Obesity: Time for a New Approach in General Practice? Part 1

Obesity is a complex problem, with enormous costs to individuals, the NHS and society. With the problem getting worse, perhaps it’s time to consider new approaches to tackle this condition.One option is a population health approach in general practice. by Ishraga Awad, Sarah Cuschieri, Michelle A Miller and Claire Beynon School of Public Health Special Interest Group for Primary Care and Public Health The first two articles on this subject provide more detail.

The starting point for dealing with obesity is understanding that obesity is not a lifestyle choice.

World Health Organization defines obesity A complex chronic disease in which abnormal/excessive body fat (obesity) impairs health, increases the risk of long-term medical complications, and reduces life expectancy. It’s a paradigm shift. And when it comes to working on an individual and collective level, it has a big impact on our approach.

Obesity is a very complex issue. It is influenced by intrinsic and extrinsic factors, including genetic/epigenetic, biological, behavioral and mental health.

External factors include economic, social, cultural, and commercial determinants that can overwhelmingly limit or completely eliminate individual choice and control. It directly and indirectly affects health inequalities. Obesity is the cause and effect of disease, poverty, poor education and poor employment opportunities.

Then there is stigma. The role of stigma in perpetuating state is well documented. Stigma is a barrier to effective healthcare because it exists among healthcare professionals and affects how they treat patients. And internalized stigma exacerbates the problem. Guilt and shame, poor body image, low self-esteem, and poor mental health leading to anxiety and depression are often direct causes of declining health consciousness. Patients rarely come to her GP to complain about their weight.

Why should I worry?

The costs at the societal level are enormous. The government estimates these at £6.1 billion for the NHS and £27 billion for the wider society (1).

On an individual level, obesity affects all organ systems in the body. This leads to metabolic problems such as non-alcoholic fatty liver disease (NAFLD), CVS disease and type 2 diabetes. It also affects psychological health – low self-esteem, depression, anxiety – and neurological problems such as chronic pain and neuropathy. I have. Obesity reduces quality of life and life expectancy. A patient with a BMI of 40 or more has a 50% chance that he will die before the age of 70.

During the pandemic, obese people experienced a 3-fold increased risk of experiencing severe illness and requiring hospitalization with COVID-19. And the effect didn’t stop there. The pandemic has contributed to rising rates of obesity, especially among children. The obligation to stay home and social isolation, along with increased anxiety and stress, have taken a toll. This resulted in more comfort food and snacking and less physical activity.

Overweight and obesity affect 60% of adults and one in three children (29% of boys and 27% of girls) in the WHO European Region. UK figures are similar for 63% of adults (see Table 1 below).

How can I manage it?

The WHO report on obesity in the European region focuses on managing obesity throughout life and addressing the circumstances that lead to obesity. We need a clinical pathway that can provide appropriate and prudent consultations leading to targeted management interventions.

Clinical approaches should be used with multicomponent behavioral interventions to achieve optimal efficacy. Lifestyle support through health coaching and lifestyle medicine approaches is an essential adjunct to other interventions for long-term weight management.

Key management interventions include sleep monitoring (see box). Sleep quality and duration are important factors in weight gain, failure to lose weight, and weight loss maintenance in adults and children.

Another important intervention is clinical psychology. Several non-normative eating behaviors have been observed in obese patients. Examples include emotional eating, binge eating, food addiction and cravings, biting and grazing. These disorders can affect patients after bariatric surgery and lead to weight loss or poor weight regain. There is a nature.

management intervention

Clinical nutrition should also be included in dietary interventions that promote healthy eating, which is essential for the prevention and management of childhood obesity. Additionally, nutritionists are important in supporting adults to maintain long-term weight loss.

Physical activity is another intervention to consider. This is of particular importance in the prevention/management of childhood obesity.

And then there is drug therapy. Pharmacotherapy is indicated as an adjunct to diet and physical activity for chronic weight management in obese (BMI >30 kg/m2) and overweight (BMI >27 kg/m2 or >28 kg/m2 with orlistat comorbidities). will be NICE guideline CG189 – updated September 2022 – recommends liraglutide for patients referred to Tier 3 services. However, it cannot be prescribed in primary care.

A systematic review and meta-analysis (n = 29,018) comparing drug therapy dose reduction and adverse events for obesity in overweight and obese adults compared placebo, orlistat, liraglutide, and other treatments not licensed for use in the UK. lorcaserin, naltrexone-bupropion, and phentermine-topiramate) were all associated with achieving weight loss of at least 5% at 52 weeks compared with the method. Liraglutide and phentermine topiramate were most likely to achieve weight loss of at least 5%. [2]

Finally, there is endoscopic surgery and bariatric/metabolic surgery. Surgery remains the most effective treatment for obesity, with reported benefits for type 1, type 2 DM, and NASH/NAFLD. For this intervention, the role of primary care is primarily timely referral and postoperative follow-up.

population health approach

Population health approaches consider broader determinants of health. the impact of obesity, the impact of inequality, the role of partnerships – health in all policies, and community resources.

Importantly, population health approaches need to consider primary care referrals, contracts, and broader health system resources. This includes managing patients within the context of their living, working and community contexts. We also consider the broader social, cultural, and environmental factors that determine these conditions (see below).

Of course, many of these factors are outside the direct influence of common practice, except within effective multi-agency partnerships. That’s not to say it can’t be done. Part 2 of this short series will show you how.

References:

1. NICE Guidance CG189, updated October 22, 2002
2. Kera, R., Murad, MH, Chandar, AK et al. (2016) Association of pharmacological treatment of obesity with weight loss and adverse events: a systematic review and meta-analysis. jam 315(22), 2424-2434.
3. Cappuccio FP and others meta-analyses of short sleep duration and obesity in children and adults. sleepy. 2008 May;31(5):619-26; Miller MA et al. Sleep duration and incidence of obesity in infants, children and adolescents: a systematic review and meta-analysis of prospective studies. sleepy. April 41, 2018 (4)
4. Spiegel K et al. Shorter sleep in healthy young men is associated with lower leptin levels, higher ghrelin levels, and increased hunger and appetite. 2004;141(11):846-850. 55
5. Cappuccio, FP, and Miller, MA (2011). Is prolonged sleep deprivation associated with obesity? BMJ: British Medical Journal, 342. (Editorial)

Ishraga Awad, PhD, GP and Public Health Specialist, Sarah Cuschieri, MD, PhD (Public Health), Michelle A Miller, PhD, Associate Professor of Biomedical Medicine, Warwick University, Warwick Medical School, Department of Public Health, Claire Beynon, Deputy Director Health , Cardiff, Vail District Public Health Team. Cardiff and Vale University Health Commission.

This article is a sister title healthcare leader