WellMan Clinic Putting
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Weight Management Lose the weight, improve the health Weight problems - why it's important to lose weight and how it should be done What is being 'overweight' and what is being 'obese'? There is now an agreed method of measuring weight in order to detect whether individuals are outside the normal weight range. The method uses the individual's height and weight measurements to calculate (weight divided by height squared) the Body Mass Index (BMI). A person with a BMI of less than 25 is not overweight. A BMI between 25 and 30 is classified as being 'overweight' whereas a BMI of 30 or more indicates 'obesity'. A person of height 5'9" weighing 12 stones 7 pounds has a BMI of 26 and is therefore overweight. If he/she was 14 stones 7 pounds then the BMI would be 30 and he/she would now be classified as obese. A large waist measurement confers greater risk in a person who is overweight or obese. Why is there so much interest in obesity at present? Obesity is now reaching epidemic proportions in the western world. There are estimated to be 90 million obese people in the USA and 9 million in the UK and the numbers are growing. The rate of increase in the UK over several years now means that 18% of women and 16% of men are obese and that a further 34% of women and 45% of men are overweight1. The prevalence of obesity amongst adults in England more than doubled between 1980 and 19961. Why are we becoming overweight? Recent changes in lifestyle are mainly to blame. The increased availability and greater consumption of high-fat, high-energy foods combined with a dramatic fall-off in physical exercise is the main problem. Obesity is becoming particularly worrying amongst children where profound reductions in physical activity have led to a quarter of all children being overweight. Genetic factors account for about 40% of obesity. This can be seen when most or all members of a family are overweight; however over-consumption and underactivity are still important factors. Patients with a genetic predisposition may require medical assistance to help them lose weight and maintain their new body weight. Medical causes such as an underactive thyroid or other hormonal imbalances are not common. However, they must be excluded because if present such conditions must be treated. Why is being overweight a problem? Being overweight increases the chances of developing many diseases including: It is also clear that being overweight reduces one's lifespan: the greater the degree of obesity, the greater the reduction in years of life (3,4). The greatly increased levels of obesity today are therefore an important public health issue in the western world. As such there has been much media interest recently and the medical profession has issued clinical guidelines on the management of overweight and obese people (5). Does losing weight help one's health? Obese people with co-existent weight related problems (such as heart disease, high blood cholesterol, diabetes, high blood pressure and shortness of breath) who lose some weight have a significantly increased life-span. Any weight reduction is beneficial and a loss of between 0.5 and 9 kg has been shown to reduce the chance of early death by 2006. Weight loss alone improves the outcome of the following co-existent diseases: Weight loss of 5-10% in those people who already have non-insulin dependent diabetes improves the blood sugar levels and reduces the requirement for medication (7). In those with high blood pressure a weight loss of just 1kg reduces a fall in pressure of 1-2mmHg. Further weight reduction produces additional incremental falls (8). Weight loss in the obese also results in reductions in blood levels of cholesterol (9). Clearly there are also benefits in the improvement of self-esteem, well-being and mood as well as breathing and pain in weight-bearing joints. Who needs to lose weight? How much weight needs to be lost? The aim of weight management is to prevent or reduce the health consequences of obesity. Even a weight loss of 5-10% reduces significantly the health risks associated with obesity. For a person weighing 15 stone this would amount to between three quarters and one and a half stone. Some people may lose greater amounts of weight but maintaining the new weight may be more difficult. The goal is to achieve modest weight loss, and then the goal weight needs to be maintained. Continued weight loss beyond six months is unlikely and the objective thereafter is weight maintenance. Weight needs to be lost slowly (1 to 2lbs per week) in order that the loss be maintained. How can weight be lost, and the loss maintained? Weight loss is initiated with a combination of a supervised diet, a programme of exercise and a change in behaviour. Very frequently weight that is lost is soon put back on. This is extremely common as people fall back into old habits. It must be realised that once the weight is lost, maintenance of the new body weight will require a change in lifestyle. Exercise does not have to be too strenuous. Brisk walking for 20 minute each day for five days of the week will help reduce weight and also to maintain the new weight. What is the role of medicines in weight loss? Obese people and some overweight patients with risk factors may need help with medicines that help reduce weight and maintain its loss. Such people may require medical therapy if after a period of dieting and behavioural modification they have not lost sufficient weight. Those with a genetic predisposition to obesity may especially need such assistance. Two new drugs that work through novel pharmacological mechanisms are now available. Xenical orlistat is a medicine that reduces the absorption of fat eaten in food from the gut. It is used along with an individually tailored low-fat diet and behavioural modification. Orlistat is itself not absorbed from the gut into the body and therefore is free from systemic side effects. As it reduces fat absorption it increases the amount of fat in the faeces. Reductil sibutramine is a medicine that is absorbed into the body and acts by increasing the body's metabolism resulting in weight reduction. It also makes one feel 'full-up' earlier thus helping to reduce the volume of food intake. These medicines are unlike older drugs for obesity which were noted for unpleasant and dangerous side effects. The medicines are however prescription only medicines and need to be prescribed by a physician with regular review of the patient. How can The Weight Management Clinic help me? The Weight Management Clinic is staffed by two experienced physicians and a senior nurse all of whom have experience and an interest in weight management. An initial assessment and medical examination along with certain blood tests and body measurements are undertaken. This is necessary in order to exclude any underlying medical causes for obesity. A specific diet and behaviour modification plan is designed for each individual. Medical therapy may be advisable for those with resistant weight problems. All patients are carefully followed up by the nurse and doctors with regular reviews and diet and behavioural control. Review of medical treatment, if initiated, is also carefully reviewed. What should I do now? If you are concerned about being overweight call our nurse on 020 7637 2018. She will ask you a number of short questions including your weight, height and waist measurement. She will then be able to quickly calculate your body mass index (BMI) and tell you the result over the telephone. She will also ask you whether you suffer from any of the following: If you are unsure about any of the above, do not worry as the doctor can check these areas if you make an appointment. If your BMI is above 25 you will be eligible for an appointment. The telephone call takes approximately 3 minutes. The Weight Management Clinic follows the recommendations contained in the report of the Royal College of Physicians, "Clinical Management of Overweight and Obese Patients with Particular Reference to the Use of Drugs", December 1998. References 1. Prescott-Clark P, Primatesta P (eds). Health survey for England. 1996. London: HMSO. 1998. |
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| Copyright: THE WELLMAN CLINIC 2006. All trademarks acknowledged. Tel: 020 7637 2018 Fax: 020 7637 2019 Address: 32 Weymouth Street London W1G 7BU |
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