OBESITY- A GLOBAL PANDEMIC CHALLENGES IN HEALTH INITIATIVES AND IMPLICATION NOR SHAFFINAZ YUSOFF AZMI JABATAN PERUBATAN HOPSITAL SULTANAH BAHIYAH

Transcription

1 OBESITY- A GLOBAL PANDEMIC CHALLENGES IN HEALTH INITIATIVES AND IMPLICATION NOR SHAFFINAZ YUSOFF AZMI JABATAN PERUBATAN HOPSITAL SULTANAH BAHIYAH

2 Content Epidemiology Health risk associated with obesity Implication of untreated obesity Treatment and education

3 Obesity Latin Ob over Esus eat obesity stout, fat, plump Disease

4 What is obesity? Abnormal accumulation of body fat, usually 20% or more over an individual's ideal body weight. Health implications Reduced life expectancy and work productivity Psychological well being Social stigma

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6 Definitions of obesity (kg/m2) Overweight : Obesity class 1 : Obesity class 2 : Obesity class 3 : 40 Super obese : 50 kg/m2 ( IW > 225% / > kg) Super super obese : 60 kg/m2 (> IW 275%/ > 150kg) Mega : 70 kg/m2

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14 When does it happen? Reduced physical activity walk less more time sitting down than walking less housework in front of TV, gadgets, computers No exercise Increased unhealthy food consumption More CHO Less protein and fibre More fast food More simple sugar and carbonated drinks

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19 What are the benefits of weight loss?

20 Weight reduction Improved quality of life Less depressed Easier to find work Easier to find partner Feels good about themselves 5 10% weight loss associated with reduction Arthralgia Stroke risk CAD risk Obstructive sleep apnea (OSA) risk reduced need CPAP/ nasal PAP Hormone related malignancies

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27 When to intervene? Patient- driven Enough is enough Goals to be reached e.g marriage, pregnancy, see children graduate, live to see grandchildren Seeks help HCP-driven Medically compromised

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32 Prevalence MetS in adolescent in Malaysia Do the prevalence and components of metabolic syndrome differ among different ethnic groups? A cross-sectional study among obese Malaysian adolescents. Narayanan P et al Metab Syndr Relat Disord 9: Cross-sectional study among 335 obese adolescent boys and girls aged years from 10 randomly selected schools

33 Prevalence MetS in adolescent in Malaysia Obesity - 8.4% 33% - MetS >90% of obese adolescents - at least one metabolic abnormality. Prevalence MetS - obese boys 40.2% - obese girls 17% Boys - higher mean WC and triglycerides - lower HDL-C

34 Prevalence MetS in adolescent in Malaysia Increased WC, TG and HPT - most prevalent (34.3%) risk factor combination followed by WC, low HDL, and high blood pressure (22.5%). Indians % Chinese -33.8% Malays -27.4% Chinese - TG Malay Indian - HPT - HDL/ IR/ obesity

35 Prevalence MetS in adolescent in Malaysia CONCLUSION: Indians had the highest prevalence of metabolic syndrome. Increased WC and triglycerides and high blood pressure comprised the most prevalent risk factor combination.

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37 How to prevent Education to all age group Basal metabolic rate (BMR) decreases with increasing age How to increase BMR/ not get obese? Limit carbohydrate and refined sugar intake Increase physical activity

38 Obesity What Why Is obesity Does it happen When Bother? Intervene? Does it happen How To intervene? Does it happen? To prevent? Where To begin?

39 Begin by asking. Are you READY to lose weight? WHAT have you DONE so far to lose weight? Prepared for hard work, discipline? Motivated and committed?

40 Obesity Clinic layout History Examination Investigations Education Support group

41 Questions the beginning Birthweight Are parents/ siblings overweight/obese? Fattest in class? In which standard/ form? What made you became obese? Were you a subject of ridicule? How does being obese made you feel? Are you isolated in school, workplace? Are you bullied?

42 Questions What was your weight before university/ college? Weight before marriage? Weight before 1st childbirth? Any stressors? Describe your typical meal pattern in a day Snacks? Beware: obese person ALWAYS underestimate what they eat and most time they don t really eat (tak makan sangat/ makan sikit saja/ skip meals

43 Examination BP Acanthosis nigricans PR Weight Height BMI Coarse hair, hoarse voice, slow relaxation phase of DTR Waist circumferance Neck circumferance Proximal myopathy, purplish red striae, dorsocervical hump, hirsutism, rounded face

44 Weight Management Progress MRN: 1st Visit Date:.. Dr. In charge: Dr.. NAME:... Dietitian In charge: TARGET WEIGHT (kg):.. HEIGHT (meter):... AFTER /MONTH DATE WEIGHT(kg) WAIST CIRCUMFERENCE (cm) BMI (kg/m2) BLOOD PRESSURE HEART RATE ** PHYSIOTHERAPY ** DIETITIAN ** Please fill in the date after seen by the staff

45 *prior to First Obesity Clinic Visit. Biochemistry. 1. Renal Profile 2. Liver Function Test. 3. Calcium, Phosphate OH Vit D 5. Fasting Blood Glucose. 6. Lipids Profile. 7. Urine Albumin (ACR) 8. Serum Uric Acid Haematology 1. Full Blood Count. Endocrinology. 1. Thyroid Function Test. 2. FSH 3. LH. 4. Oestradiol. 5. Testosterone. 6. Prolactin 7. SHBG, Free Androgen Index. 8. HbA1c. 9. +/-24 hour urine cortisol. BLOOD TESTS FOR OBESITY CLINIC.

46 Components of successful weight loss Motivation and goal plan Reasonable weight loss goal Dietary management Physical activity Behaviour modification Family involvement

47 What we do in obesity clinic Obesity FMSS \WEIGHT MANAGEMENT (2).docx Weight loss plans Goals : short, medium and long term

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51 Hydrotherapy

52 Pedometer

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54 Goals for obesity therapy 1. Achieve weight loss 2. Maintain lower body weight 3. Prevent further weight gain 4. Treat comorbidities / underlying causes

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56 Behaviour therapy More than WHAT to change HOW to change Facilitate self monitoring Set goal Problem solving Weight loss 8-10% over 6/12 Structured daily meals and activities Support group Jeffrey RW. J Consult Clin Psychol. 1998

57 Obesity support group Peer counselling Tell of feelings Vent out anger, frustrations Receive support because everyone has similar problems and understands Tips and tricks on weight loss from successful patients

58 Medical therapy Phentermine Acts on neurotransmitter NE to reduce appetite 3/12 use only S/E : HPT/ tachycardia/ insomnia/ headache/ anxiety Sibutramine NE + serotonin reuptake blocker : increase satiety S/E : Depression and suicidal Orlistat Pancreatic lipase inhibitor Greasy stool, stool incontinence

59 Surgical intervention: Why is it needed? Do all patients need it? Most effective treatment for obesity Colquitt JL et al. Cochrane database Long-term weight loss 14-25% at 10 years Improvement in obesity-related conditions Decrease in overall mortality 29% reduction vs standard weight loss procedure Sjostrom L et al. NEJM 2007

60 When is it needed? BMI > 40kg/m 2 BMI > 35 kg/m2 with important co-morbidity e.g DMT2, uncontrolled HPT and severe OSA Failed other form of therapies ** Suitability of candidate criteria must be fulfilled first ** Complete pre-op assessment mandatory

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67 Summary Obesity associated with many adverse health outcome and shorter lifespan Prevention is the best treatment and education to high risk group is important Obese patients will lose weight with structured meal plan, exercise and behavioural therapy if adhere strictly and disciplined Sustained weight reduction reduces morbidity and mortality

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69 THANK YOU FOR YOUR ATTENTION, I REALLY APPRECIATE IT BUT YOU HAVE TO GET UP NOW TO MOVE BEFORE THE NEXT SESSION BEGINS