Obesity
Weight gain can happen slowly over time and obesity can change a person's life for the worse. The patient should be aware that it is important to take care of their symptoms before the problems worsen. In extreme cases of morbidly obese patients hospitalisation or even death can occur.
A report by the Royal College of Physicians in 1998 lists the following potential benefits that can accrue from a weight reduction of 10% from an initial weight of 100kg in those patients with associated diseases7:
- A substantial fall in systolic and diastolic blood pressure.
- A fall of 10% in total cholesterol.
- A greater than 50% reduction in the risk of developing diabetes.
- A 30% to 40% fall in diabetes related deaths.
- A 40% to 50% fall in obesity related cancer deaths.
- A 20% to 25% fall in total mortality.
Body Mass Index (BMI) is a tool to assess the extent to which a person is overweight or obese. It takes into account a person's body weight and height. It is commonly used as the most practical way of measuring how overweight a person is. This assessment of body fat achieved by using body mass index (BMI) is valid in all but the very tall, very muscular, in children and the elderly.
The National Institute for Health and Clinical Excellence (NICE) classify degrees of overweight and obesity according to a person's body mass index (BMI) measured in kg/m2
Underweight - <18.5
Desirable - 18.5-24.9
Overweight - BMI of 25–29.9
Obesity l - BMI of 30–34.9
Obesity ll - BMI of 35–39.9
Obesity lll - BMI of greater than or equal to 40
In the UK, people with a BMI between 25 and 30 are categorised as overweight, and those with a BMI above 30 are categorised as obese. People with a BMI of 40 or more are described as morbidly obese. Patients on a weight reduction programme should aim for a BMI of less than 27 (men) and 26 (women).
It must be noted that South Asian patients should have a lower BMI to reduce their risk further than Caucasians.
The NICE target for initial weight loss in overweight patients with type 2 diabetes is 5-10% of body weight. Lesser weight gains will still provide some benefit.