during and after pregnancy, at the menopause, and when trying to quit smoking.
The guidance provides care pathways for the management of obese adults and children, presenting opportunistically or for a related condition. It recognises the sensitivity of raising the topic of excess weight, and the need to tailor advice according to a patient's individual circumstances and risk profile. The importance of patient preference is recognised.
Multi-component interventions are emphasised. These include behavioural change strategies to increase activity, focussing on activities that fit easily into patients' lives, such as walking, gardening and any other pleasurable activity. Improvements in eating behaviour and to the quality of the diet are encouraged. The importance of involving the whole family in the changes is highlighted, particularly for childhood obesity. Referral to an appropriate specialist should be considered for children who have significant comorbidity or complex needs.
Drug treatment should be considered only after dietary, activity and behavioural approaches have been tried and evaluated. For children, drug treatment should only be undertaken in a specialist setting. Surgery is recommended as the first-line treatment for adults with a BMI over 50, and as an option for adults with a BMI over 40 if various criteria are met. Surgery for children should only be considered in exceptional circumstances.
Primary care teams are at the forefront of identifying and managing overweight and obese patients. The key tasks are to improve patient and public awareness of the real risks to health associated with obesity, to use the NICE guidance to offer evidence-based management to those patients who wish to lose weight, and to work with the local PCT to commission the necessary services for the full care pathway.
With this guidance, GPs and their teams are in a position to make a real impact on the prevention and treatment of overweight and obesity.
Dr Ken Snider
MBChB MPH MFPH
Director, County Durham and Tees Valley Public Health Network and member of the NICE obesity guideline development group