What we’ll cover:

• Obesity as a complex disease
• Understanding BMI
• The various factors that impact Obesity
• Treatment of Obesity

Obesity is a significant public health issue in the UK, affecting millions of people and contributing to chronic conditions like type 2 diabetes, heart disease, and joint problems. Managing obesity requires recognising it as a complex and ongoing condition influenced by genetics, environment, psychological factors, and socioeconomic challenges. These factors go beyond personal responsibility, making a compassionate, patient-centred approach essential for effective care.

Understanding BMI and Its Limitations

Body Mass Index (BMI) is a common way to assess obesity. It calculates weight in kilograms divided by height in metres squared (kg/m²). For most adults, the categories are:

• 18.5 to 24.9 is considered a healthy weight
• 25 to 29.9 may indicate overweight
• 30 or above may indicate obesity
• 40 or above may indicate severe obesity

While BMI is widely used, it has limitations. It doesn’t account for differences in muscle mass, fat distribution, or ethnicity. For example:

• People with higher muscle mass may have a higher BMI without excess body fat.
• Visceral fat (around internal organs) poses a higher health risk than subcutaneous fat (under the skin).
• People from ethnic minority backgrounds may face a greater risk of conditions like type 2 diabetes at lower BMI levels.

To provide a clearer picture of health risks, healthcare professionals often use additional measures, such as waist circumference, alongside BMI.

The Complex Causes of Obesity

Obesity is not simply a matter of eating too much or exercising too little. It is influenced by many interconnected factors:

• Genetics: Genes can affect appetite, metabolism, and fat storage, playing a significant role in body weight.
• Environment: Modern lifestyles often promote sedentary behaviour and easy access to calorie-dense, low-nutrient foods, making weight management harder.
• Socioeconomic Factors: Limited access to nutritious food, safe spaces for exercise, and healthcare support can make weight management more challenging for people in disadvantaged communities.
• Psychological Factors: Mental health, stress, and emotional eating can affect food choices and activity levels. Addressing these often requires psychological support alongside other routine medical care.
• Cultural Influences: Cultural attitudes towards weight, health, and body image can shape behaviours and impact care approaches.
• Biological Responses: The body’s natural response to weight loss, such as slowing metabolism and increasing hunger signals, makes maintaining weight loss difficult over time.

Treatment

In the UK, obesity treatment follows a tiered approach, starting with lifestyle changes and progressing to medical or surgical options when needed.

1. Lifestyle Interventions:
   Programmes like Roczen focus on long-term lifestyle changes, including:
   • Tailored diet plans
   • Exercise guidance
   • Behavioural support provided by nurses, dietitians and psychologists
2. Medications:
   When lifestyle changes alone aren’t enough, medications can support weight loss by targeting appetite, metabolism, or fat absorption. Examples include:
   • GLP-1 and GIP receptor agonists (e.g., Wegovy, Mounjaro): These mimic natural hormones released after eating to regulate appetite and slow digestion, enhancing fullness. These are only to be used alongside lifestyle interventions, with a reduced calorie intake and increased physical activity.
   • Fat absorption inhibitors (e.g., Orlistat): These reduce the absorption of dietary fat.
   • Combination medications (e.g., Phentermine-Topiramate): These work on appetite control and cravings, often helpful for emotional eating.
3. Bariatric Surgery:
   For people with severe obesity (BMI ≥40 or BMI ≥35 with related health conditions), surgical options like gastric bypass or sleeve gastrectomy can lead to significant and sustained weight loss. These procedures also improve obesity-related health issues and quality of life.

Summary

Obesity is a complex condition shaped by genetic, environmental, psychological, and socioeconomic factors. It cannot be understood solely through BMI, as other measures and personalised care are often needed. Effective treatment requires a compassionate, individualised approach, combining lifestyle interventions, medical therapies, and, where necessary, surgical options. Roczen’s programme is designed to support sustainable, long-term weight management with dietary, physical activity and medication interventions, helping patients achieve better health and wellbeing.