Obesity
- Obesity (BMI more than 30) is usually caused by a combination of medical, social and environmental issues
- Be respectful and consider the dignity of larger people — do not blame or judge people
- Obesity is a chronic condition and can lead to significant co-morbidities, eg increased risk of other chronic condition and joint problems
- Weight loss should not be recommended for children under 16 years of age unless recommended by paediatrician
- Weight loss should not be recommended during pregnancy
- Weight loss in people over 65 years or people with end-stage diseases should be monitored by a health professional
- Very low energy diets, medicines and surgery can help people with a BMI more than 35 to lose weight — these treatments require specialist assessment and management — medical consult and refer to dietitian
- Public funding for surgery may be available for eligible people
- While medicines may be registered for use in obesity their cost is not subsidised
Considerations when caring for larger people
- Move and handle people to reduce the risk of injury to yourself and the person — assess weight bearing capacity and person’s ability to assist with transfers and repositioning (eg respiratory, cardiac and joint conditions) — encourage independence where safe
- Use correct equipment if available — most standard equipment has a weight limit of 120kg — bariatric equipment (eg beds, chairs, stretchers, gowns, bedpans) may be needed for larger people
- If person needs transport — inform transporting and receiving services of person’s weight, height and waist circumference
Do
- Adult health check if due
- Provide brief interventions on healthy eating and exercise
- Aim for 5–10% loss of body weight for people who are overweight (BMI more than 25kg/m2) — loss of a few kilograms can improve BP, BGL and arthritis
- Monitor rapid and unintentional weight loss — risk of malnutrition
- Follow-up outstanding referrals
- Refer to dietitian and mental health services
- Assist in finding local programs that may help address social and environmental issues
People with BMI more than 35kg/m2 with risk factors or comorbidities
- medical consult and refer to dietitian for individualised management plan
- Consider referral to endocrinologist for medical management including consideration of very low energy diets, medicines and/or surgery
- Ongoing support from doctor and dietitian will be required for people using very low energy diets
- Weight loss medicines and very low energy diets can lead to side effects such as gallstones, diarrhoea, constipation, headaches, fatigue — medical consult
Follow-up care of people who have had bariatric (weight loss) surgery
- A multi-disciplinary team is needed to provide follow-up care post-surgery
- Monitor weight loss progress
- Monitor for complications — abdominal pain, diarrhoea, reflux, nutritional deficiencies (eg anaemia, nausea, fatigue, dizziness, hair loss, mouth ulcers at every visit) — medical consult
- Medical follow-up for medication dose adjustments and nutritional supplements — multivitamin, oral iron, Vitamin B12, folic acid, thiamine, calcium and Vitamin D
- Annual bloods — FBC, UEC, LFTs, ferritin, folate, calcium, Vitamin D, PTH, Vitamin B12
- Bariatric surgery guide for primary care physicians
- Management of bariatric patients guide