Page 34 - The SA Journal Diabetes & Vascular Disease Volume 9 No 4 (November 2012)

SA JOURNAL OF DIABETES & VASCULAR DISEASE
176 VOLUME 9 NUMBER 4 • NOVEMBER 2012
Prevention in Practice
TAKING THE WEIGHT: A PRIMARY
CARE TEAM APPROACH TO
OBESITY MANAGEMENT
S Afr J Diabetes Vasc Dis 2012;
9: 176–179
Dr Matthew S Capehorn
Clinical Director, National Obesity Forum; Clinical
Manager, Rotherham Institute for Obesity Most of the UK population – including the patients we see every day – are now more likely to have
a weight problem than be of a healthy weight. Instead of focusing our efforts, and valuable re-
sources, on managing the consequences of obesity, we should tackle its causes and appropriately
manage patients motivated to address their unhealthy weight.
In 2008, two-thirds of adults in England were classified as either over-
weight [body mass index (BMI) 25–30 kg/m2 ] or obese (BMI > 30 kg/m2 ),
while a quarter were obese. Furthermore, 44% of women and
34% of men had an unhealthy waist circumference (> 88
cm in women or > 102 cm in men), indicating significant
levels of unhealthy central, or visceral, fat.
As the prevalence of obesity rises, we should expect
associated medical problems to also increase. Obesity
has particular implications for women’s health, reduc-
ing their fertility and increasing the risks of serious
complications during pregnancy. Obese women are
also at greater risk than obese men of developing
type 2 diabetes, and once they develop diabetes,
their risk of coronary heart disease is higher.
THE TEAM APPROACH
As primary healthcare professionals we should
care about weight as a modifiable risk factor
(Table 1), and support our patients who wish to
lose weight. But, whether we argue that obes-
ity is due to genetic predisposition, learned be-
haviour or the obesogenic environment, obesity
is a chronic, relapsing condition. So prevention of
weight regain must be part of all obesity manage-
ment programmes.
The Rotherham Institute for Obesity (RIO) is a unique centre for
the management of weight problems. It is the specialist tier of in-
tervention for adults and children with weight management problems
in the overall NHS Rotherham Obesity Strategy. It uses a multidisci-
plinary team to deliver different approaches to weight management
(Table 2).
An effective weight- •
management clinic can be run
with a height measure, some
accurate scales and a tape
measure
500 fewer kcal a day results in •
500 g weight loss each week
or 25 kg in one year
Waist circumference •
measurement is important to
assess unhealthy visceral fat
Four-weekly measurement •
of weight and waist
circumference avoids
confusion due to hormonal
fluid retention
Encourage patients to •
incorporate physical activity
into their daily routine
Talking therapies help to •
identify underlying causes and
help to break the pattern of
comfort or habit eating
Since obesity is a chronic, •
relapsing condition, prevention
of weight regain must be part
of all obesity management
programmes
KEY POINTS
Originally in Br J Prim Care Nursing
2012