Diabetes and Obesity Choose To Change A Tier 3 Weight Management Service ABL Health. Dr Sheena Bedi: Chief Executive

Transcription

1 Diabetes and Obesity Choose To Change A Tier 3 Weight Management Service ABL Health Dr Sheena Bedi: Chief Executive

2 Hull ABL Health Services Wigan Tameside & Glossop St Helens Oldham Lancashire Manchester Stockport East Cheshire Salford Wirral

3 Obesity Costs and Consequences 1993: 13% 2012: 24% 2025: 50% M, 33% F 2050: 60% M, 50% F, 25% children 50bn/yr direct & indirect 4.2bn/yr direct 5.1bn/yr consequences life expectancy 9 yrs

4 Diabetes and Weight 12.4% of obese adults have diabetes 1/3 of predicted rise in diabetes prevalence by 2030 attributable to obesity (6% 9.5%) 7 x greater risk of diabetes if obese (vs healthy weight) Higher risk of death in diabetics if BMI

5 Diabetes and Weight 90% of aged 16 54y with T2D are overweight (NDA) Most deprived quintile 40% more likely to have T2D (PHE) Obesity = T2D Men with increased waist Circumference 5 times more likely to have T2D compared with women 3 times Duration and age of onset of obesity

6 Diabetes and Weight Good News Excess weight main modifiable risk factor for T2D Up to 80% of T2D cases can be delayed or prevented by making lifestyle changes. (NICE/Diabetes UK) Weight management interventions generate biggest savings through preventing diabetes Weight management is recommended for anyone considered high risk of developing T2D BMI 25+ BMI 23+ (South Asian or Chinese descent) (NICE)

7 Adult Obesity

8 Obesity Rates ADULTS England North West Overweight 40.4% 41% Obese 24.4% 25.6% Combined 64.8% 66.6%

9 6 boroughs in GM, St Helens BMI > 35 Choose To Change Tier 3 NICE compliant bariatric pathway support Health professional referral 12 month programme intensive intervention and maintenance support 4,000 assessments since 2015

10 Choose To Change Tier 3 Since ,000 assessments since % Type 2 diabetes 41% pre diabetes

11 Choose To Change The Team Specialist GPs Psychological therapists Dietetic support Physical activity specialists Lifestyle coaches Consultant endocrinology / obstetric support MDT review Project Management / business intelligence

12 Choose To Change The Service Holistic care / behaviour change Care closer to home Multidisciplinary assessment (MDA) Group & 1:1 interventions Bariatric pathway Domiciliary pathway Nutrition support Psychological interventions Physical activity support Maternity programme LTC Pharmacology MDT / case management

13 Medical Assessment - Tier 3 Cardiovascular disease Peripheral vascular disease Cerebrovascular disease Carotid artery disease Aortic aneurysm Dyslipidaemia Hypertension Type 2, Diabetes Thyroid disorder Joint problems Gallbladder disease Gout Sleep Apnoea Syndrome Subfertility PCOS Cancer (endometrial, breast, colon) Urological problems Alcohol dependence Prader Willi Syndrome Obesity hypoventilation

14 Psychological Assessment Tier 3 Learn about any significant current psychological or behavioural barriers to weight loss Make informed decisions about appropriate pathway through the service Start the motivational enhancement process

15 Psychological Assessment Psychosocial barriers: depression, anxiety, psychosocial distress, bereavement, core low self esteem, insufficient occupational engagement Behavioural barrier: compulsive/binge eating

16 Psychological Clinical Themes Binge eating 26% Binge eating + depression 35% Binge eating + bereavement 3% Depression 30% Anxiety and other 6% (total binge eating 64%) Serious loss / sexual abuse / domestic abuse

17 Bariatric Support 1 st April 2013 Adults >18y BMI 35+ with comorbidities or 40+ Obesity present for at least 5y Minimum 6m Local Specialist Obesity Service CCG funded from 2017 Gastric Bypass Sleeve Gastrectomy Duodenal Switch Gastric Band Education Recommendation Post op

18 Obesogenic Medication Corticosteroids (>7mg daily for >3m) Hypoglycaemic agents sulphonylureas, thiazolidinediones, insulin Antidepressants tricyclics, mirtazapine, MAOIs Anticonvulsants sodium valproate, gabapentin, vigabatrin Atypical antipsychotics olanzapine, clozapine, quetiapine, amisulpiride, risperidone B blockers Pizotifen Depot contraception

19 Our results No significant difference between weight loss outcomes of diabetic (Not on Insulin) vs. non diabetic patients Achieving 5% or more weight loss 55% Achieving 3% of more weight loss 73% 95% are GP referral 25% are T2D Patients on Insulin Achieving 5% or more weight loss 21% Achieving 3% or more weight loss 40%

20 Our Diabetes Support Diabetes Information and booklets Holistic review of clients conditions and how they are managing their diabetes Pharmacology Diabetes 1:1 and group information sessions and review for patients that require additional support Support delivery of the DESMOND educational programme

21 Focus on Prevention Nature vs nurture Nudge theory Prioritise young people Women as influencers Granular understanding of social structures Raising the issue

22 Measuring Childhood Obesity 23% Reception, 33% Yr 6: overweight or obese 9% Reception, 19% Yr6: obese 79% obese children obese adults Children Reception Obese Reception Combined Year 6 Obese Year 6 Combined England 9.3% 22.1% 19.8% 34.2% Northwest 9.8% 22.1% 20.6% 35.2%

23 Family Weight Management Family and home assessment / intervention Nutrition support Psychological intervention Physical activity levels Sedentary behaviour / screen time Self esteem Perceived body image Parenting efficacy & education Child protection

24 Effective 75% of children/young people completing, maintained or improved nutrition score 79.17% of children/young people completing, maintained or improved physical activity score 70.83% of parents completing, maintained or improved their own self efficacy 66.67% of children/young people completing, maintained or improved BMI of which; 41.67% reduced their BMI 25% maintained their BMI

25 To Finish Holistic care Obesogenic environment Invest on effective weight management interventions Children, families, communities Raise the issue

26 www. ablhealth.co.uk Head office Thankyou for listening