*
Fiona Chan
Specialist Dietitian
Weight Management and Bariatrics
Salford Royal Hospital
*Diet and obesity
*Dietetic input in medical management of
obesity
*Dietetic input in surgical management of
obesity
*
*
Obesity: identification, assessment and management
of overweight and obesity in children, young people
and adults (updated November 2014)
Classification
BMI (kg/m 2 )
Healthy weight
18.5–24.9
Overweight
25–29.9
Obesity I
30–34.9
Obesity II
35–39.9
Obesity III
40 or more
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*
1
General advice on healthy weight and
lifestyle
2
Diet and physical activity
3
Diet and physical activity; consider
drugs
4
BMI
classification
Waist circumference
Diet and physical activity;Comorbidities
consider
drugs; consider surgery present
Low
High
Very high
Overweight
1
2
2
3
Obesity I
2
2
2
3
Obesity II
3
3
3
4
Obesity III
4
4
4
4
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*
*Dietary
*Physical activity
*Behavioural
*
* Faddy diets
* Slimming groups
* Restrictive diets
* Meal replacements
* Intensive Exercise regimes
*
*Consider low-calorie diets (800–
1600 kcal/day), but be aware these are
less likely to be nutritionally complete.
*Do not routinely use very-low-calorie
diets (800 kcal/day or less) to manage
obesity (defined as BMI over 30).
*Continued clinical support with a multicomponent strategy to maintain the
weight lost is vital.
*
* Tier 3 service
* MDT approach : Physicians, Clinical
Psychologists, Dietitians.
* Initial assessment usually carried out by
physicians with subsequent follow up by
dietitians and physicians.
* Based in Salford Royal Hospital
* Provides 1:1 weight loss advice
* Prepares patients for bariatric surgery with
education sessions.
*
*Assessment
*Nutritional management in
relation to medical concerns
*Energy balance
*Behavioural e.g. emotional eating
*
*Intervention
*Translating evidence based advice
into realistic dietary changes
*Support for eating behaviour related
emotions and changes
*Empowerment: dietary education
*
* Changes to induce calorie deficit
* Meal replacements
* Weight management groups, including
commercial slimming clubs
*
* Shop on a full stomach and stick to a shopping list. You
are less likely to be tempted to buy high fat and sugar
foods.
* Half a plate of vegetables or salad at lunch and evening
meal. Salad and vegetables are filling and very low in
calories. They can be fresh, frozen or tinned.
* Are you hungry? Having a regular meal pattern especially
having breakfast mean you are less likely to overeat or
snack through the day
*
* Portion sizes of your meals are just as
important. Use a smaller plate at meal times
to reduce the amount of food you are eating.
* Eating habits affects how much food we need
to feel satisfied. Eating slowly and chewing
each mouthful at least 15 times could mean we
will feel satisfied with less food.
Cravings
Comfort
“addiction”
*
Satiety –
Head hunger VS
Real hunger
Habits
Stress
Boredom
*Orlistat- Lipase inhibitor
- The only currently licensed drug in UK for
weight loss
- Low fat diet recommended (<30% fat as total
energy)
- Bowel effects include diarrhoea (with urgency
which may lead to faecal incontinence), oil leakage
from rectum, abdominal pain and wind.
- Patients are offered dietetic advice and
support before and during taking orlistat.
*
*Assist patient in fulfilling funding criteria for
NHS England, which include:
* Show commitment to changes for weight loss
*Pre-bariatric surgery education to ensure
understanding of surgery
*Attendance of bariatric support group (at least
twice)
*
*Provide guidance and support before
and after surgery
*Pre – bariatric surgery education
* Liver reduction diet
*Post surgery recovery diet
*Advice and support for long term
maintenance of weight loss and
nutrition
*
*Restrictive diet low in carbohydrates
*Only used 2 weeks pre surgery
*To shrink liver by limiting glycogen and
water storage
*Variations of the diet recommended by
different centres e.g. milk and yoghurt
based, food based.
*
*Stages to build up textures
*To re-establish a new relationship
with food and eating habits
*To promote wound healing
*To prevent complications caused by a
severe calorie deficit e.g. protein
energy malnutrition; micronutrient
deficiencies.
*
Surgery/
Diet
Band
(Weeks)
Sleeve
(weeks)
Bypass
(Weeks)
Liquid
2
3
3
Puree
2
3
3
Soft
2
3
3
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*Intensive support immediately post surgery for
recovery diet
*Macronutrient and micronutrient balance post
surgery
*Eating habits and eating behaviour to prevent
complications and encourage weight loss
*Weight maintenance post surgery
*Advice and support for weight regain
*Guidance and advice for pregnancy post surgery
*
Solution:
Adequate Fluid
between Meals
Increase Fibre
intake
Symptoms - vomiting,
nausea, weakness,
sweating, faintness and
diarrhoea.
Solution –
Limit sugars & fats
Solution - Avoid fatty
foods – this will also aid
weight loss.
Dumping
Syndrome
Constipation
Diarrhoea
Vomiting
Solution:
Eat slowly
Chew Well
Eat Smaller
portions
Stop when full
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