The Obesity Epidemic by Mediaplanet UK&IE

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JUNE 2018 HEALTHAWARENESS.CO.UK

The Obesity Epidemic

Nearly one in four children are overweight

says Caroline Cerny from the Obesity Health Alliance. P2

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14 & 15 November 2018

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Giving healthcare professionals the real-world skills and relevant knowledge to help them care for, and empower, people affected by obesity, diabetes and their related conditions.

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IN THIS ISSUE

Bariatric surgery Why funding is needed for surgery according to Dr Shaw Somers, from the British Obesity and Metabolic Surgery Society (BOMSS). P6

Fat shaming How negative stereotypes and stigma can perpetuate problems in overcoming obesity. P6

BEFORE

AFTER

Weight loss transformation Diagnosed with Type 2 diabetes, Bob’s weight soared to 31st 5lb. A fear of daily insulin injections spurred his eight stone weight loss journey. ONLINE

Obesity is one of the biggest public health challenges facing the UK today

The figures are startling. Nearly one in four children enter primary school with a weight status classed as overweight or obese; this rises to more than one in three when they enter secondary school.

ut it’s not just children. Today, almost two thirds of adults in England are overweight or have obesity. Based on current trends, half of all children will have obesity or be overweight by 2020 – which will increase their risk of health problems as adults.

What are the health implications of obesity? Excess weight is directly associated with serious health problems including heart disease, Type 2 diabetes, stroke and cancer. There are also mental health problems that are associated with being overweight or obese. As well as the high cost of obesity to the individual in health and wellbeing terms, there is also a significant financial cost to the NHS. The direct cost to the NHS of treating health conditions linked to obesity is estimated to be at least £6.1 billion

a year. That’s the equivalent of the salary of around 163,000 nurses or 85,000 hospital doctors - and the cost of carrying out more than 115,000 heart transplants or more than 718,000 hip replacements.

What can be done to address the challenge? Prevention is key. The environment in which our children are growing up is conducive to eating more than we need and sedentary lifestyles. It’s often difficult to make healthy choices with relentless promotion of readily-available, unhealthy food. The aim of Government policy should be to reduce the number of children who are classified as overweight and obese to see healthier future generations. The introduction of the Soft Drinks Industry Levy – commonly known as the ‘Sugar Tax’ – is a huge step in the right direction and already many companies have reduced the amount of sugar in their drinks.

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Caroline Cerny Obesity Health Alliance (OHA) Lead

It’s often difficult to make healthy choices with relentless promotion of readily-available, unhealthy food.

The Obesity Health Alliance is a coalition of over 40 health charities, medical royal colleges and campaign groups, working together to tackle obesity through evidence-based policy. We have a number of key priorities, which we hope will form part of the government’s updated Childhood Obesity Plan expected to be published this month. These include: •Closing existing loopholes to restrict children’s exposure to junk food marketing across all the media they are exposed to. The rules currently only apply to 26% of children’s TV viewing time. Adverts for foods and drinks that are high in fat, sugar and salt (HFSS) are still allowed to air during ‘family viewing time’ – between 6pm–9pm, when the number of children watching TV is at its highest. Restrictions should apply to on demand and streaming services and across all non broadcast media such as online, social media and outdoor posters.

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•Addressing the types of price promotions which encourage us to buy more unhealthy choices. These should be balanced to include healthy choices and backed by regulation so there is a level playing field for all retailers. •Taking action to ensure everyday food is healthier by incrementally reducing sugar, saturated fat and salt as well as overall calories with ambitious targets. Compliance with these targets should be monitored and the Government should commit to bringing in meaningful sanctions for non-compliance. It is only with concerted action across all levels of society – from government and industry through to schools and individuals, that the obesity epidemic can be stalled. The future health of the nation depends on it.

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Project Manager: Lucy Harris E-mail: lucy.harris@mediaplanet.com Phone: +44 (0) 203 642 0737 Business Development Manager: Katie Kierans Content and Production Manager: Kate Jarvis Managing Director: Alex Williams Digital Manager: Jenny Hyndman Junior Designer: Mushada Raquib All images are supplied by THINKSTOCK unless otherwise credited

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Reduce your risk of Type 2 diabetes with lifestyle weight management A lifestyle weight management programme for people at high risk of Type 2 diabetes can help healthier nutrition, increase activity levels and reduce risk of the disease. SPONSORED

arlier this year, a report from Diabetes UK indicated that the total number of diabetes diagnosis has more than doubled over the last 20 years. In the UK, 90% of diabetes cases are Type 2. With 12.3 million people at an increased risk of the disease1, Libby Dowling, Senior Clinical Advisor at Diabetes UK, believes it is the fastest growing health crisis of our time. She expressed her concern at the proliferation of these numbers. “Both Type 1 and Type 2 diabetes are serious conditions. Both can lead to devastating health complications such as amputation, blindness and kidney disease if people don’t receive a timely diagnosis and get the support and education they need to manage the condition correctly,” she says. Research shows family history, age and ethnic background are all risk factors for Type 2 diabetes, but being overweight or obese is the leading cause for developing the condition. “What’s alarming is that around three in five cases of all Type 2 diabetes diagnoses could be prevented or delayed with the right interventions” says Dowling. “To reduce your risk of developing Type 2 diabetes, we recommend living an active lifestyle, eating a healthy and balanced diet that is low in fat, salt and sugar and keeping an eye on your portion sizes.”

Zoe Griffiths Registered Dietitian and Head of Public Health, Weight Watchers

Libby Dowling Senior Clinical Advisor, Diabetes UK

It is key to find a proven and liveable programme that fits with your life, where you can tap into support whenever you need it. Improve health outcomes with modest weight loss Research from the British Medical Journal shows lifestyle interventions that focus on diet, physical activity and losing weight can reduce the risk of developing Type 2 diabetes by 50%2. Crucially, these lifestyle changes do not have to be extreme in order to reduce your risk. “It’s important to understand that, even if you are one of those 12.3 million people in the high-risk category for Type 2 diabetes, you don’t have to achieve the perfect BMI,” says Zoe Griffiths, Registered Dietitian and Head of Public Health at Weight Watchers. “Key studies on Type 2 diabetes prevention from Europe, China and the US have shown that an intensive lifestyle programme, that helps people to lose seven per cent of their body weight, achieves dramatic reductions in risks of Type 2 diabetes,” says Griffiths. “To put that in perspective, seven per cent weight loss in a

14-stone person means just 14 pounds. We are talking relatively modest amounts of weight loss, which can have a major impact on your health,” says Griffiths.

How to make lifestyle changes As research shows, modest weight loss can reduce the risk of Type 2 diabetes, improve health and wellbeing for high-risk categories, but it is crucial that people understand how to go about making positive changes. For Griffiths, the key to reducing your risk of Type 2 diabetes lies in the incremental changes you make to what you eat and your activity, building healthier habits that stick. “It is key to find a proven and liveable programme that fits with your life, where you can tap into support whenever you need it,”says Griffiths. Recent research published in the Journal of the American Medical Society3 found that there is no ‘one size fits all’ approach when it comes to adopting a healthier pattern of

eating; what worked was finding a programme that people could stick with for the long term. Even making simple changes to what you eat, still has positive effects on your health regardless of weight. “Even if you stay the same weight but change the profile of your diet – i.e. eating more fruit and vegetables, increasing the amount of fibre and reducing saturated fats – you will make a positive impact on reducing your risk of Type 2 diabetes,” says Griffiths. Similar positive health benefits occur with improving the amount of activity you do every week. Current recommendations suggest that 150 minutes of moderate activity every week can greatly reduce the risk of Type 2 diabetes. “If you add all these incremental changes together, it is fantastic for your health. It’s much more positive to set realistic goals, and the evidence demonstrates that modest changes to your lifestyle reaps big impacts, ” says Griffiths. Alex van den Broek 1.

2. 3.

https://www.diabetes. org.uk/Professionals/ Position-statements-reports/ Statistics?gclid=CjwKCAjwr-PYBRB8EiwALtjbz5rxSosxX9Zg2EZ84Bbrd5qvuRVgQ1JDVL4xq_dbKTpupgLMQq1vSxoCnV8QAvD_BwEhttps://www.ncbi.nlm.nih.gov/ pubmed/19398692 https://www.ncbi.nlm.nih.gov/ pmc/articles/PMC1796695/ https://jamanetwork. com/journals/jama/ article-abstract/2673150

Read more on weightwatchers.com/uk

Ian Butcher Weight Watchers Success Story I was diagnosed with Type-2 diabetes in 2010. In the lead up to my diagnosis I was in and out of hospital with check-ups on my knee replacements and a stomach ulcer. The condition I was in really inhibited my movement and my weight was really getting out of hand.

Over the following years, I was still putting on weight. In 2015, my doctor told me I had to lose weight, or I’d need to use insulin injections permanently – which for me was a turning point. I hadn’t really taken the advice seriously up till then. I have a huge phobia of needles and the thought of regular injections turned my stomach. It was time to do something about it. My daughter had been a member of Weight Watchers for three months and encouraged me to come along. To be honest, I thought it wasn’t going to be for me. I was made to feel incredibly welcome by the group coach, the rest of the class and of course my daughter. The level of support you receive is so important when struggling with weight loss and Type-2 diabetes. Once I got used to the programme and learning healthy habits, the weight started falling off. I went from 31 stone 5lbs to 23 stone 2lbs (just under eight stone) in three years – a healthy and sustainable rate of weight loss. My Type-2 diabetes was beginning to be something I felt I could control. Now, when I go back to the doctor every six months, I’ve lost around two stone. He’s absolutely flabbergasted. Out of all the patients he had, I was the most reluctant to lose weight and yet the results are incredible. I’ve been told my health has improved dramatically and I am now off medication. It feels brilliant. Alex van den Broek

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Talking about Type 2 diabetes: Top tips for healthcare professionals •

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Diabetes is complicated. And those living with it can feel isolated and overwhelmed. The language you use can go a long way towards motivating a person with diabetes to manage their condition well and feel supported. Some things are hard to talk about and that’s fine. Just be frank and use clear, simple language. It’ll help both you and your patient feel more relaxed and comfortable. Sometimes there’s a lot to talk about in an appointment, and you might need more time. You could suggest booking a double appointment next time and highlight other ways to get in touch, such as email. Don’t forget about our helpline that’s there to offer support as well. We understand clinics are busy and colleagues may need to ask questions when you’re in a consultation. Try putting a simple sign on your door that reads ‘busy’ to help reduce the number of interruptions.

Talking to healthcare professionals: Top tips for patients •

•

• •

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Diabetes is complicated and different for everyone. There’s no such thing as a silly question. So don’t be afraid to ask about whatever’s on your mind. It’ll really help if you go to your appointment with some questions in mind. You could write them down, or send them to your doctor’s healthcare team beforehand. This time is for you, so let your healthcare team know what you’d like to talk about from the start. Sometimes you’ll have more to talk about and you might need more time. If you can, book a double appointment so you don’t have to rush. There might be things you feel uncomfortable talking about. But your healthcare team is there to help, so be honest and make the most of their medical expertise.

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Having difficult conversations about obesity and Type 2 diabetes The UK is facing a diabetes crisis. In the last 20 years, the number of people living with diabetes has doubled. Today there are 4.6 million people living with the condition. Of these cases, around 90% are living with Type 2 diabetes.

hile our already stretched health service deals with this explosion in diabetes diagnoses, the UK is also sitting on a Type 2 diabetes time bomb. Diabetes UK estimates that as many as 12.3 million people in the UK are at an increased risk of the condition which, without careful management, can lead to devastating complications that include blindness, amputation and heart disease. We don’t fully understand what causes Type 2 diabetes. We know that family history, age, ethnic background and weight can all contribute to a person’s risk of developing the condition. While you can’t do anything about age, ethnic background or family history, that doesn’t mean that the public and healthcare professionals are powerless to turn the tide of Type 2.

3/5 cases could be prevented by lifestyle changes After all, we know that as many as three in five cases of Type 2 diabetes could be prevented or delayed by encouraging people to make simple lifestyle changes such as eating a healthy, balanced diet and doing regular exercise. That’s why it is so important that healthcare professionals are equipped with the tools to empower those at increased risk of Type 2 diabetes to make positive changes to their lifestyle, and in doing so reduce their risk. Having these conversations isn’t easy; discussions about weight and lifestyle choices are emotive and loaded with

each will inevitably bring up lots of tough, burning questions.

Make the most out of appointment times

Dan Howarth

Head of Care, Diabetes UK

The sensitive topics of weight, obesity, lifestyle and Type 2 diabetes can be equally challenging for the patient as they are for the professional. feelings of stigma, blame and guilt. So, this year, to mark Diabetes Week (11 – 17 June 2018), Diabetes UK has developed a list of top tips the help healthcare professionals and patients alike navigate these sometimes-tricky conversations. Navigating the sensitive topics of weight, obesity, lifestyle and Type 2 diabetes can be equally – if not more – challenging for the patient as they are for the professional. Talking about lifestyle changes, learning you’re at increased risk of Type 2 diabetes, or facing a diagnosis of the condition can all be incredibly difficult for patients, and

Whether they’re at risk of Type 2 diabetes, or have been diagnosed with the condition, the time a person spends with their healthcare professionals is limited and precious, so it is important they get the most out of it. The most important thing a patient can remember is that, regardless of how embarrassed you might feel about asking certain questions, healthcare professionals have heard it all before. They’re not there to judge, they’re there to help, but this can only happen if the patient feels comfortable, empowered and confident to talk about their health. To support this, Diabetes UK has also developed some simple, top tips to make talking to the healthcare team easier on the patient. Handled well, an honest, open conversation between patient and practitioner can make all the difference to someone at risk of, or diagnosed with, Type 2 diabetes. On the grand scale, having these conversations could help in a very real way begin turning the tide of the diabetes crisis. It’s good to talk, which is why this Diabetes Week, Diabetes UK is asking people to share their top tips and experiences of talking to people about their diabetes on social media using the hashtag #talkaboutdiabetes, or via the website at: www.diabetes.org.uk/diabetesweek

Find out more on diabetes.org.uk

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Lesley McCormack CEO, Helping Overcome Obesity Problems charity (HOOP)

Fat shaming stigma threatens obesity agenda Despite science documenting weight stigma as a strong risk to public health promotion and interventions, a national mind set of justifying fat blaming and shaming as a way of motivating individuals to lose weight is the biggest hurdle in combating obesity that we face today.

It is shameful that, decades on from extensive scientific evidence showing that weight stigmatisation fails to act as a beneficial incentive for healthier lifestyle choices and is in fact harmful to psychological and physical health, we live in a society where bias based on weight and body image is not only prevalent, but it is still widely considered acceptable. Studies have also shown that children who experience weight-based teasing are more likely to engage in binge-eating and unhealthy weight control behaviours compared with overweight peers who are not teased. Other research has consistently documented a positive association between weight-based victimisation and eating disorders such as binge-eating disorders or bulimia. The empirical evidence available cannot be understated.

Anti-fat bullying can trigger negative cycles Not a day goes by without one or more of our HOOP members reporting incidents of weight stigma. They face regular anti-fat messages and bullying with the common misperception that they are the architects of their own ill health and personally responsible for their weight problems because of harmful stereotyping such as they are lazy, overeat, lack self-discipline, have poor willpower, are unintelligent and are unsuccessful. We see posts in our online support groups about experiences in the workplace, in a health or care setting, at school or college, while attempting physical activity, out shopping or enjoying leisure time. Prejudice even occurs at home from family and friends. As a direct consequence of weight stigma, many members get stuck in a spiral of shame and guilt, followed by binge eating, reduced exercise take-up and yo-yo dieting. Such a negative cycle can derail those who are already making positive changes to their lifestyle, perhaps with the help of specialists offering costly obesity interventions. It can also destroy the confidence to take up exercise and, worryingly, to attend medical appointments or take up NHS screening such as for cervical, testicular, bowel or breast cancers. This is especially true with our more vulnerable members with higher BMI and/or comorbid mental health illness. At HOOP, we understand the potential, long-term harm from weight stigma and we know it is an influential and insidious problem to overcome. It creates a significant barrier to change, which needs specialist psychological services alongside obesity interventions and treatments to surmount. With a lack of such resources, obesity policies and interventions are not only failing to get traction but they fall far short of what’s needed for most of our members.

Weight stigmatism in healthcare sector must be addressed Weight bias should and cannot exist in health settings if we are to ensure overweight and obese individuals receive effective and timely medical care. To reduce health disparities, the NHS needs to make it a priority to challenge and address weight stigmatisation and discrimination among its workforce. Simple steps like having gowns to fit and beds, equipment and examination tables functional to obese sizes are also necessary and appropriate. All patients, irrespective of weight, should be treated with dignity and respect. It is vital, too, that the media examine its role in helping to shape societal beliefs around obesity. Anti-fat messages fail where tolerance, understanding and positive change in lifestyle narrative can succeed. We must put a stop to weight stigma across the board if we are to alleviate the heavy burden of obesity in the UK.

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Bariatric surgery The magic wand? Despite science documenting weight stigma as a strong risk to public health promotion and interventions, a national mind set of justifying fat blaming and shaming as a way of motivating individuals to lose weight is the biggest hurdle in combating obesity that we face today.

or many people suffering with obesity, there appears to be no way to control their weight in the long-term. But we know that weight loss is a powerful medicine. There is no doubt that a 10% reduction in weight will alleviate most weight-related illnesses such as diabetes, high blood pressure, fatty liver and sleep apnoea – the silent killer. With up to a 25% weight reduction, most people report life-changing improvements in health and quality-of-life. Bariatric surgery is one of the few treatments that can achieve these benefits in the long-term. So, why does bariatric surgery work so well? We now know that hunger, satiety (satisfaction with food intake) and metabolic function rarely change for the better with diets alone. However, after bariatric surgery is performed, measurements show significant and sustained improvements in all three of these key elements of weight control. Most people who undergo weight loss surgery report a rapid change in their feelings towards food, with improved food behaviours and enhanced satisfaction with smaller meal sizes.

Recovery in just two weeks The fast pace of progress in the understanding of obesity as a disease - plus advances in minimally invasive (‘keyhole’ surgery) - have established bariatric surgery as a mainstream treatment. Many hundreds of thousands of people have been helped worldwide. It is safe, well-tolerated by patients and demonstrably effective in reducing weight and improving health. Our UK National Bariatric Surgery Registry proves that all forms of weight-loss surgery are among the safest abdominal procedures. People having bariatric surgery can expect to stay less that 48 hours in hospital after surgery, and have full recovery within two weeks.

Prepare for the procedure with specialists, don’t just pick one off the internet

Dr Shaw Somers Specialist Upper Gastrointestinal and Bariatric Surgeon, British Obesity and Metabolic Surgery Society (BOMSS)

Most people who undergo weight loss surgery report a rapid change in their feelings towards food,with improved food behaviours and enhanced satisfaction with smaller meal sizes.

There is a variety of surgical options for people with obesity. All bariatric operations have been shown to achieve good weight loss when correctly performed and when patients receive appropriate follow-up. The choice of bariatric procedure should be made individually with the guidance of a bariatric specialist team. It is seldom possible to achieve a good result by simply picking a procedure after an internet search. The key to successful outcomes is good preparation by a multidisciplinary team including dietitian, specialist nurse, psychologist and bariatric specialist. These professionals will be involved in the post-operative dietary rehabilitation and longer-term follow-up.

More funding needed for NHS bariatric services Is this treatment available on the NHS? Yes, but despite bariatric surgery paying for itself within three to five years in reduced medications and operations, new money needs to be invested in services before these savings are realised. This has significantly hampered the development of NHS bariatric services. By comparison, we perform about 10 times fewer procedures than France. This clearly needs to change if we are going to have any impact on the spiraling costs of severe obesity in our population. When I am asked, I would suggest that people considering weight-loss surgery should seek advice from a specialist service run by experienced professionals. There is a network of regional NHS centres for this, which can be accessed via referral from a GP. Read more on healthawareness.co.uk

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Weight loss with swallowable balloon SPONSORED

David Kerrigan, an internationally renowned bariatric surgeon and the founder of Phoenix Health.

No hospitalisation needed Given the continued growth of the global obesity rate, what solutions are available for the two billion overweight and obese people out there? There are huge breakthroughs in the weight loss industry and new, swallowable balloon treatment means patients can simply walk in and out with no hospitalisation needed.

Dieting can be difficult, and some people need a boost to start their weight loss journey. For that reason, weight loss balloons have become increasingly popular for overweight and obese patients. A soft balloon is placed in your stomach and inflated with air or liquid. Weight loss balloons work by inducing a feeling of fullness, providing more substantial weight loss than diet and exercise alone1,2. Traditionally, an endoscopy is required to insert and remove the balloon from the stomach, while the

Professor David Kerrigan Pheonix Health

It is potentially a game changer as, unlike surgical procedures, it is not a big deal. patient is under general anaesthetic. However, recent developments require no surgery and no anaesthesia; instead, a pill can simply be swallowed. “The advantage, compared to other surgical procedures, is that it is relatively non-invasive,” says Professor

“Previously, the patient would be admitted to hospital and the balloon placed under sedation using a camera.” However, new technology has developed a system whereby no endoscopy is needed*. The process can take less than 20 minutes and the patient can either walk – or drive – back to work afterwards. “This is an ambulatory outpatient procedure: the patients walk in fully dressed, swallow a capsule, the balloon is inflated, and it’s checked via an X-ray. That’s it. It is potentially a game changer as, unlike surgical procedures, it is not a big deal, which makes it potentially more acceptable and much more widespread.” The new procedure has been on the market since December 2015; more than 5,200 patients have received the treatment. It is not currently approved by NICE so is only available in the private sector, where it costs around £3,200. But this compares very favourably, not only to a gastric bypass or gastric sleeve, which weigh in at about £9,500–£10,500, but even to specialist diet plans and gym memberships,

which can be very costly. For example, Hetsie’s journey started two weeks ago: “I’m really enjoying this experience,” she said. “My weight loss journey is much easier this time thanks to the fact that I’m not hungry. For the first time ever I’m realising when my body is really hungry and actually needs food. I’ve already lost 12 pounds!” A proper diet and exercise regime is crucial for patient success. This new balloon is designed to be at the center of a comprehensive programme. It combines the support of a healthcare team and an app that communicates directly with a scale and your dietician. “For a whole year, you have the motivational support to lose weight,” says Professor Kerrigan.

For those with BMI over 27 To qualify for the procedure, a patient must have a BMI upwards of 27. For someone standing at 5’10”, that would mean about 13 1/2 to 14 stone and someone at 5’5” 12 to 12 1/2 stone3,4. Most patients can expect to lose around two and a half stone. Traditional weight loss balloons have to be removed – surgically – after six months, but recent developments see the balloon self-emptying after 16 weeks. The balloon opens inside the

stomach, empties and passes out of the body naturally. In rare cases, a balloon can get stuck, which will require surgery to remove, but the risk is one in 1,000 and the operation is straightforward. Gastric balloons are not suitable for everyone, but if you have a BMI over 27 and are over 18 years old, you can start a conversation with your doctor. Courcoulas et al. Int J Obes. 2017; 41(3):427-33. Ponce et al. Surg Obes Rel Dis. 2015; 11(4): 874-81. Raftopoulos and Giannakou. SOARD. 2017; 13(7):1174-82 4 Machytka Evzen et al. Obesity Surgery Vol. 26. 2017; 49(02): 154-160 1 2 3

About the Elipse Balloon

The Elipse Balloon is the world’s only weight loss balloon that is swallowed and removed without surgery, endoscopy, or anaesthesia*. The Elipse Balloon fills the stomach and helps the user feel full and eat less. The Elipse Balloon is swallowed during a brief office visit, and four months later, passes naturally without the need for a removal procedure. It is part of a six-month comprehensive weight loss programme where you will be guided by a team of healthcare professionals, including a physician and a nutritionist. You will also be given a free, wireless digital scale that provides constant updates on your progress to your care team and helps you review your results in real time. * In rare cases the Elipse Balloon may require endoscopic or surgical intervention for removal. Results may vary from one participant to another.

Find out more on allurion.com/en

Overfed but undernourished system complications. In addition, people are tending to lead more sedentary lifestyles and are less active, subsequently burning fewer calories.