Improving outcomes for patients with obesity

In England there has been a sharp increase in the prevalence of overweight and obesity in adults. In 1993 58% of men and 49% of women were classified as overweight or obese compared with 65% and 58% respectively in 2011; 24% of men and 26% of women were classed as obese in 2011. Body mass index (BMI) is the most commonly used measure to classify people into weight categories. While the use of BMI has limitations, as it does not take into account the difference between muscle and fat, it is a good quick indicator of increased risks. Obesity increases the risk of hypertension, coronary heart disease, deep vein thrombosis and pulmonary embolism. It is also associated with an increased risk of certain cancers. Obesity is an important risk factor for non-alcoholic fatty liver disease which if left untreated can progress to severe forms of liver disease, such as non-alcoholic steatohepatitis, fibrosis and cirrhosis. The risk of sleep apnoea is raised in obese individuals as is that for gastro-oesophageal reflux and gallstones, stress incontinence in women and erectile dysfunction in men. Lifestyle weight management programmes should be multicomponent, developed by a multidisciplinary team, and delivered by individuals who have undergone appropriate training. They should focus on long-term weight loss and prevention of weight regain and continue for a minimum of three months. Effective programmes include setting dietary targets, such as specific reductions in energy intake. Other options that GPs and practice nurses might offer within the practice, over and above referral to lifestyle programmes, include help with intermittent or regular motivational support, and/or drug therapy.