A starting point for today 30/04/2015. Obesity does matter. Obesity is modifiable. Reducing weight has demonstrable health benefit

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1 Obesity Intervention for Front-Line Healthcare Providers Welcome to our MBTelehealth sites! A special evaluation plan for the day Linking Learning to Practice for FPs: Earn 2 Mainpro-C and 2 bonus Mainpro M1 credits Welcome! Check out all today s resources at our website 2015 Accredited CPD Provider Innovation Award umanitoba.ca/cpd/obesityday THANKS to our Planning Committee and Staff Casey Hein BSDH, RDH, MBA (Chair) Linda Berg, Manitoba Dental Association Brenda Dawyduk RN NP MSc Ian Jones MPAS, PA-C, CCPA B.J. Hancock MD, FRCSC, FACS Christina Lengyel PhD, RD Heather Long M.Sc. B.P.E. Kim McIntosh B.Sc.Pharm Christine Polimeni MD, CCFP Brenda Stutsky RN,EdS, PhD Jeff Toews M Ed Sandra Webber PhD, BMR(P) Karyn Iversen Lenore Chipman Tolu Dare Cindy Lewkiw Ingrid Toews Tim Webster Holly Harris Laura Friesen Cheryl Moser Tanya Walsh Program Disclosure This program has not received funding from any commercial interest 1

2 100% Figure 2.3.1: Male BMI Distribution Over Time, Manitoba, Measured/Corrected BMI 90% 18.4% 22.8% 23.7% 24.8% 25.8% 28.3% 80% 70% 60% 42.0% Obese 50% 40% 49.8% 47.0% 49.5% 46.9% 45.0% Overweight Normal + Underweight 30% 20% 10% 39.6% 27.3% 29.4% 25.6% 27.3% 26.7% 0% Residents of First Nations Communities excluded Source: Manitoba Centre for Health Policy, 2011 A starting point for today Obesity does matter Obesity is modifiable Reducing weight has demonstrable health benefit Weight is a sensitive issue 2

3 Obesity is modifiable Peirson L et al. Treatment for overweight and obesity in adult populations: a systematic review and metaanalysis. CMAJ Open 2014;2:E trials with behavioural interventions (diet, exercise and/or lifestyle mod.) Baseline BMI 32 Intervention group lost 3.1 kg more than controls group Lowered BMI by an additional 1.09 Reduced their waist circumference by an additional 3.05 cm More likely than controls to lose 5% (NNT 9) and 10% (NNT 12) of weight Reducing weight has health benefits Loss of 5% and 10% of baseline weight associated with a 38% reduction in the incidence of diabetes in pre-diabetic populations (NNT 17). Peirson L 2014 Diabetes Prevention Program Outcomes: the risk of diabetes remained 34% (95% CI: 24 to 42) lower after structured interventions than in controls during a 10 yr study extension Knowler WC, Lancet 2009 No trials reported on overall mortality or other disease incidence Today s Objectives 1. Identify emerging crises associated with obesity 2. Discuss the evolving roles of healthcare practitioners 3. Implement novel, yet practical, ideas for obesity management 4. Collaborate with professionals outside of your discipline 5. Enhance the potential for reduced morbidity in people who are obese A remarkable day of learning SESSION ONE: Perspectives from different disciplines and a patient Panel Discussion Round Table Case Based Discussions during Working Lunch SESSION TWO: Patient Counseling in Obesity Intervention Gaspard Theatre at 1:30, then Standardized patients in the CLSF 3

4 A Big Idea for Physicians Intervention in Obesity Jeff Sisler MD MClSc CCFP FCFP Disclosure CMAJ February 17, 2015 Relationships with commercial interests: Grants/Research Support: None Speakers Bureau/Honoraria: None Consulting Fees: None 1. Tell patients what their BMI is 1. Tell patients what their BMI is 2. Consider secondary obesity 3. Be ready with basic suggestions 4. Look for co-morbidities 5. Focus on referrals when BMI > 30 and at high risk for diabetes 6. Know your local programs 4

5 2. Consider secondary causes beta blockers corticosteroids, Depo-Provera diabetes drugs (insulin, sulfonylureas) atypical antipsychotics (clozapine, olanzapine, risperidone, aripiprazole (Abilify), quetiapine valproic, lithium, pramipexole tricyclics, SSRIs 3. Be ready with basic suggestions Increase activity ½ hour a day Eat a balanced breakfast Limit sweet drinks 1 daily Limit fast food 1 weekly Limit screen time 4. Look for co-morbidities Blood pressure Diabetes Hyperlipidemia Sleep disorders Osteoarthritis Depression Eating disorders 5. Focus on referrals when BMI > 30 and at high risk for diabetes STRONG evidence Structured behavioural intervention Every kg of weight loss in people with IGT is associated with a 16% reduction in the incidence of diabetes. Peirson L 2014 What is a structured intervention? 6. Know your local programs Intensive behavioural modification programs involving several sessions over weeks to months. behaviourally based interventions focused on healthy eating, activity or lifestyle changes, alone or in combination 5

6 6. Know your programs Summary 1. Tell patients what their BMI is 2. Consider secondary obesity 3. Be ready with basic suggestions 4. Look for co-morbidities 5. Refer if BMI > 30 & at high risk for diabetes 6. Know your local programs 6