Hal Robertson Dip Physio (NZ), Dip OHS, MAPA Ergonomist, Workforce Health, Workforce Division, South Australia Health (P22, Wednesday, NZI 5 Room, 12-12.30)

1. The Obesity Epidemic
-do we only treat or do we demand
change
Hal Robertson
>Manual Tasks Services
>Workforce Health

2. Obesity is now the Number 1 World
Health Problem
• Approx 25% of
Australian and 26.5%
NZ adults have a
BMI>30.¹
• NZ and Australia are
ranked 6th and 7th in
the world for obesity. ²
'07-08 National Health Survey. ² Australian Bureau of Statistics (2009).
www.oecd.org/health/fitnotfat

3. Obesity Epidemic 2005-2010
Obesity as a percentage of total population.
Country 2005 2010 Change
United States 30.6% 33.8% 10.5%
New Zealand 20.9% 26.5% 26.8%
Australia 21.7% 24.8% 14.3%
United Kingdom 23.0% 24.5% 6.5%
Luxembourg 18.4% 20.0% 8.7%
http://www.abcdiamond.com/overweight-and-obesity

4. Bariatric definition
Person fits two or more of the
following criteria:
> Weighs 120+Kg
> BMI 40+
> Seated hip width >20” (51cm)
Body mass Index (BMI)=weight in KG/height in metres ²
SA Health

5. Bariatric statistics
Royal Adelaide Hospital and Flinders Medical Centre
> 2% of inpatient admissions are bariatric.
Ie approx 80 inpatients per month at RAH
> 5% of maintenance stay patients waiting
for nursing home placement (RAH) are
bariatric
> The average acute LOS for a patient over
120kg is 1.6 times longer than a normal
weight patient and 1.8 times longer if the
patient is over 150kg compared for other patients
with same Diagnostic Related Group matched for age and sex.
SA Health

6. The Risks
> Adverse patient
outcomes and
inequitable
standards of
care
> Increased injury
risk for workers
SA Health

7. Increase risk of worker injury
Bariatric patients…
> Are involved in between 14%-21% of body
stressing incidents assoc with patient care in
acute hospitals in Adelaide
> Caused 30% body stressing Workcover claims
FMC 2009-10- the relative risk of workers
sustaining Musculoskeletal injury is 19:1
SALHN 2010: Nursing and Allied Health Survey on Care of
Bariatric Patients
> 20% did not feel safe caring for a B patient
> 70% reported appropriate equipment is rarely
available
SA Health

8. Increased risk due to poor design
• Patient 250kg
• Room 15²m
• 7 workers
• Bed removed
for Chair
access
SA Health

9. Impact on Heath Care systems
> Acute hospitals-increased risks to workers
and the patient with dependent
patients>200kg
> Aged Care Facilities- struggle to care for
dependant residents in 120-150kg range
> Community support programs- limited
equipment options, environment and
home design restrictions, and often only
1-2 worker(s) available
SA Health

10. Managing Obesity
SA Health

11. Methods of management
> BMI 20-25 food choice, exercise, behaviour change
> BMI 25-30 dieting-low calorie diets
> BMI 30-35 very low calorie diets, drug therapy
> BMI 35-40 very low calorie diets, drug therapy,
surgery
> BMI 40-50 surgery
> BMI 50-100 surgery
National Clinical guidelines for weight control and Obesity management in Adults, NHMRC 2003

12. Dieting –it is not easy!
Combined approach
•Calorie controlled diet
•Regular exercise
•Self monitoring
•Motivation or strong reason to
change
•Good relapse strategy
•Long term support
www.drsharma.ca

13. Maintaining weight loss
> Weight loss tends to
plateau at 3- 6
months (Less body
fat, reduces resting metabolic
rate and hence reduces
energy requirements)
> Studies show 20% retain 10%
of initial weight loss for 1 year
Wing RR, Phelan S. Long term weight loss maintenance.
Am J Clin Nutr. 2005:82 (1): 2225-2255.

14. Yoyo dieters

15. Achieving long term weight loss
> National Weight Control Registry Australia
• Little similarity in weight loss methods
> Common behaviours in weight loss
maintenance
• Low calorie diet
• Low to moderate fat intake
• Limited fast food
• Eat breakfast most days
• Regular self monitoring
• Engaging in high levels of physical activity
(min 1 hour a day)

16. Drug therapy for weight loss
> Weight loss drugs
developed in past have had
harmful side effects
> Phentermine is effective but
there is no safety data for
long term use
> Be aware of other
pharmaceuticals that have
side effect of weight gain

17. Obesity and Mental health
> People with a severe
mental illness are 1.5-2x
more likely to be obese
> Reduced physical activity
> Poor nutrition habits
> Medication side effects-
weight gain
> Poor motivation
Mental health -40% Glenside Hospital clients have BMI>30kg/m²
(Survey August 2011)

18. Bariatric Surgery
> Aim-reduce mortality from obesity
related co-morbidities
> Dietary, psychological and medical
assessments
> Commitment to change. Pre surgery
weight loss requirement

19. Sleeve Gastrectomy
> Vertical stapling of
stomach
> Excise greater curve
> ‘restrictive’
> Mal absorption-need
long term dietary
supplements
> 1-2 day post OP stay
> 50% excessive weight
loss

20. Laparoscopic Adjustable Gastric
Banding
> Silicone band placed around
upper stomach
> Subcutaneous access port
> Inflate or deflate band
> ‘restrictive’
> No real mal absorption
> Day surgery or overnight stay
> 50% excessive weight loss
> Safest option

21. Why are we gaining weight?
> Energy input ≠ energy
expenditure
> There is only a very
slight daily discrepancy
of 50-80Kcal required
to gain 3kg a year

22. High fat, high energy diet
> 1/3rd of food is 1970 Now Food item
consumed outside of 350 600 Cheese burger
cal cal
the home
Size Bagels
> Portions are bigger X3
since 1970s (‘portion 375ml 600ml Soft drink
can can
distortion’)
200 625 Serve of
> Reduced physical cal cal French fries
activity
Plates

23. Sugared drinks
Primary obesity and diabetes strategy (Centre of
Disease Control USA)
> ‘reduce intake of sugar sweetened beverages’
> Since late 1970s USA soft drink consumption
has↑ 2x for females and 3x for males
> On average 8% of USA children’s calories come
from sugared drinks
> Advertising companies spend billions pa and aim
advertising at children and teenagers
–www.cnn.com/2011/08/31/health/soda-drinking-
habits/index.html

24. Projected increase in diabetes 2000-
2030
• USA 36.5%
• China 75.5%
• India 134%
Centre of Disease Control USA

25. Link with advertising and obesity
Food promotion is having an effect
particularly on children's’ preferences,
purchases behaviours and consumption.
Hastings et al 2003
77% of obese children will become
obese adults.
Pre schoolers in the USA will see on
average 5000 fast food ads by the
time they reach 5.
www.yaleruddcenter.org

26. Focus on PREVENTING obesity
•Healthy lifestyle
programmes- are they
working?
•Programmes for the
younger generation are
showing some
success–but it will be
decades until we see the
results
http://www.drsharma.ca/oecd-dont-place-all-your-bets-on-obesity-prevention.html

27. How do we control obesity?
Need for public health policies?
 Factual nutrition disclosures on food packaging
• Denmark-Taxes on foods with sugars and saturated
fats
• France-Govt health warnings on adverts for
processed, sweetened or salted food. Fines if
companies to not comply.
• NY. Menu label laws. Menu displays calorie count of
meal
• Proposed sugar tax in some USA states-
unsuccessful to date
Pomeranz JL, Teret SP, Sugarman SD, Rutkow L, Brownell KD. Innovative legal approaches to
address obesity. Milbank Quarterly. 2009 Mar;87(1):185-213.

28. > 62 yo patient weighing 276kg UTI and chest infection
> Ambulance retrieval-2 teams
> HIGH STAFF DEMAND:
• 6 staff to roll her when she was acutely ill, and 3 staff to
assist with placing her on a bed pan when she was
‘well’.
• 5 physiotherapy staff to stand her from lying in bed, + 2
nurses to move equipment during this procedure.
> STAFF INJURY
• 2 physiotherapists were injured attempting to lift her
legs back onto the bed. (legs weighed 80kg each)
> Specialist equipment needed
> POOR PATIENT OUTCOME
• Patient quickly became deconditioned due to limited
resources to mobilise her
• She died in hospital 4 months after admission
SA Health