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Weight Loss<br />
Obesity has reached epidemic proportions globally. Historically more prevalent in<br />
high-income countries, obesity is now common in low-to-middle income countries<br />
with nearly one-third of the world's population now obese or overweight.<br />
According to the World Health Organization (WHO), 44% of diabetes, 23% of<br />
heart disease, and 7%–41% of certain cancers are attributable to excessive<br />
weight.<br />
Obesity is typically the result of an increased consumption of high-calorie<br />
foods without a corresponding increase in physical activity. Environments that<br />
promote healthy eating and exercise typically contain fewer individuals who are<br />
overweight.<br />
The risk of heart disease, indigestion or heartburn, gallstones, sleep apnoea<br />
(see Sleep Problems), type 2 diabetes and certain cancers increases in people<br />
who are overweight. Reducing weight to within the healthy range reduces most<br />
of these risks and may also benefit customers with osteoarthritis or those having<br />
issues with reproductive health.<br />
Maintaining a healthy weight makes exercise and movement easier and<br />
increases life expectancy. More information is available through the NZ Ministry<br />
of Health’s HealthEd website (www.healthed.govt.nz).<br />
mass index (BMI) as medically obese (BMI more than 30). Weight loss is also<br />
recommended for people with a BMI of more than 25.<br />
»»<br />
BMI is calculated as body weight divided by height squared, ie, kg/m 2 .<br />
Calculate this by obtaining a person’s weight (in kilos), dividing by their height<br />
(in metres), and then dividing by their height again. A BMI of 18.5–25 is a<br />
healthy body weight. People should aim for a BMI of 25 or less.<br />
»»<br />
For people of Asian or Indian descent, a lower BMI may be desirable.<br />
• Waist circumference should also be measured as this gives an indication of<br />
truncal or abdominal obesity.<br />
»»<br />
Weight carried mainly around the middle part of the body is associated<br />
with a higher risk of metabolic complications (ie, high blood pressure,<br />
dyslipidemia, insulin resistance) which can lead to heart disease, diabetes,<br />
stroke, and gall-bladder disease.<br />
• People with a high muscle mass (eg, body builders) may have a higher BMI<br />
but may not be overweight. Waist circumference may be a more accurate<br />
measure of body fat in very muscular adults, in ethnic groups with a smaller<br />
body size (eg, South Asian populations) and in older people.<br />
When is weight loss important?<br />
• Weight loss is extremely important when a person is defined by their body<br />
TREATMENT OPTIONS<br />
Category Examples Comments<br />
Weight loss programmes eg, System: Slim Personal, trained consultants are available on site at specific pharmacies. Consultants<br />
provide weight management advice and eating plans to develop good eating habits using<br />
normal grocery items. Dietary supplements are also available but meal replacement formulas<br />
are not used. Weekly visits to consultants are encouraged (www.systemslim.co.nz).<br />
Meal replacements eg, Optifast VLCD (Very Low Calorie Diet) VLCDs are intended for people with a BMI greater than or equal to 30 or greater than 27<br />
with obesity-related medical complications. People should see a health professional twice<br />
a month while on the programme, and people with type 2 diabetes and hypertension need<br />
careful monitoring. See www.optifast.com.au<br />
Oral medication for weight<br />
loss<br />
Other products<br />
Natural / herbal products /<br />
supplements<br />
eg, Kate Morgan Weight Management<br />
Programme<br />
[PHARMACIST ONLY MEDICINE]<br />
eg, Orlistat (Xenical)<br />
eg, IsoWhey Weight Management, Radiance<br />
WellTrim, XL-S Medical Direct Oral Powder<br />
Whey protein powder<br />
Hoodia (eg, Go Healthy Slim Hoodia)<br />
Caralluma fimbriata, garconia cambogia, green<br />
coffee bean<br />
eg, Synetrim Slim*<br />
5-way weight management programme. Replace two meals per day with Kate Morgan meal<br />
replacement, which also contains essential vitamins and minerals. Guidance on low GI foods,<br />
low fat meals and physical activity provided (www.katemorgan.co.nz).<br />
Xenical can be sold only to people with an initial BMI of greater than or equal to 30 or<br />
greater than 27 with additional risk factors (eg, high BP, raised cholesterol, diabetes). It<br />
blocks approximately 30% of dietary fat from being absorbed. The recommended dose is one<br />
capsule taken three times daily with each main meal (breakfast, lunch and dinner), or up to<br />
one hour after a meal. Use with well-balanced, low-fat meals and regular physical activity.<br />
May contain ingredients that bind fat or create a feeling of fullness.<br />
Whey protein may help reduce body weight and increase insulin sensitivity.<br />
Hoodia is used by Kalahari bushmen to prevent hunger during long journeys. Growing and<br />
extracting the active ingredient out of the plant is difficult and evidence of a benefit for<br />
weight loss is limited. Evidence for a benefit for caralluma fimbriata or garconia cambogia is<br />
also limited. Small studies have been favourable towards green coffee bean extract.<br />
Synetrim Slim is a multi-action formula containing Cissus quadrangularis, green tea, green<br />
coffee bean seed and chromium for weight management.<br />
Products with an asterisk have a detailed listing in the Weight Loss section of OTC Products, starting on page 267.<br />
Significant learning<br />
opportunity: Wound care<br />
Your new Group 3 CPD project<br />
Page 168 HEALTHCARE HANDBOOK <strong>2017</strong>-2018 Common Disorders
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