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Overweight

Obesity is the result of eating more calories than the body can burn or use on a regular basis, however weight control is more complex and depends on many factors.

  • The body then stores the excess calories as fat.
  • As the extra calories are consumed each day, the body continues to accumulate extra fat stores, leading to obesity.

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Obesity Life cycle

Obesity should be monitored from the moment of pregnancy (never diet and have the intention to loose weight in pregnancy but instead eat healthy and do moderate exercise) to when the child is born to teenager to adult hood.

  • Pregnant women attending their first appointment with a midwife were either overweight or obese.
  • Evidence shows a significant relationship between maternal obesity and the birth of babies above a normal weight range, and the subsequent development of childhood and adult obesity.
  • Children who live in a family where at least one parent or carer is obese are more at risk of becoming obese themselves.
  • Children with obesity are more likely to be obese in adulthood and thus increase the risk of obesity for their own children in later life.
  • Poor diet and a low levels of physical activity are the primary causal factors of excess weight.
  • This can lead to:
    • Stigmatisation
    • Low self esteem
    • Poor psychological and emotional health
    • Bullying
    • School absence,
    • Increased later ill health and/or disability
    • Premature mortalilty in adult hood

Obesity and excess weight are significant health issues for adults across the life course and into old age.

  • Carrying excess weight can have significant implications for an individual’s physical and mental health.

Some of the significant issues are:

  • Reduction in life expectancy by 3 years on average. Severe obesity reduces it by between 8 and 10 years
  • Less likely to be in employment
  • Discrimination and stigma
  • Increased risk of hospitalisation

Many factors affect obesity, examples are shown below and they are not all one fault, it is simply not the case that it’s the individual fault:

Psychosocial

The term ‘psychosocial’ relates to the way that social factors affect states of mind. Psychosocial influences play a role in what people eat and how active they are. For example:

  • Social and cultural norms and family habits are a strong influence on taste preferences and dietary choices
  • Food consumption – the what and how much – can be affected by emotional states
  • Often people experiencing challenging circumstances are less able to make decisions that favour long-term benefits; therefore making healthy choices may be more difficult for those living in such circumstances

Behavioural

  • Our daily lives are filled with choices, whether it is the food we eat or how active we are. However, many of these are automatically formed around our habitual behaviour.
  • Habits are difficult to change, especially in an environment which encourages inactivity and the consumption of too many calories. It is almost inevitable that some people will gain weight and/or find it difficult to reduce their weight.

Biological and Physiological

There are a number of biological factors that can increase the risk of an individual gaining excess weight, especially when faced with an unhealthy environment. These include:

  • Genetic predisposition
  • Rare genetic conditions that can increase the risk of severe obesity e.g. leptin deficiency
  • Certain medical conditions e.g. hypothyroidism
  • Certain medications e.g. anti-psychotics
  • Maternal and early life factors e.g. maternal obesity

Environmental

  • Our environment tends to encourage unhealthy lifestyle choices relating to food and physical activity.
  • Unhealthy food and drink choices (including alcohol) are easy to access and are often high in energy.
  • We also tend to be less active and lead more sedentary lifestyles than previous generations, persons tends to rely more on technology, less manual jobs, increase travel time and longer hour jobs.

What Group is Most Affected And What Inequalities Are Associated With Obesity?

Obesity affects many. However it does not affect all groups equally, it is more common among:

  • Women from more deprived areas
  • Children in poor deprived areas.
  • Older age groups (above 45 years)
  • Some black and minority ethnic groups i.e Indian, Pakistani bangladeshi groups.
  • People with disabilities

e-Learning for Healthcare

BMI calculator

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Weight Loss treatment

  • Obesity is a serious issue that need tackled, not only can it lead to heart disease and cancer.
  • It is about consuming less calories than body needs to function and can affect our social life, finances and our well being.

Body Mass Index

  • This reading should be used as a guide to check if one is under or overweight.
  • It is not completely accurate for those who have a lot of muscle (since muscle adds on weight to one’s body hence the waist should also be measured),bone density (how heavy one’s bone are), overal body shapes,age, genetics , fitness, pre-existing disease, size,metabolism (how quickly one burns energy), racial and sex differences.

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If less than 18.5 Underweight
18.5 – 24.9: Aim to stay at weight ideal
Asians: should aim to be between 18.5-23
25 – 29 Overweight
30 – 34.9 Obesity 1: Moderate Overweight
35 – 39.9 Obesity II: Severe Overweight
40 or greater Obesity III: Need to check one’s health

Video link to measure height and weight:

  • Remove shoes , keep hair down , afros and turbans can’t be measure accurately.
  • Ask person to look straight ahead , top of ear canal should be inline with cheekbone,
  • If patient can’t stand there is a method to measure via the arm but must be done by a trained medical professional in anthropometry
  • Make sure weight machine is calibrated to zero before using a
  • Person place feet on the right part of machine (stand in centre of machine with weight distributed evenly through their feet onto the scale) and does not lean to one side,
  • Remove any jewellery, heavy jacket and clothing and empty pockets to obtain an accurate reading.
  • Operate the machinery to the manufactures instruction and make sure one waits (wait for fluctuations to settle) for the final reading.

Waist size

Video link to measure waist

  • Do not rely on cloth measurements it can vary.

BMI determines the degrees of overweight or obesity in adults and is associated with health risk, it does not make any specific measurement of fat , therefore one can have a high BMI with low fat ie athletes, physically muscular and or highly physical active and ethinic background persons  with a healthy BMI reading can still be at risk of medical conditions such as diabetes , hence waist size needs to be measured and these reading need to be considered as well.

  • Middle eastern, Chinese, south asian , afro- Caribbean, black caribean have a high risk of diabetes type 2 despite normal BMI range hence need alternative measurement, and on top of that it varies with in asian ethiniciites so there are no valid cut off points on measurement, therefore WHO guidelines are recommended as International classification rather than specific to races.
  • Waist circumference provides information on distribution of fat particularly central adiposity (overweight/obese).
  • Patient with abdominal or central distribution of fat increased risk of cardiovascular risk  and increased insulin resistance.
  • More fat you have it leaks a chemical which stops glucose being used correctly  and  it increases insulin resistance.

Box 1: International guidance on BMI/waist circumference thresholds

WHO advice on BMI public health action points for Asian populations (World Health Organization 2004)
White European populations Asian populations Description
Less than 18.5 kg/m² Less than 18.5 kg/m² underweight
18.5–24.9 kg/m² 18.5–23 kg/m² increasing but acceptable risk
25–29.9 kg/m² 23–27.5 kg/m increased risk
30 kg/m² or higher 27.5 kg/m² or higher high risk
International Diabetes Federation guidance on waist circumference thresholds as a measure of central obesity (Alberti et al. 2007)
European Men ≥ 94 cm (37 inches)
Women ≥ 80 cm (31.5 inches)
South Asians Men ≥ 90 cm (35 inches)
Women ≥ 80 cm (31.5 inches)
Chinese Men ≥ 90 cm (35 inches)
Women ≥ 80 cm (31.5 inches)
Japanese Men ≥ 90 cm (35 inches)
Women ≥ 80 cm (31.5 inches)
Ethnic south and central Americans Use south Asian recommendations until more specific data are available
Sub-Saharan Africans Use European data until more specific data are available
South Asian Health Foundation position statement on BMI and waist circumference (Kumar et al. 2010)
Recommends lower thresholds for advising South Asians to adopt a healthier lifestyle and avoid further weight gain. States that South Asians should be targeted as a special group for raising awareness of the risks of obesity. The Foundation supports a lower threshold of 23 kg/m2 for classification as overweight in British South Asians, as suggested by other expert groups. It acknowledges that more research is needed to establish appropriate thresholds for waist circumference in different sub-groups. In the meantime, it suggests that men with a waist circumference greater than 90 cm (35 inches) and women with a waist greater than 80 cm (31.5 inches) should be considered overweight.

 

Waist circumference giude (regardless of BMI):

 

 

Low waist circumference

 

 

 

men <94cm

Ethnic minority  men:   <90cm

women <80cm

 

Ethnic minority women<80cm

 
 

High waist circumference

 

 men <  94 cm -102 cm women 80-88cm
 

 

Very high waist circumference

 

 men >102cm women >88cm

BMI and Waist size guidelines (and its relationship) and when to see your medical doctor

 

Men

BMI Waist less than 94cm Or 37 inches Waist larger than 94cm or 37 inches Waist greater than 102cm or 40 inches
Asians:
Waist larger than 90cm or 36 inches
25-29.9 No increased risk Increased risk High risk
30-34.9 Increased risk High risk very high risk

Women

BMI Weight less than 80cm Or 32 inches Waist larger than 80cm or 32 inches Waist greater than 88cm or 35 inches
Asians:
Waist larger than 80cm or 32 inches
25-29.9 No increased risk Increased risk High risk
30-34.9 Increased risk High risk very high risk

If there is a risk of disease one should make an appointment to see their medical doctor

  • One needs to see your medical doctor
  • One needs to see your medical doctor urgently

Intervention:

When one needs to do something about their weight and fat distribution

  • The level of intervention is related to waist circumference, BMI and  current health condition

BMI

 Waist circumference Waist circumference Waist circumference Comorbidy present (other conditions i,e diabetes, heart condition, high cholesterol)

Low

 High Very high

Overweight

 1 2 2

3
Obese 1

2

 2 2

3
Obese 11

3

3

3

4

Obese 111

 4 4 4

4

 

  1. General advice on healthy weight and weight loss
  2. Diet and physical activity
  3. Diet and physical activity and consider medicine
  4. Diet and physical activity and consider medicine/surgery

NICE Clinical Guideline 189

One can:

  • Reduce Calorie intake
  • Change their sedentary status (increase physical status, change behavioural ways)
  • Use medicine and/or surgery (but one needs to talk to their Pharmacist, Medical doctor , dietitian and/or specialist first!!)

Cause

Symptoms

  • Excess or abnormal amount of body fat/weight gain i.e around waist (not due to muscle)?
  • Large belly/belly sticks out?
  • Shortness of breath/Feeling out of breath and or breathing difficulties?
  • Sleep apnea and/or snoring?
  • Long term persistent indigestion and/or frequent heartburn and/or constant abdominal pain and swelling?
  • Hot flushes and/or flushed face and/or warm skin and/or slight sweating and/or dislike to heat?
  • General discomfort (muscle weakness), uneasiness or ill feeling (malaise) and/or fatigue (tiredness)?
  • Back pain?
  • One find passing stools difficult (can be painful) and constipated?
  • Joint pain stiffness and pain?
  • Aching, painful muscles, muscle cramps/spasms/stiffness?
  • Skin  fungal rashes(from moisture accumulating in the folds of skin)?
  • Acanthosis nigricans (dark velvety skin around the neck and other areas)?
  • Stretch marks on the hips and back?
  • Inability to perform simple physical tasks (that one could easily do)?
  • Feeling low and depressed?
  • Feelings of isolation/unsociable/self blame/alone/shame?
  • Flat feet?
  • Early puberty (unusual early vaginal bleed) in girls/delayed puberty in boys?
  • Loss interest of sex and/or low sex drive?

Male:

Do not wait, phone for ambulance if have or develop:

This condition can lead to:

Please talk to your healthcare professional (i.e Medical Doctor/Pharmacist) for further advice

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