Obesity

Obesity (BMI more than 30) is usually caused by a combination of medical, social and environmental issues
Be respectful and consider the dignity of larger people — do not blame or judge people
Obesity is a chronic condition and can lead to significant co-morbidities, eg increased risk of other chronic condition and joint problems
Weight loss should not be recommended for children under 16 years of age unless recommended by paediatrician
Weight loss should not be recommended during pregnancy
Weight loss in people over 65 years or people with end-stage diseases should be monitored by a health professional
Very low energy diets, medicines and surgery can help people with a BMI more than 35 to lose weight — these treatments require specialist assessment and management — medical consult and refer to dietitian
Public funding for surgery may be available for eligible people
While medicines may be registered for use in obesity their cost is not subsidised

Considerations when caring for larger people

Move and handle people to reduce the risk of injury to yourself and the person — assess weight bearing capacity and person’s ability to assist with transfers and repositioning (eg respiratory, cardiac and joint conditions) — encourage independence where safe
Use correct equipment if available — most standard equipment has a weight limit of 120kg — bariatric equipment (eg beds, chairs, stretchers, gowns, bedpans) may be needed for larger people
If person needs transport — inform transporting and receiving services of person’s weight, height and waist circumference

Adult health check if due
Provide brief interventions on healthy eating and exercise
Aim for 5–10% loss of body weight for people who are overweight (BMI more than 25kg/m2) — loss of a few kilograms can improve BP, BGL and arthritis

Follow-up outstanding referrals
Refer to dietitian and mental health services
Assist in finding local programs that may help address social and environmental issues

People with BMI more than 35kg/m2 with risk factors or comorbidities

Consider referral to endocrinologist for medical management including consideration of very low energy diets, medicines and/or surgery
Ongoing support from doctor and dietitian will be required for people using very low energy diets
Weight loss medicines and very low energy diets can lead to side effects such as gallstones, diarrhoea, constipation, headaches, fatigue — medical consult

Follow-up care of people who have had bariatric (weight loss) surgery

Monitor weight loss progress
Monitor for complications — abdominal pain, diarrhoea, reflux, nutritional deficiencies (eg anaemia, nausea, fatigue, dizziness, hair loss, mouth ulcers at every visit) — medical consult
Medical follow-up for medication dose adjustments and nutritional supplements — multivitamin, oral iron, Vitamin B12, folic acid, thiamine, calcium and Vitamin D
Annual bloods — FBC, UEC, LFTs, ferritin, folate, calcium, Vitamin D, PTH, Vitamin B12