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What is the clinical definition of ‘being overweight’?

The World Health Organisation (WHO) uses Body Mass Index (BMI) to define whether one is overweight.

An individual’s BMI is calculated using the following formula: weight (kg) / height² (m²).
BMI readings are interpreted as follows:

• Healthy – 18.5 to 24.9
• Overweight – 25.0 to 29.9
• Clinically Obese – Exceeding 30

It is worth noting that these WHO classifications are based on data drawn from a predominantly White population. For non-White populations, it is recommended to subtract approximately 2.5 from calculated BMI for classification purposes.

For example, if you are of Asian origin, the adjusted classifications are:

• Healthy – 16 to 23.0
• Overweight – 23.0 to 27.49
• Clinically Obese – Exceeding 27.5

Should you wish to calculate your BMI, the NHS has a calculator available at:
https://www.nhs.uk/live-well/healthy-weight/bmi-calculator/

Is being overweight a problem?

Excess weight is directly correlated with a number of diseases, such as Type 2 Diabetes, high bloodpressure, high cholesterol levels, metabolic syndrome, and polycystic ovarian syndrome, to name a few.

The majority of these diseases lead to an increased risk of cardiovascular problems, such as ischaemic heart disease (heart attack), or stroke. When one is diagnosed with a disease such as Type 2 Diabetes, high blood pressure or high cholesterol levels, medication is prescribed to manage these conditions, and reduce your cardiovascular risks. However, medications do not really address the underlying culprit, which is the excess weight itself.

Therefore, managing your weight should be the most important intervention, to ensure better health outcomes.

Is excess weight a treatable condition?

Yes!

Medical and surgical advancements in recent years has made excess weight a highly treatable condition. The mainstay of treatment is, of course, lifestyle changes, such dietary modifications and increasing activity levels. However, some individuals continue to struggle with shedding excess weight, despite making the necessary changes. This is when considering alternative options to aid weight loss is important.

What treatments are available?

The most important thing to consider when trying to lose excess weight, is the support one will need from family, friends, and your healthcare team. Weight loss, in and of itself, is a challenge. It requires the application of willpower, the demonstration of determination, and substantial investments of time, effort and knowledge over prolonged periods.

Once the weight is lost, maintaining that loss can prove to be an even greater challenge. Weight loss is a worthwhile endeavour that translates into significantly improved health outcomes, but it pays to be aware of potential challenges before you begin.

In instances when lifestyle changes are not sufficient in achieving one’s weight loss goals, medical intervention could be the next step. When considering non-surgical options, there are a number of licensed products available in the United Kingdom:

1. Orlistat
   This is an oral medication taken with each meal to reduce the absorption of fat from food by approximately 30%.
   Orlistat is not highly effective when it comes to weight loss, with results in the range of 1 – 3%. However, it can be useful as a small boost to one’s weight loss efforts if required.
2. MySimba (Naltrexone with Buproprion)
   Another oral medication, MySimba’s mechanism of action is currently not well understood. However, it has resulted in loss of 3 – 5% of total body weight. It should be noted that the effectiveness of MySimba in the long-term remains unknown, due to
   lack of studies.
3. Glucagon-like peptide-1 injections (GLP-1)
   Glucagon-like peptide-1, or GLP-1, is a hormone produced by the gut when we eat. It is responsible for signalling to the brain that we are full, and should limit or cease food intake. GLP-1 has been shown to work in at least 2/3 of patients, with weight loss dependent upon the type of injections used. The long-term safety profile of this medication is good, as GLP-1 has been used in the treatment of Type 2 Diabetes for more than a decade. It is only recently that it has gained license for use as a weight loss medication.
   1. Saxenda (Liraglutide)
      Saxenda is the first GLP-1 injection to be approved for weight loss in the United Kingdom. Average weight loss is in the range of 5 – 10%.
   2. Wegovy (Semaglutide)
      Wegovy is currently approved in the United States, and is soon to be approved in the United Kingdom. Results with this medication are highly impressive, with average weight loss reported at 15%. Of interest is that 15% loss of total body weight is the amount suggested by the Diabetes Remission Clinical Trial (DiRECT) for reversal of Type 2 Diabetes.

Weight loss surgery remains the most effective treatment, although is certainly not everyone’s cup of tea.

The availability of new medications such as Wegovy, resulting in weight loss as significant as 15%, is certainly promising.

What can we offer for individuals looking to manage their weight?

Dr Tan leads the Tier 3 Weight Management Service at Royal United Hospital Bath. He has more than 3 years of experience in managing excess weight, and is keenly aware of the challenges surrounding weight loss.

Dr Tan seeks to help patients overcome these challenges by adopting a ‘whole person’ approach, obtaining a comprehensive understanding motivation, health and lifestyle factors, and adhering to research-driven best practice.

He is well-placed to provide the support that is required for one’s weight loss journey, including interpretation of the latest studies, advice regarding lifestyle changes, and guidance in exploring medication options best suited to your health, lifestyle, and weight loss goals.