Dr Aresh Anwar
Birmingham Heartlands Hospital

Ms Paula Noble
Birmingham Heartlands Hospital

Weight problems are not new. Hippocrates observed that overweight people died earlier than people with normal weight did. There was no real evidence until the mid 1990s of the severity of weight problems, when it was found that 6% of men and 8% of women were obese. Obesity is described as a BMI (body mass index) of over 30 and is calculated on weight/height ratio.

In 1995 a Government White Paper was published on weight problems and the associated health risks. The aim of the white paper was to reverse the weight gain trend. It said in the paper that 17% of men and 21% of women in the UK were now obese, a substantial increase. Obesity is a topical issue today for both health and economic reasons.

Research into obesity in 1953 by Kennedy isolated lipostat, which was thought to be a model for weight control, but it was not until 1994 when the 'fat controller' (leptin) was found. Leptin is a hormone produced by the body fat, which affects the appetite control centre in the brain. When the body loses fat the lack of leptin stimulates the appetite. When fat accumulates the extra levels of leptin depresses our interest in food. Research has also found that giving mice leptin can reduce their weight, but unfortunately it does not in man. Further research has shown that a person's appetite and their eating patterns may be linked to specific genes. There are about 30 compounds that are linked to weight at this present time.

Having an increase in intra-abdominal fat is a health risk, as is where the weight is distributed, although different races can deposit fat differently.

Hormonal influences on weight

The hypothalamic - pituitary axis controls and regulates hormones.

The Adrenal glands and Cortisol are responsible for fat cell development. Hepatic (liver) gluconeogenesis attenuates the action.

An overactive Thyroid Gland (thyrotoxicosis) reduces weight. Myxoedema (underactive thyroid) causes weight gain.

Lactation (Prolactin) increases food intake, but is not associated with weight gain. Bromocriptine modulates seasonal fattening.

Low Testosterone can cause excess intra-abdominal fat.

Oestrogen is important for Adipose tissue, particularly during the menopause for fat distribution.

GH deficient adults have 6-8 kg excess fat mass. Treatment will reduce the fat mass, but weight remains the same.

Weight control is a complex problem and is not fully understood.

Weight control & Nutrition

Energy balance is a scientific formula used to predict the energy requirement (basal metabolic rate) × activity of any person. Factors such as age, sex, weight and height affect the final outcome.

A stable weight is obtained if the energy taken in (from food and drink) is equal to the energy used up (metabolic rate × physical activity).

Calories come from all food types i.e. carbohydrates, fats, and proteins.

Weight management

Losing 10% of your body weight can have significant health benefits such as:

• Reducing diastolic and systolic blood pressure.
• A possible reduction in cholesterol, but only if total daily intake in fat is less than 30% of daily calorie intake.

If combined with an increase in activity and/or exercise this weight loss also:

• Burns calories.
• Increases metabolic rate.
• Controls appetite.
• Improves health.
• Improves confidence and general feeling of well-being.

How to manage

• Use a family centred approach.
• Be SMART (Specific, Measure, Achievable, Realistic, Timed). In other words set small goals that you can reach reasonably quickly.
• Behavioural change management.
• Use slimming clubs, providing they have a healthy eating plan.
• Increase exercise and activity. If you can only manage stairs once a day try twice or get off the bus two stops earlier.
• Attend weight management clinics.

Think positive. Each little step you take can improve your physical and mental well-being.