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What GPs need to know about obesity and its treatment


Medtronic


17/10/2023 2:33:52 PM

SPONSORED: Obesity is a global epidemic caused by many factors. The disease, and how surgery and adjunct therapies fit in, should be understood.

GP speaking to patient about obesity.
Obesity is one of the leading risk factors for ill health in Australia, with 67% of the population either overweight or obese.

Is obesity a disease? It’s a common question that in the past may have generated varied answers.
 
However, in 2013, the American Medical Association voted to categorise obesity as a disease – a position that was subsequently adopted by the Australian and New Zealand Obesity Society and many other medical organisations around the world.
 
Why did they make this move? The answer is that labelling obesity as a disease can: 

  • help reduce stigma and discrimination that many experience
  • allow those living with obesity to receive appropriate treatment
  • improve understanding of obesity and place greater urgency for action to address it. 
Obesity in Australia
Sixty-seven per cent of Australians are either overweight or obese, with at least one-third being obese, placing an enormous burden on the healthcare system and accounting for 8.6% of Australia’s health expenditure.
 
Obesity is caused by a multitude of complex factors including genetics, diet, lifestyle and certain medical conditions.
 
It is also one of the leading risk factors for ill health in Australia. A raised Body Mass Index (BMI) is related to many chronic diseases and conditions, including
 
  • type 2 diabetes
  • heart disease
  • some cancers including breast, ovarian, prostate and colon cancer
  • sleep apnoea and snoring
  • heart disease
  • high blood pressure
  • infertility
  • polycystic ovarian syndrome (PCOS)
  • anxiety and depression.
The risk of these comorbidities increases with BMI.
 
Treatment options
GPs are well placed to identify overweight and obesity; however, the topic can be sensitive to bring up, and must be approached with sensitivity and empathy.
 
BMI is a common method used to screen obesity, but it’s important to note that it has limitations as a diagnostic tool, and other factors including waist circumference and waist-to-hip ratio should be taken into account. The BMI thresholds proposed by the World Health Organization (WHO) are outlined in the table below.
 
BMI (kg/m2) Classification
18.5 – 24.99 Healthy weight
≥25 Overweight
≥30 Obesity
≥40 Severe Obesity
 
Treatment options can include:
 
  • lifestyle changes including diet and exercise, with a focus on healthy eating and reduction in energy intake
  • pharmacotherapy, which should be considered adjunct to lifestyle intervention in patients
  • bariatric surgery, combined with lifestyle changes such as dietary modifications, increased physical activity and psychological support
Patient engagement is critical for all considered treatment options. Referrals to specialist management for complex cases or those with more severe comorbidities can be considered.
 
Bariatric surgery
For the first time in 30 years, the American Society for Metabolic and Bariatric Surgery/International Federation for the Surgery of Obesity and Metabolic Disorders (ASMBS/IFSO) have issued new evidence-based clinical guidelines expanding patient eligibility for weight-loss surgery.
 
Under the new guidelines, anyone with a BMI over 35 could be considered for surgery, regardless of whether they have comorbidities, or a BMI for people with metabolic disease, and appropriately selected children and adolescents.

Surgery could also be considered for individuals with a BMI between 30–34.9 who do not achieve significant or durable weight loss or comorbidity improvement through non-surgical methods. These changes mark a significant departure in thinking and practice.
 
Types of bariatric surgery
While bariatric surgery has existed for several decades, the field has continued to evolve and develop. Gastric banding became very popular in the mid-2000s, before being replaced with more effective weight loss surgery.
 
The three most widely used procedures in Australia today include:
 
  • sleeve gastrectomy
  • Roux-en-y gastric bypass
  • one anastomosis gastric bypass.
Each type of surgery has its own unique benefits and risks, and the most appropriate choice will depend on the patient’s individual needs.
 
Webinar on demand
Obesity: understanding the disease and how surgery and adjunct therapies fit in.
 
This webinar will be focused on understanding obesity as a disease, and tailoring solutions for individual patients. The session will cover a range of medical and surgical treatment options, and explore the potential benefits of combining therapies to effectively manage obesity.
 
Watch now.
 
This advertorial was commissioned by Medtronic (13141-092023) and independently reviewed by newsGP.
 
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