The Oakwood Surgery

Clinical Protocols

Obesity

http://publications.nice.org.uk/obesity-cg43

Author Sister Jemma Parker

Date Created November 2012

Reviewed October 2014 (Dr Eggitt)

Review Date October 2015

Introduction

Normal weight is currently classified according to a patient’s BMI where a “normal” BMI is associated with a no significant impact on a patient morbidity or mortality. As a patient deviates further away from the normal BMI, there is an expectation that their morbidity and mortality rates increase.

Underweight <18.5

Normal 18.5 – 24.9

Overweight 25 – 29.9

Obese 1 30 – 34.9

Obese 2 35 – 39.9

Obese 3 >39.9

Management

There are various management options available for the treatment of obesity.

1.  Advice

·  Base meals on starchy foods such as potatoes, bread, rice and pasta, choosing wholegrain where possible.

·  Eat plenty of fibre-rich foods – such as oats, beans, peas, lentils, grains, seeds, fruit and vegetables, as well as wholegrain bread, and brown rice and pasta.

·  Eat at least five portions of a variety of fruit and vegetables each day, in place of foods higher in fat and calories.

·  Eat a low-fat diet and avoid increasing your fat and/or calorie intake.

·  Eat as little as possible of:

o  fried foods

o  drinks and confectionery high in added sugars

o  other food and drinks high in fat and sugar, such as some take-away and fast foods.

·  Eat breakfast.

·  Watch the portion size of meals and snacks, and how often you are eating.

·  For adults, minimise the calories you take in from alcohol.

·  Make enjoyable activities – such as walking, cycling, swimming, aerobics and gardening – part of everyday life.

·  Minimise sedentary activities, such as sitting for long periods watching television, at a computer or playing video games.

·  Build activity into the working day – for example, take the stairs instead of the lift, take a walk at lunchtime.

2.  Weight loss programmes

Local programmes for weight loss include

Healthy Weight Solutions (adults)

Slimming World (adults)

Weight Watchers (adults)

More Life (for under the age of 18)

Referral forms for these can be found on the shared drive under referral forms

3.  Dietician

The dietician can either be accessed via the Healthy Weight Solutions or More Life programmes outlined above, or a referral letter can be sent direct to the DRI.

4.  Orlistat

Orlistat is used in the treatment of obesity. It is a lipase inhibitor and reduces the absorption of dietary fat. In order to qualify for Orlistat treatment on the NHS, patients need to have met the following criteria

·  BMI >30 with no co-morbidities

·  OR// BMI > 28 with any of the following co-morbidities

o  Diabetes

o  Hypertension

o  High cholesterol (total cholesterol > 5)

o 

The dose of Orlistat is 120mg TDS, with or after food.

1st Visit
Week 1 / Check weight, BMI, and calculate 5% target weight loss after 12/52.
Give dietary advice and prescription
Week 4 / Check weight, give dietary advice and prescription
Week 8 / Check weight, give dietary advice and prescription
Week 12 / Check weight and see if target weight has been achieved.
If it has been achieved then pt can stay on orlistat for further 3/12 proving they lose a further 5% weight loss.
If target weight loss not achieved, pt not to be given further prescriptions.

If the patient has been on orlistat for 12 months, they will require a review by their GP.

Advise patient of diet rich in fruit and vegetables containing approx 30% calories from fat. Warn patient of possible contraception failure if severe diarrhoea is experienced.

Side effects

·  Faecal incontinence

·  Oily stools

·  GI upset

·  Flatulence

·  Tooth and gingival disorders

·  Headache

5.  Cognitive behavioural therapies

6.  Bariatric surgery

Surgery for obesity is not routinely commissioned for patients in Doncaster. To be eligible for this, certain criteria must be met. This can be found in the prior approval schedule which can be found here. Approval for surgery must be sought by writing a letter of application the NHS Doncaster CCG outlining how the patient fulfils the prior approval criteria.

After receipt of confirmation from the NHS Doncaster CCG, a patient can then be referred to an acute trust for bariatric surgery.