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Last Updated: Wednesday, 13 December 2006, 00:41 GMT
Q&A: Tackling growing obesity
Obese woman
Obesity is on the rise due to bad diets and sedentary lifestyles
The National Institute for Health and Clinical Excellence has published guidance on preventing and managing obesity in England.

The recommendations are the first from NICE to include measures for professionals outside the NHS.

Main recommendations

  • Obese and overweight adults should be given advice on healthy eating and doing at least 30 minutes of physical activity on five or more days a week
  • Those with a BMI over 30 can be offered drug therapy if they fail to lose weight with lifestyle changes
  • Surgery should be considered in people with a BMI over 40 who have failed to lose weight through other means or those with a BMI over 35 who have health problems associated with their weight
  • Children over 12 who are obese can be offered drug treatment if other lifestyle approaches have not worked and in extreme cases can be considered for surgery
  • Local authorities and town planners should provide safe places to exercise and encourage activity through the design of buildings and open spaces
  • Schools and employers should promote healthy eating and physical activity

Why are levels of obesity rising?

In 1980, 8% of women and 6% of men were classified as obese.

By 2004 this had increased to 24% of men and women. Experts blame diets high in fat and calories combined with reduced levels of physical activity.

However, it has been reported that previous generations had a higher calorie intake but were much more active and had physically demanding jobs.

Children are also suffering from increased levels of obesity, with 16% of children aged two to 15 classed as obese in 2003 compared with 10-12% in 1995.

When is someone classed as obese?

The most commonly used measure for assessing if someone is overweight is the body mass index.

This is calculated by dividing weight in kilograms by height in metres squared and is a way of roughly assessing if someone is the right weight for their height.

A BMI under 18 is classed as underweight, 25 to 29.9 is overweight, 30 or over is obese and 40 or over is morbidly obese.

BMI is not always accurate, as people with a lot of muscle may have a high BMI but be very slim, but can be used as a guide.

NICE also recommend that in people with a BMI less than 35, doctors should measure waist circumference, which has been shown to be associated with the risk of diabetes and cardiovascular disease.

For men, a waist circumference of more than 94cm is considered high and more than 102cm is very high. In women a waist circumference of more than 80cm is high and more than 88cm is very high.

Why is obesity bad for your health?

Obesity is associated with a greatly increased risk of heart disease, diabetes and cancer.

On average, it reduces lifespan by seven years.

But the good news is even losing a small amount of weight, for example 5 to 10% of total weight, can dramatically reduce the risk of diseases such as diabetes.

Obesity is also associated with higher rates of diseases such as arthritis, because of the pressure on the joints.

What does it cost the economy?

The Commons health select committee has estimated that obesity costs England up to 3.7bn per year.

This breaks down into 49m for treating obesity, 1.1bn for treating the consequences of obesity, 1.1bn for premature death and 1.45bn for sickness absence.

If the cost of people who are overweight is added in, the figure grows to between 6.6bn and 7.4bn a year.

What is new about this guidance?

The recommendations from NICE have all been made before by various organisations and experts, but this is the first set of national guidelines covering everything from prevention, to identification and management of obesity.

Unlike other NICE guidelines, they include recommendations for bodies outside the NHS, such as schools, local authorities and employers.

What does the guidance say?

The guidelines include advice for healthcare professionals on what advice to give, how to manage people with obesity and when to use more extreme measures such as drugs and surgery.

Drugs which promote weight loss such as orlistat and sibutramine can be considered if lifestyle changes have not been successful.

Surgery to restrict the size of the stomach or bypass a part of the digestive system is a last resort for people with a BMI over 40, or between 35 and 40 if they have other health problems caused by their weight.

This should only be used for people for whom the other options have failed, but it does have quite a high success rate. In adults with a BMI over 50, however, surgery can be considered as a first-line option.

Surgery and drugs can be used in children who are overweight, but only in exceptional cases.

Local authorities are encouraged to make streets cleaner and safer and to design buildings and public spaces to encourage physical activity as well as setting up cycle and walking routes.

Schools and employers should also take steps to promote healthy eating and exercise.

There is also separate advice for the public on how to keep an eye on your weight, what constitutes a healthy diet and how to increase levels of physical activity.

How are people advised to lose weight?

Adults are advised to follow a diet aimed at losing no more than 0.5-1kg a week, so that weight loss is gradual, but sustained.

They should only use low calorie diets of less than 1,000 a day for 12 weeks at most.

They should also do at least 30 minutes of moderate-intensity exercise five times a week.

Children are advised to do at least 60 minutes of moderate activity a day.

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