Parkhead Pharmacy Ltd

Gastro-intestinal system

Being overweight, in particular being grossly overweight or obese, is a major health problem. It carries an increased risk of heart attacks, stroke, blood clots, high blood pressure, diabetes, liver disease, lung disease, cancer, arthritis, infertility and premature death. In England alone, an estimated 30,000 deaths occur each year as a result of obesity.

66 out of every 100 adults in the UK is considered to be overweight, with 25 out of every 100 considered to be obese. Of even greater concern, is the rapid rise in obesity in children, with 13 out of every 100 eight year olds and 17 out of every 100 fifteen year olds now classed as obese.

Healthcare professionals use a measure called the body mass index (BMI) to determine if you are overweight or obese. Your BMI is your body weight measured in kilograms divided by the square of your height in metres. So, for example, a person weighing 70kg who is 1.6 metres tall will have a BMI of 27.3 (70 divided by 1.6 x 1.6).

The following are measures of BMI:

• BMI between 18.5 and 24.9 - healthy weight
• BMI between 25 and 29.9 - overweight
• BMI between 30 and 40 - obese
• BMI between 40 and 50 - morbidly obese
• BMI over 50 - malignantly obese

Previously, most obesity experts considered that total body fat was the main predictor of weight-related disease. Now, it is thought that the location of fat is equally if not more important than total body fat. If you have more weight in the waist area (apple shaped) you are at greater risk of health problems than if your extra weight lies on your hips and thighs (pear shaped). For example, if you are a man with a waist measurement greater than 94cm you are at risk of developing weight-related health problems, and the risk is even higher if your waist measurement exceeds 102cm. If you are a woman with a waist measurement greater than 80cm you are at risk of developing weight-related health problems, and the risk is even higher if your waist measurement exceeds 88cm.

Although BMI is widely used for weight assessment, it is not appropriate for everybody. Athletes with a high proportion of muscle mass will have a high BMI but will have very little excess fat. Also, BMI is most applicable to the physique of people of Western origin, and may therefore under-state the health risks of people of Far Eastern origin who tend to weigh less and have a lighter body frame. Special charts are used to assess weight in children.

Your body weight is determined by the amount of energy obtained by eating food compared with the amount of energy your body uses. Most of the surplus energy from the food and drink you eat will be stored as fat. In order to lose weight, the energy intake from your diet should be less than the energy you expend. So, the main causes of being overweight are a combination of eating the wrong kinds of food, over-eating and a lifestyle with little exercise.

Fast foods with a high saturated fat content and high calorie snacks are perhaps the greatest cause of obesity, particularly among children. These foods tend to give a short-lived energy boost, but have a very low nutritional value. Once the energy boost has gone the body craves another energy boost and, because the body still lacks the essential vitamins and minerals it was seeking in the first place, you feel that you want to eat again, establishing a cycle of eating and craving that leads to weight gain. A balanced diet rich in fruit and vegetables, eaten at proper meal times, helps to break this cycle.

Over-eating is another cause of obesity. Do not regard eating large portions ‘as a challenge’. The part of your brain that controls appetite soon adapts to these large portions and does not send the message to tell you to stop eating. Meal sizes get bigger and bigger, and the weight piles on.

Lack of physical activity is another important factor. Taking the car instead of walking, watching television or playing computer games instead of exercising, non-physical occupations all prevent us from using the energy obtained from food.

Looking in the mirror and getting on the weighing scales will no doubt reveal the most obvious symptoms of being overweight. Even without these, being slightly overweight can affect the way you feel and the things that you do. You may feel more lethargic than usual and may find that your day to day activities make you more breathless and more tired than they used to do. You may have difficulty sleeping and you will have a tendency to snore when asleep. If you are severely overweight there will be an increased likelihood of health problems, such as heart disease, diabetes, back pain and arthritis. Many of these diseases develop over a long time, and you may not realise that you have a health problem until it is well advanced.

Medicines

The main aim of treatment is to encourage a healthy, balanced diet and lifestyle that includes an appropriate increase in exercise. For most people, a brisk walk every day for between 30 minutes to an hour will show benefits. Weight loss should be gradual and most experts would advise that a weight loss of one to two pounds a week is adequate. Usually, doctors recommend that weight loss will be achieved by eating around 600 calories less each day than you normally do, but this will depend on how much weight you need to lose. A healthy diet means foods lower in fat, lower in sugar and less alcoholic drinks. It also means increasing the amount of starchy foods and high fibre foods that you eat (wholemeal bread, brown rice and pasta). Eating five portions of fruit and vegetables each day is also recommended and you should choose leaner cuts of meat. Steaming or boiling is a healthier way of cooking than frying.

Adopting a healthy, balanced diet will provide all of the calories and essential nutrients that the body needs and is more likely to be successful in the long run in helping you lose weight and maintain a healthy weight than calorie counting diets or fad diets.

In extreme cases, drug treatment may be used in an attempt to help lose weight. However, drug treatment is only recommended for patients with severe obesity, that is a BMI equal or greater than 30, or those with a BMI equal or greater than 27 who have other risk factors such as diabetes or high cholesterol levels. Drug treatment must be used as part of a weight loss programme and the person must show that they have the commitment to follow the weight loss programme and are not simply relying on the drugs to achieve weight loss.

The only drug still licensed for the treatment of obesity is orlistat. It works by inhibiting an enzyme called lipase. This enzyme normally breaks down fat in the intestine allowing it to be absorbed. When orlistat inhibits lipase, fat that is eaten remains in the intestine rather than being absorbed. People who do not restrict the fat that they eat when taking orlistat are likely to have oily, smelly diarrhoea because the fat is excreted rather than being absorbed.

Sibutramine (Reductil) was withdrawn from the market on 21 January 2010 following a review that suggested that the risk of it increasing non-fatal heart attacks and strokes outweighed its benefits of weight loss. The product is no longer prescribed or dispensed. Anyone still taking sibutramine should stop taking the drug and is advised to make a routine appointment with their doctor to discuss alternative ways of losing weight.

For those that are morbidly obese, BMI 40+, there are a variety of surgical techniques such as stapling or removing a portion of the stomach that may be attempted as an extreme measure to try to reduce weight.

Regard your pharmacist as part of the healthcare team, somebody who is there to help you and to support you in helping to achieve weight loss. Your pharmacist will be able to offer advice about which foods to eat and which not to eat, about exercise and whom to speak to if you have any concerns.

Your pharmacist is able to supply orlistat without a prescription as part of a reduced calorie, low fat diet, for weight loss in adults over the age of 18 years who have a BMI of 28 or over. When supplying orlistat your pharmacist will ask if the medicine is for you or, if not, the age of the person to whom it is to be supplied. Your pharmacist will also ask about other medicines and health food supplements being taken, previous medical history and about diet and exercise. If your pharmacist is satisfied that it is safe and appropriate, orlistat may be supplied together with advice about how to use the medicine properly, diet-related side effects, weight loss expectations and healthy lifestyle. If your pharmacist thinks that it is not appropriate to supply the medicine, you will be advised to see your doctor.

Some pharmacists also provide other services such as measuring blood pressure, cholesterol and blood glucose levels that can help identify if your weight is causing other problems.

If your doctor has prescribed medicines to help you lose weight and you are worried about side effects or how to take the medicines, your pharmacist will help.

If you are worried about your weight you should see your doctor. Your doctor will examine you, measure your BMI and waist measurement and take a full medical history of you and your family to assess the risk of other health problems. Depending on how overweight you are and whether you have other health problems, your doctor will probably talk to you about the benefits of eating a healthy diet and taking regular exercise. You may be given dietary advice on how to cut down the amount of fat in your diet. Your doctor may set a ‘target weight’ for you and ask you to come back again after a few weeks to see if you have managed to achieve the target. If your BMI remains high, then the doctor may suggest a stricter fat controlled diet or consider drug treatment.