Overweight (BMI)

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

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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.

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

Waist circumference giude (regardless of BMI):

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

Men

Women

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

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!!)