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Obesity Q n A - Ministry of Health Website

7 February 2014

Obesity  Q n A - Ministry of Health Website

Obesity questions and answers

Obesity is defined as an excessively high amount of body fat (adipose tissue) in relation to lean body mass. Obesity is associated with a substantially increased risk of a number of health conditions.

Why are we concerned about obesity?

There is evidence that obese children and adults are at greater risk of short-term and long-term health consequences.

Obese children are likely to be obese into adulthood and to have abnormal lipid profiles, impaired glucose tolerance and high blood pressure at a younger age. Obesity in children is also associated with musculoskeletal problems, asthma and psychological problems including body dissatisfaction, poor self esteem, depression and other mental health problems. Obesity is also associated with a long list of adult health conditions including Type 2 diabetes, ischaemic heart disease (IHD), stroke, several common cancers, osteoarthritis, sleep apnoea and reproductive abnormalities.

The impact of excess body weight on these diseases operates, at least in part, through its effects on insulin resistance, blood glucose, blood lipids and blood pressure. It is important to note that although BMI cut-offs have been used to define overweight and obesity, the risk of disease increases as BMI increases in all population groups, even those within the ‘normal’ range.

What causes overweight and obesity?

Overweight and obesity are the result of a positive energy balance – that is, a long term excess of energy intake (food and beverage consumption) over energy expenditure (basal metabolic rate, physical activity).

Although some people are more genetically susceptible to weight gain than others, the rapid increase in the prevalence of obesity in recent years has occurred too quickly to be explained by genetic changes and most experts believe it is due to living in an increasingly ‘obesogenic’ environment – one that promotes over-consumption of food and drinks and limits opportunities for physical activity.

How is obesity measured?

Body mass index (BMI) is a commonly used measure to classify underweight, overweight and obesity in both children and adults. BMI is a measure of weight adjusted for height and is calculated by dividing weight in kilograms by height in metres squared (kg/m2).

International cut-off points for adults aged 18 years and over
ClassificationBMI score (kg/m2)Risk of co-morbidity (multiple diseases)
Underweight < 18.50 Low risk (but risk of other clinical problems increased)
Normal range 18.50–24.99 Average risk
Overweight 25.00–29.99 Increased risk
Obese:

Obese (class I)

Obese (class II)

Obese (class III)

≥ 30.00

30.00–34.99

35.00–39.99

≥ 40.00

High risk

Moderate risk

Severe risk

Very severe risk

For children aged 2−17 years, BMI cut-off points developed by the International Taskforce on Obesity (IOTF) are used to define thinness, overweight and obesity. The IOTF BMI cut-off points are sex and age-specific, and have been designed to coincide with the WHO BMI cut-off points for adults at age 18 years

Tackling diabetes with weight loss surgery

Tackling diabetes with weight loss surgery

This is music to a Bariatric Surgeon's ears!! It is definitely good to hear people talking about the issues related to Obesity.  And, yes, prevention has not been taken seriously as yet.  It is an issue that needs a concerted effort on the part of regulators and politicians and health care providers alike.  Our society is obesogenic and the messages that come through to us in our everyday life promote overeating and sedentary activities as the norm.  This is going to be a very difficult process to reverse.  The good news is that Bariatric Surgery is an effective treatment for Type 2 Diabetes and the other metabolic consequences of being obese.  This is now accepted by both Surgeons and Medical Physicians such as Dr Jeremy Krebs as quoted in the article below.  I personally think that this is a step in the right direction and that Weight loss surgery can be the turning point for lots of people who have lost the battle with their BMI.  If you want more information, please drop me a note through the website. Happy holidays! 

Steph Ulmer 

Bariatric Surgeon

 
Weight loss surgeries in New Zealand are on the rise, along with increased funding for the procedures.

Weight loss surgery (bariatric surgery) might not be the preferred way to reduce diabetes, but it's emerging as one of the most effective.

Surgeries like a gastric bypass or gastric banding could reduce the risk of developing type 2 diabetes by around 80 per cent in obese people, compared with standard care, according to new research published in The Lancet Diabetes & Endocrinology journal.

"Our results suggest that bariatric surgery may be a highly effective method of preventing the onset of new diabetes in men and women with severe obesity," says study author Professor Martin Gulliford of King's College London.

Other studies have shown bariatric surgery to reverse diabetes in some cases, sending it into remission in half to two-thirds of diabetic patients who have the procedure.

Though it's still not known how long these effects last, evidence for the case of surgical intervention is mounting.

Like most working in this field, Gulliford would prefer to see changes in people's environment so they don't become obese in the first place, but the problem is here and it needs addressing.

"Unfortunately, we are now faced with a situation in which about one quarter of adults are obese and one in 50 have morbid obesity (BMI over 40)," he told Fairfax from London.

Being overweight or obese is the main modifiable risk factor for type 2 diabetes.

"For people with morbid obesity, weight loss surgery may relieve or prevent some of their health problems. Over a 20-year perspective, the procedures are cost-effective."

MORE SURGERIES THE ANSWER?

So, does this mean weight loss surgery should be used more widely as an intervention for morbid obesity?

Gulliford is keen to know more, especially how weight loss surgery might be combined with other interventions, such as healthy eating and physical activity, as part of a diabetes prevention strategy.

But not everyone sees surgery as part of the answer. AUT professor of nutrition Elaine Rush says public dollars would be better spent on prevention rather than treatment.

"Long-term, prevention will give us the biggest bang for our buck compared with the 'ambulance at the bottom of the cliff' response."

Rush is all for bariatric surgery on an individual level, but says on a population level "we can't afford it".

"When you look at the cost-effectiveness of bariatric surgery, it's an enormous amount of money that has to be invested. But if you look at early childhood interventions, it costs much less for a longer-term outcome."

PUBLICLY-FUNDED OPTIONS FOR KIWIS

Funding for weight loss surgeries in New Zealand has already increased over the past four years, and with that, so have the number of procedures performed.

In the 2013/2014 year 399 publicly funded bariatric procedures were performed, compared with 131 procedures in 2007/2008.

With this year's budget it was announced $10 million would be set aside to fund at least 480 surgeries over the next four years, in addition to the bariatric procedures already funded out of DHB elective surgery budgets.

Different types of bariatric surgeries have their own pros and cons. Some not only restrict food intake by creating a very small stomach pouch for food to go into, but also have metabolic effects to combat diabetes.

According to Dr Jeremy Krebs, endocrinologist and a leading voice for diabetes in New Zealand, for some people surgery is the only option.

"There is unquestionably a place for bariatric surgery in the management of obesity, particularly for those individuals who have already developed either pre-diabetes or diabetes."

He says lifestyle interventions such as diet and lifestyle changes are obviously the preferred approach, and in the case of pre-diabetes can reduce the progression to diabetes by as much as 70 per cent.

"But for many individuals, achieving the sustained lifestyle changes they need, is extremely difficult."

He says a multi-factorial approach is needed. "Simply doing it with personal responsibility and education is not going to work. It's going to require a regulatory environment, which is able to change the food environment we live in. And unless that happens we're not going to win the battle."

He says bariatric surgery has a place among a host of other factors in managing obesity at large.

While procedures are on the increase both publicly and privately, Krebs says strict criteria means that those who could benefit from surgery don't always make the cut.

"I think there is definitely room for an increase in the number of operations being performed here. I think there's scope for these surgeries to grow – there is a clinical need out there."

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