Scenarios

Chapter 8: Obesity

Angela is a 45-year-old divorced mother of three children, aged 18, 16 and 12 years of age, of black Caribbean descent. Angela is classified as obese with a BMI of 30 and a waist circumference measuring 40 inches of 102 centimetres.

Angela is effectively an unsupported single parent who works as a receptionist in the local authority where she has to face an often hostile public on a daily basis as part of her role and she lacks confidence, especially as sometimes the public make unflattering and personal remarks about her appearance.

She desperately wants to lose weight and has struggled for many years with various diets and inconsistent exercise classes, all of which with little success and, worryingly, she has steadily gained weight over the years. Over time Angela has suffered from numerous health problems associated with being obese including hypertension, lower back pain, depression, fatigue and sleep apnoea.

Angela is seen in the outpatients department where she tells the doctor that she wants to have a gastric band fitted as she has seen celebrities on television who have had this procedure and they have reported that they have lost significant amounts of weight. Angela is adamant that this is the only acceptable choice she has, as all her previous attempts at weight loss have been unsuccessful and left her with low self-esteem.

• 1. What advice would you give to Angela?

  Show Answer

  Correct answer:
  Most people who are overweight or obese express a desire to lose weight for health or aesthetic reasons and many will have tried on previous occasions usually by dieting or portion control. There is not a strong evidence base to guide the choice of strategies to manage adult obesity and to maintain weight loss in the long term, particularly for men. Interventions in non-clinical settings that are shown to be effective in terms of weight management are likely to demonstrate significant improvements in participants' dietary intakes (usually fat and calorie intake) and/or physical activity levels.

  Bariatric surgery is used for patients with life-threatening obesity:

  • Having a body mass index (BMI) of 40 or above
  • Having a BMI of 35 or above and having another serious health condition that could be improved such as type 2 diabetes or high blood pressure.