Obesity Clinic'

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Obesity Clinic.

• 11/10/04

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Clinic comprises of

• Consultant
• Dietician
• And scales that weight to 300kg (normal G.P
  scales go to 150kg)
• No psychologist attached at present
• Mr May, upper GI cancer surgeon sees patients
  considered for surgery when all else has failed,
  and usually BMI gt40

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Referral Criteria

• BMI gt30usually gt35
• Evidence of motivation
• Evidence of previous attempts to loose weight
• Having seen a dietician
• Children are not seen in clinic under 16 years,
  and there is no dedicated paediatric service

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Outline.

• Patients taken on for 2 years initially, and only
  kept longer if losing weight.
• Patients seen 3 monthly in clinic
• Dietician may see more frequently, especially in
  beginning
• Initial visit is an assessment by consultant and
  then dietician.

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Typical Questions Asked in History.

• Where you overweight as a child?
• When did you start to put on weight?
• What is your lightest adult weight?
• What things have you already tried?
• What medications have you tried?
• How is your weight affecting your health?
• How is your general health?
• Sob, snoring, sleep apnoea/daytime sleeping,
  thyroid, ammenorrhea

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Typical Questions Asked in History.

• Are your family overweight?
• Do you eat 3 meals a day?
• Any particular food cravings/weaknesses?
• What snacks?
• What exercise do you do?
• WHY DO YOU WANT TO LOOSE WEIGHT?
• Have you got a target in mind and what
  timescale?

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Examination.

• Many have acanthosis nigracans around neck and
  axilla
• Pulse, resting tremor, thyroid
• BMI
• Waist Hip ratio

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Investigations.

• Bloods FBC, UE, Chol, TFT, LFT, Haematinics,
  Testosterone, /- FSH, LH,
• /- ECG

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The Importance of Breakfast!

• Shown by 2 recent U.S Studies
• Calories taken earlier in the day are easier to
  burn off than those taken later.
• People who eat breakfast are less likely to
  become obese.

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Management.

• Diet Modification for 3 months
• Exercise
• Review after 3 months
• If losing weight, continue
• If stable consider orlistat (need lt30 fat diet
  to work) or sibutamine
• If gaining weight reassess and re-iterate.

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Dietician

• Sees each new patient after consultant assessment
• Offered some support
• In depth food sheet of typical day
• Plan agreed with patient of how to modify diet.
• Tailored to each patient fat/calorie/protein
  reduction accordingly

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The Future.

• The clinic has not been formally assessed, so
  success rate is unknown at present.
• Dr Whitelaw hope to expand the service, bringing
  in a psychologist and ENT supportfunding!
• Anyone interested can arrange to go
  along.especially if thinking of setting up a
  GPwSI service!