Healthy Weight for Ireland
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1 Healthy Weight for Ireland Donal O Shea, HSE Lead for Obesity 7 th March 2018 St Columcilles & St Vincents University Hospitals, National Childrrens Research Center & University College Dubin donal.oshea@hse.ie
2 Disclosures - none Jaring Timmerman
3 Outline of talk Obesity the backdrop HSE Lead Update Research
4 Outline of talk Obesity the backdrop HSE Lead Update Research
5 Obesity human, animal, global
6 Overwieght tracks from childhood 82% BMI 52 Juonala et al, NEJM 2011
7 Obesity causes and worsens all disease Dementia Cardiovascular Disease Diabetes Cancer Fatty Liver Disease Gout
8 Obesity kills 1000 per Million per year
9 Obesity in last 30 years BMI -50 BMI -40 BMI -30 BMI 52 Sturm and Hattori, Int J Obes 2013
10 NK cells NK cell
11 NK cells NK cell
12 Socio-economic separation by age 3 3% of upper socio-ecominic 12% of lower socio-economic
13 Societal influences Individual psychology Food Production Food Consumption Individual activity Activity environment Biology
14 Products and Names
15 Cheryl Donal Francis Bernadette Ed
16 Consumption of free sugar has soared
17 Products and Placement
18 The Italian Manager
19 The Italian Manager
20
21 Product and Names
22
23 Public Policy Measures The race we don t want to win Tackling Ireland s obesity epidemic Policy Group on Obesity. August 2014
24 Outline of talk Obesity the backdrop HSE Lead Update Research
25 The Policy Context Obesity Taskforce Report 2005 Healthy Ireland Framework ( ) Obesity Policy & Action Plan ( ) House of the Oireachtas Committee on the Future of Healthcare Report (May 2017)
26
27 National Programme Governance Department of Health HSE Leadership Team National Director H&WB HEAL Programme National Lead HEAL Programme Team H&WB NCAGL Clinical Lead Programme Manager Working Groups CAG RCPI
28 National Programme Management Arrangements Appointed by RCPI: National Clinical Lead Programme Manager Clinical Advisory Group (CAG) comprising of doctors with expertise in the specialty Three main objectives of the CAG, to: to provide clinical strategic vision and input review and sign off guidelines and models of care proactively support and facilitate the implementation of the programme on a nationally agreed model Multidisciplinary Working Group(s) are usually established to conduct the work of the Programme
29 National Obesity Programme Established jointly by the HSE Health & Wellbeing Division and RCPI Three main objectives, to: improve quality of care improve access improve value Four main deliverables, to: developing standardised care pathways clinical guidelines models of care evolution of innovative ideas and solutions
30 National Programme Draft General Principles Overweight & Obesity needs to be recognised as a modifiable driver of all disease by all members of health sector Must be appropriate education undergraduate and postgraduate of all health professionals in relation to weight related lifestyle modification The socioeconomic divide needs to be acknowledged, the addressed
31 National Programme Draft Vision: Primary Care Main site for identifying of, and delivery of care for, overweight and obesity in children and adults Adequate resourcing to deliver, evaluate and revise the ICGP Obesity algorithms for children and adults Appropriate access to pharmacotherapy and secondary care weight management centres Must be evidence based, evaluated and tailored to regional strengths (PHEW, Croi, MECC)
32 National Programme Draft Vision: Secondary Care Must play a leadership role in identification and management of overweight and obesity Will be the site for dedicated adult weight management services for BMI>40 or 35 with comorbidities
![BMI>35 & comorbidity] n=92,573 BMI>35 & T2DM with complications.](/docs-images/90/103886018/images/33-2.jpg "n=11,231 Current service provision SVUH/SCH (est. 2001) GUH (est. 2006) ~50 cases per year <0.")
33 Bariatric Surgery - Current Status 1.1 million obese adults in Ireland 1.13 billion per year Numbers eligible for Bariatric Surgery 1 11,231 NICE criteria: [BMI>40 or BMI>35 & comorbidity] n=92,573 BMI>35 & T2DM with complications. n=11,231 Current service provision SVUH/SCH (est. 2001) GUH (est. 2006) ~50 cases per year <0.1% of demand 1. O Neill, Finucane, le Roux et al. SOARD 2017
34 By 2025: National Programme Draft Vision: Bariatric Services One specialised service in each Hospital Group Hub & spoke model Surgery performed in Model 3 & 4 hospitals Follow-up & outpatient services - Model 2 Phased Introduction: : Develop services in SVUH & GUH cases per year : Roll out a successful template to approx. 4 other Centres Paediatric & Adolescent Service must be grown with a single National surgical service
35 National Programme Progress to date Central Mental Hospital Clinical Lead in post National Clinical Advisor Group Lead Acute Hospitals Children's Hospital Group ICGP Sep 17 Dec 17 Jan 18 Feb 18 Programme Manager in post Assistant National Director Health Protection Healthy Eating Active Living Prevention Programme National Dietetic Advisor Members of: ASOI IrSPEN NCP Diabetes NCP Pediatrics Obesity Policy Implementation Group Healthy Ireland Demonstration Project
36 National Programme - Draft Workplan 2018 Initiate Model of Care Central Mental Hospital Minister of Finance Inaugural CAG Meeting Initiate Model of Care Paediatric & Adolescent Initiate Review ICGP Algorithms March 17 Minister of Health Healthy Eating Active Living Prevention Programme Initiate Centre(s) of Excellence Bariatric Services AHP Engagement NCP Diabetes: Diabetes Prevention Gestational Diabetes Metabolic Services Begin to consider Knowledge & Skills Framework Competency Framework Role & Responsibilities (5A s) Healthy Ireland Demonstration Project
37 Outline of talk Obesity the backdrop HSE Lead Update Research
38
39
40
41 Circulating Immune System 10 mls (1 tablespoon) of blood drawn from each patient day 1 Contains 20 million white cells Divided into functional subtypes based on size and surface markers
42 Cell subtypes determined by size and different surface markers CD3 6B11
43 Different Subtypes 60-80% 10-15% 5-15% 1-5% 0.1-1% 1-3% T cells B cells NK cells γδ T cells inkt cells MAIT cell 60-70% 30-40% Myeloid Cells CD4+ T helper cell CD8+ Cytotoxic T cell Monocyte Dendritic Cell Macrophage
44 Natural Killer (NK) cells Lymphocyte subset (ILC-1) Approximately 10-15% of lymphocytes NK cell Found in circulation also tissue resident Innate effector cells (subsets have memory) Anti-tumour/viral function (lytic granules & Th1 cytokines)
45 CD56 NK cells NK cells (% % Lymphocytes) NK cells are depleted in obese children Lean Obese *** 15 CD Lean Obese
46 Obese NK cells show increased levels of lipid fatty infiltration
47 Obese NK cells show inability to take aim at tumour cells
48 The fatty infiltrate reproduces the defect
49 Obese NK cells show increased levels of lipid fatty infiltration
50 The Italian Manager
51 The NK cell is like its owner..
52 Benefits of 10% weight Loss Mortality Blood pressure Diabetes Lipids >20% in total mortality >30% in diabetes related deaths >40% in obesity related deaths of 10 mmhg systolic and 6 mmhg diastolic pressure 50% in fasting glucose 10% total cholesterol 15% in LDL 30% in triglycerides 8% in HDL Jung 1997
53 Summary Childhood obesity is the biggest health challenge we face The immune system is defending weight loss Replace sugary drinks with water & watch portion size Be active for more than 1 hour and sleep for 8 hours daily Porridge or Weetabix only cereals in house
54 Need similar attitude to children not smoking
The role of the health care professional in the obesity epidemic
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