Overweight (BMI)

Obesity is the result of eating more calories than the body can burn or use on a regular basis, however weight control is more complex and depends on many factors.

• The body then stores the excess calories as fat.
• As the extra calories are consumed each day, the body continues to accumulate extra fat stores, leading to obesity.

VerywellHealth

• It is characterized by excess adiposity (the state of having an excess of body fat) that leads to alterations in the function of tissues, organs, or the individual’s overall ability to perform daily activities.
• The aim is to regain or improve body functions that have been impaired by excess body fat.

Preclinical obesity

• Refers to individuals who have excess body fat but do not currently have health complications directly resulting from this adiposity (the state of having an excess of body fat). However, they are at significantly increased risk of future obesity-related health issues.

Metabolically obese normal weight

• The condition in which an individual has a normal weight but exhibits metabolic health issues typically associated with obesity is often referred to as “metabolically obese normal weight”

Obesity Life cycle

Obesity should be monitored from the moment of pregnancy (never diet and have the intention to loose weight in pregnancy but instead eat healthy and do moderate exercise) to when the child is born to teenager to adult hood.

• Pregnant women attending their first appointment with a midwife were either overweight or obese.
• Evidence shows a significant relationship between maternal obesity and the birth of babies above a normal weight range, and the subsequent development of childhood and adult obesity.
• Children who live in a family where at least one parent or carer is obese are more at risk of becoming obese themselves.
• Children with obesity are more likely to be obese in adulthood and thus increase the risk of obesity for their own children in later life.
• Poor diet and a low levels of physical activity are the primary causal factors of excess weight.
• This can lead to:
  • Stigmatisation
  • Low self esteem
  • Poor psychological and emotional health
  • Bullying
  • School absence,
  • Increased later ill health and/or disability
  • Premature mortalilty in adult hood

Obesity and excess weight are significant health issues for adults across the life course and into old age.

• Carrying excess weight can have significant implications for an individual’s physical and mental health.

Some of the significant issues are:

• Reduction in life expectancy by 3 years on average. Severe obesity reduces it by between 8 and 10 years
• Less likely to be in employment
• Discrimination and stigma
• Increased risk of hospitalisation

Many factors affect obesity, examples are shown below and they are not all one fault, it is simply not the case that it’s the individual fault:

Psychosocial

The term ‘psychosocial’ relates to the way that social factors affect states of mind. Psychosocial influences play a role in what people eat and how active they are. For example:

• Social and cultural norms and family habits are a strong influence on taste preferences and dietary choices
• Food consumption – the what and how much – can be affected by emotional states
• Often people experiencing challenging circumstances are less able to make decisions that favour long-term benefits; therefore making healthy choices may be more difficult for those living in such circumstances

Behavioural

• Our daily lives are filled with choices, whether it is the food we eat or how active we are. However, many of these are automatically formed around our habitual behaviour.
• Habits are difficult to change, especially in an environment which encourages inactivity and the consumption of too many calories. It is almost inevitable that some people will gain weight and/or find it difficult to reduce their weight.

Biological and Physiological

There are a number of biological factors that can increase the risk of an individual gaining excess weight, especially when faced with an unhealthy environment. These include:

• Genetic predisposition
• Rare genetic conditions that can increase the risk of severe obesity e.g. leptin deficiency
• Certain medical conditions e.g. hypothyroidism
• Certain medications e.g. anti-psychotics
• Maternal and early life factors e.g. maternal obesity

Environmental

• Our environment tends to encourage unhealthy lifestyle choices relating to food and physical activity.
• Unhealthy food and drink choices (including alcohol) are easy to access and are often high in energy.
• We also tend to be less active and lead more sedentary lifestyles than previous generations, persons tends to rely more on technology, less manual jobs, increase travel time and longer hour jobs.

What Group is Most Affected And What Inequalities Are Associated With Obesity?

Obesity affects many. However it does not affect all groups equally, it is more common among:

• Women from more deprived areas
• Children in poor deprived areas.
• Older age groups (above 45 years)
• Some black and minority ethnic groups i.e. Indian, Pakistani, Bangladeshi groups.
• People with disabilities

e-Learning for Healthcare

BMI calculator

weightwatchers

Weight Loss treatment

• Obesity is a serious issue that need tackled, not only can it lead to heart disease and cancer.
• It is about consuming less calories than body needs to function and can affect our social life, finances and our well being.

Body Mass Index

• This reading should be used as a guide to check if one is under or overweight.

BMI does not take account of:

• High muscle mass
• Bone density
• Age
• Sex
• Ethnicity
• Fluid retention
• Loss of limbs
• Overall body shapes
• Genetics
• Fitness
• Pre-existing disease
• Size
• Metabolism (how quickly one burns energy)
• Are under 18 years old (please click link to calculate BMI for children and teenagers)
• Are pregnant
• Adults who loose muscle as they get older (may fall into ‘healthy weight’ range even though they have excessive fat.
• Have been diagnosed with an eating disorder, or think you may have one
• Have a condition that affects your height
• Further information

Video link to measure height and weight:

• Remove shoes, keep hair down, afros and turbans can’t be measure accurately.
• Ask person to look straight ahead, top of ear canal should be inline with cheekbone.
• If patient can’t stand there is a method to measure via the arm but must be done by a trained medical professional in anthropometry
• Make sure weight machine is calibrated to zero before using.
• Person place feet on the right part of machine (stand in centre of machine with weight distributed evenly through their feet onto the scale) and does not lean to one side,
• Remove any jewellery, heavy jacket and clothing and empty pockets to obtain an accurate reading.
• Operate the machinery to the manufactures instruction and make sure one waits (wait for fluctuations to settle) for the final reading.

Waist size

Video link to measure waist

• Do not rely on cloth measurements it can vary.

BMI determines the degrees of overweight or obesity in adults and is associated with health risk, it does not make any specific measurement of fat , therefore one can have a high BMI with low fat i.e. athletes, physically muscular and or highly physical active and ethnic background persons  with a healthy BMI reading can still be at risk of medical conditions such as diabetes , hence waist size needs to be measured and these reading need to be considered as well.

• Middle eastern, Chinese, South Asian, Afro- Caribbean, Black Caribbean have a high risk of diabetes type 2 despite normal BMI range hence need alternative measurement, and on top of that it varies with in Asian ethnicities so there are no valid cut off points on measurement, therefore WHO guidelines are recommended as International classification rather than specific to races.
• Waist circumference provides information on distribution of fat particularly central adiposity (overweight/obese).
• Patient with abdominal or central distribution of fat increased risk of cardiovascular risk  and increased insulin resistance.
• More fat you have it leaks a chemical which stops glucose being used correctly  and  it increases insulin resistance.

Box 1: International guidance on BMI/waist circumference thresholds

Waist circumference guide (regardless of BMI):

BMI and Waist size guidelines (and its relationship) and when to see your medical doctor

Men

Women

If there is a risk of disease one should make an appointment to see their medical doctor

• One needs to see your medical doctor
• One needs to see your medical doctor urgently

Intervention:

When one needs to do something about their weight and fat distribution

• The level of intervention is related to waist circumference, BMI and  current health condition

1. General advice on healthy weight and weight loss
2. Diet and physical activity
3. Diet and physical activity and consider medicine
4. Diet and physical activity and consider medicine/surgery

NICE Clinical Guideline 189

1. General advice on healthy weight and weight loss
2. Diet and physical activity
3. Diet and physical activity and consider medicine
4. Diet and physical activity and consider medicine/surgery

NICE Clinical Guideline 189

When to consider medication

• Use of medication will only be considered if you are overweight and have met the criteria above, only obtain from a medically trained healthcare professional.

When to consider surgery

• Please note if one has a BMI greater 35kg/m2 with Comorbidity or  greater than BMI 40kg/m2, surgery intervention should be considered.
• If has a BMI 30-34.9 kg/m2 and one has poorly controlled diabetes and has tried and failed to achieve clinical beneficial weight by all appropriate non- surgical methods including medication.

Waist to height ratio

Other methods to check Obesity is the waist to height ratio, it takes account of excess fat around the abdominal area.

• It is not useful in patients:
  • Adult with a BMI over 35
  • The person you’re using it for is under 5 years old
  • Pregnant
  • Diagnosed with an eating disorder, or think you may have one
  • Growth disorder or any other condition that affects your height

• One measure their height and waist circumference and calculates the ratio.
• Height divided by waist circumference (measure as above) in the same units cm or inches.

For example if has a waist circumference 81.2cm and is 170cm tall, his ratio is: 81.2/170 = 0.47 which is a healthy condition.

• Healthy = 0.4- 0.49
• higher risk = 0.49- 0.59
• Increased higher risk 0.6 or more

The aim is to maintain a ratio of 0.5 or less, if higher than 0.5 please talk to a healthcare professional on measure to loose weight.

Intervention:

When one needs to do something about their weight and fat distribution

• The level of intervention is related to waist circumference, BMI and current health condition based upon waist to height ratio:

1. General advice on healthy weight and weight loss
2. Diet and physical activity
3. Diet and physical activity and consider medicine
4. Diet and physical activity and consider medicine/surgery

When to consider medication

• Use of medication will only be considered if you are overweight and have met the criteria above, only obtain from a medically trained healthcare professional.

When to consider surgery

• Please note if one has a BMI greater 35kg/m2 with Comorbidity or  greater than BMI 40kg/m2, surgery intervention should be considered.
• If has a BMI 30-34.9 kg/m2 and one has poorly controlled diabetes and has tried and failed to achieve clinical beneficial weight by all appropriate non- surgical methods including medication.