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Weight Loss Treatment Service - OBESITY

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What is obesity?
Obesity is more than just a few extra pounds.

Obesity is the heavy accumulation of fat in your body to such a degree that it rapidly increases your risk of diseases that can damage your health and knock years off your life, such as heart disease and diabetes.

The fat may be equally distributed around the body or concentrated on the stomach (apple-shaped) or the hips and thighs (pear-shaped).

For medical purposes, the body mass index (BMI) is used to determine if your weight is in the healthy range.

Doctors use BMI because it compares your weight against your height.

  • You are in the normal range if your BMI is between 18.5 and 25 (kg/m2).
  • You are overweight if your BMI is between 25 and 30.
  • You are obese if your BMI is 30 or higher.
  • You are morbidly obese if your BMI is 40 or higher.


Body mass index
Your body mass index (BMI) is a good estimate of how much of your body is made up of fat. It relates your weight to your height. You can work out your BMI by dividing your weight (in kilograms) by the square of your height (in metres).

So, for example, if you weigh 70 kg and are 1.75 metres tall, your BMI is 70 / 1.75 x 1.75, which is 22.9.


How common is obesity?
Around one in four men and one in three women in the UK are overweight, according to government statistics.

While slightly more women than men are obese (24 per cent versus 23 per cent), in the last ten years there has been a greater increase in the number of men who are obese.

The Department of Health predicts that if this trend continues, by 2010 around 6.6 million men will be obese compared to 6 million women.

Stomach obesity, where weight is concentrated on the tummy, is the most common type of obesity and affects 30 per cent of adult men.

Obesity and stomach obesity are rapidly increasing, especially in young people.


What problems can obesity cause?
Psychologically, being overweight can affect your body image and damage self-esteem. In some cases this can cause social anxiety and depression.

Common physical problems include:

  • difficulties breathing
  • difficulties walking or running
  • increased sweating
  • pain in the knees and back
  • skin conditions such as acne
  • gallstones.

The following medical conditions are also more common in obese people than in those of normal weight:

  • high blood pressure
  • high cholesterol
  • diseases related to hardening of the arteries such as heart attack and stroke (cardiovascular disease).
  • type 2 diabetes
  • some types of cancer.

These conditions are often known as obesity-related diseases and are some of the most common causes of death before the age of 75. This is why obesity increases your risk of mortality.


Weight Loss

The best way to lose weight, and keep the weight off, is to be committed to a change in lifestyle. This includes eating a healthy diet and doing some physical activity on most days for about 60 minutes.


Weight Reduction - How to Lose Weight Top Ten Tips

  • The main portions of your meals should be made up from starch-based foods (such as bread, cereals, potatoes, rice, and pasta), and fruit and vegetables.
  • Cut out as much fat as you can from your diet. Fat contains twice as many calories as starchy or protein foods of the same weight. Tips include: use low fat spreads on bread; measure out oil when cooking; grill food instead of frying it; cut off excess fat from meat; choose leaner cuts of meat in smaller portions. Watch out for hidden fat in cakes, biscuits, pastry, chocolates, crisps, chips, pies, and pasties. Eat low fat versions of milk, cheese, yoghurt, etc, which have the same calcium content as 'full-fat' versions, but less calories.
  • Low fat foods are generally best. But remember, some low-fat foods and drinks are high in calories such as alcohol, sugary drinks, and sweets. Have water as your main drink.
  • It is best to eat three healthy meals each day, including breakfast. Eat each meal slowly. Don't skip meals. Skipping meals will just make you feel more hungry, make you think more about food, and you are more likely to overeat in the evening. Do not snack between meals.
  • Do as much physical activity as you can. If you are not used to it, try starting with an extra 30 minute brisk walk every day, and build up from there. Any increase in walking, dancing, swimming, cycling, etc, is good. Try and build up the amount of activity you do each week until you are doing 60-90 minutes on at least five days a week.
  • Consider keeping a diary to monitor the amount that you eat, and the amount of physical actvity you do. This may help you become aware of your changing behaviour patterns.
  • Plan what you are going to eat each day, rather than look in the cupboard or fridge to see what is there. Don't shop for food when you are hungry. Shopping after a meal is best.
  • Be realistic. You do not need to aim for a 'perfect' weight. If you are overweight or obese, you are likely to get most health benefits from losing 5-10% of your weight (often 5-10 kg).
  • It is best not to lose weight too fast. If you lose more than a kilogram per week, you may lose muscle tissue rather than fat. It is best to lose an average of ½-1 kg per week (about 1-2 lb per week). To do this you need to eat 500-1000 calories per day less than you did before. You will lose 6-12 kg if you keep this up for three months. Don't be disheartened by minor increases or levelling off in weight for a few days. Look for the overall trend over months.
  • Tell others about your plans to lose weight. Support from family and friends can help you to stay motivated. Consider joining a local slimming club or similar support group.


Orlistat (Xenical)- Help With Weight Loss
Orlistat is a drug that can help you to lose weight if you are obese or overweight. It works by interfering with the way that fat is digested and absorbed into the body. Doctors have guidelines as to when orlistat can be prescribed. If you take orlistat, as it may possibly interfere with the absorbtion of some vitamins, you should take a multivitamin supplement at bedtime. Tell your doctor if you take any other drugs as orlistat can interfere with the absorbtion of some drugs. Common side-effects include headache, urgent or increased need to open the bowels, flatulence (wind) with discharge, and oily or fatty stools.


How does orlistat work?
Orlistat works by blocking chemicals (enzymes) in your gut which digest fat. Nearly a third of the fat that you eat is blocked by orlistat. The undigested fat is not absorbed into your body, and is passed out with your faeces (stools). The normal dose is one capsule, three times a day with each meal. However, you do not need to take one if there is no fat in the meal or if you miss a meal.


How effective is orlistat?
Studies have shown that, on average, orlistat, plus a weight-reducing diet and exercise, causes more weight loss than a weight-reducing diet and exercise alone. Some people lose 10% or more of their body weight within six months with the help of orlistat. In others, it is less effective.

One reason why orlistat may not work is that you may think that you can relax your weight-reducing diet, and the orlistat will 'do it all'. This is not true. You still have to eat less. Remember, orlistat prevents only some of the fat that you eat from being absorbed (just under a third). But, if you do not keep to a healthy weight-reducing diet, and eat more fat (chocolates, cakes, etc), the extra fat that you eat will easily cancel out the effect of the orlistat.


References
Dr Roger Henderson, Obesity Clinical Knowledge Summaries (2008), NetDoctor, Patient UK, Practice Guidance: OTC Orlistat - Royal Pharmaceutical Society of Great Britain (2009).

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