Obesity

With Professor Ian Caterson, Consultant Endocrinologist at Royal Prince Alfred Hospital, New South Wales, Australia

Introduction

Obesity is a topic that it not often addressed on the wards but is extremely common.

Case 1

You are an Intern caring for a patient who is very obese and think to yourself, should I be doing anything about this patient?

• Obesity is very common in Australia, around 30% of people are obese and another 35% are overweight.
• In hospital we generally deal with the complications of obesity – diabetes, hypertension, sleep apnoea, arthritis and many others
• If patients have an acute issue related to their weight, treat that problem. But it should also be incumbent on all of us to remind our patients that their weight is contributing to, causing or making their medical problems worse, and that they should consider doing something about it
  • The junior doctors role is to organise support for the patient to lose weight
    • Let the GP know about it
    • Suggest a community program such as Weight Watchers
    • GP practice nurse may be able to support managing it
• Many hospitals will have specialty services which can help, depending on the hospital it may be through dietetics or a specialty obesity service
• There are hospital programs for very large patients, that include
  • Very low energy diets (usually as meal replacement drinks or bars) which work quite well to get weight off
  • Medications to help weight maintenance rather than support weight loss
    • Phentermine – caution for those with cardiovascular disease
    • Orlistat – over the counter, avoid a high fat diet
    • There are a few more on the way
    • This is dependent on the patient being able to afford it, as these medications are not on the PBS
  • Bariatric surgery is also a consideration especially for those with diabetes
    • Bariatric surgery does work, but it is not magic – patients continue to have to work at keeping the weight off. It helps patients eat less but does not remove the need to exercise