FLASO and FELAEM Declaracion de Recife
Pan American Health Organization (PAHO) and World Health Organization (WHO) published a joint statement in September 2015.
The report notes that sales of industrially processed, foods including fast food and sugary drinks, ultra-processed products have increased steadily in Latin America and are contributing to increased obesity rates across the region, especially from 2000 to 2013 with great acceleration of sales in low-income countries. With this report the displacement of feeding patterns, with a feed resulting from excessive caloric density rich in free sugars and saturated fat, high in salt and low in fiber is reflected.
FLASO and FELAEM are committed to the health of their members populations, so join the WHO statement and propose some additional guidelines.
Read the full declaracion here.
England NHS changes threaten Bariatric Surgery Services
A major change in the way in which bariatric surgery is commissioned and paid for has been announced by NHS England. For the past two years in England, bariatric surgery has been commissioned and funded within the National Health Service by a central specialist commissioning authority according to nationally agreed guidelines. On Wednesday October 8th, NHS England announced that from 2015 commissioning will be devolved to the 221 Clinical Commissioning Groups (CCGs: General Practitioner-led NHS organisations set up in 2012 to organise the delivery of NHS services in England.)
Each CCG will have to develop its own care pathways and is not obligated to follow NICE or National guidelines - they can opt out citing 'local priorities.' Prior to centralised commissioning by NHS England, there was a ‘postcode lottery’ in which each area imposed its own non-evidenced based, rationing criteria for access to surgery.
Professor Nick Finer, chair of World Obesity Clinical Care and a member of the body that advises NHS England on specialist obesity services, said that the devolvement to CCGs similarly threatens the rational development of access to bariatric surgery and equity for patients. He said: “Already CCGs have failed to develop community-based multi-disciplinary obesity services (called Tier 3 services.) It is unlikely that there will be sufficient local expertise across each of the 221 areas to advise and help develop care. England already under-provides bariatric surgery: the number of operations done fell from 6,294 in 2012/13 to 5,767 in 2013/14, an 8% decrease.”
All this comes at a time when NICE is about to approve its recommendation that the BMI threshold for surgery should be reduced to 30 kg/m2 in those with type 2 diabetes.
This information is based on the original NHS Commissioning Intentions document
IOTF definitions of child obesity – extra tables
An expanded set of cut-offs defining child thinness and overweight based on the IOTF methodology (Cole et al BMJ 2000) has been published. The new tables give cut-offs for boys and girls aged 2 years to 18 years in one-month steps, for a range of BMI values equivalent to BMI 16, 17, 18.5, 23, 25, 27, 30 and 35 in adults.
The tables of cut-offs can be downloaded here.
The paper describing the cut-offs was published online on 19 June 2012 in Pediatric Obesity, available here. A reprint is also available by request from tlobstein@worldobesity.org
5As of Obesity Management
The Canadian Obesity Network - Réseau canadien en obésité (CON-RCO) have developed a new toolkit for health practitioners which provides a roadmap for obesity management.
The toolkit - called the 5As of Obesity Management - provides health practitioners with five steps to better manage their patients' weight and related health issues:
- ASK for permission to discuss weight and explore readiness
- ASSESS obesity related risks and 'root causes' of obesity
- ADVISE on health risks and treatment options
- AGREE on health outcomes and behavioural goals
- ASSIST in accessing appropriate resources and providers
The 5As of Obesity Management includes a desktop tool to facilitate discussions on weight with patients, as well as a practitioner's guide to incorporating the 5As into daily practice. They are available for a nominal fee from the Canadian Obesity Network at www.obesitynetwork.ca/5As