Transcript Obesity Clinic.

Obesity Clinic.
11/10/04
Clinic comprises of:
• Consultant
• Dietician
• And scales that weight to 300kg (normal
G.P scales go to 150kg)
• No psychologist attached at present
– Mr May, upper GI cancer surgeon sees
patients considered for surgery when all else
has failed, and usually BMI >40
Referral Criteria
• BMI >30……usually >35
• Evidence of motivation
• Evidence of previous attempts to loose
weight
• Having seen a dietician
– Children are not seen in clinic under 16 years,
and there is no dedicated paediatric service
Outline.
• Patients taken on for 2 years initially, and
only kept longer if losing weight.
• Patients seen 3 monthly in clinic
• Dietician may see more frequently,
especially in beginning
• Initial visit is an assessment by consultant
and then dietician.
Typical Questions Asked in History.
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Where you overweight as a child?
When did you start to put on weight?
What is your lightest adult weight?
What things have you already tried?
What medications have you tried?
How is your weight affecting your health?
How is your general health?
– Sob, snoring, sleep apnoea/daytime sleeping, thyroid,
ammenorrhea
Typical Questions Asked in History.
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Are your family overweight?
Do you eat 3 meals a day?
Any particular food cravings/weaknesses?
What snacks?
What exercise do you do?
WHY DO YOU WANT TO LOOSE WEIGHT?
Have you got a target in mind – and what
timescale?
Examination.
• Many have acanthosis nigracans around
neck and axilla
• Pulse, resting tremor, thyroid
• BMI
• Waist : Hip ratio
Investigations.
• Bloods – FBC, U+E, Chol, TFT, LFT,
Haematinics, Testosterone, +/- FSH, LH,
• +/- ECG
The Importance of Breakfast!
• Shown by 2 recent U.S Studies:
– Calories taken earlier in the day are easier to
burn off than those taken later.
– People who eat breakfast are less likely to
become obese.
Management.
• Diet Modification for 3 months
• Exercise
• Review after 3 months:
– If losing weight, continue
– If stable consider orlistat (need <30% fat diet
to work) or sibutamine
– If gaining weight – reassess and re-iterate.
Dietician
• Sees each new patient after consultant
assessment
• Offered some support
• In depth food sheet of typical day
• Plan agreed with patient of how to modify
diet.
– Tailored to each patient fat/calorie/protein
reduction accordingly
The Future.
• The clinic has not been formally assessed,
so success rate is unknown at present.
• Dr Whitelaw hope to expand the service,
bringing in a psychologist and ENT
support……funding!
• Anyone interested can arrange to go
along….especially if thinking of setting up
a GPwSI service!