Obesity prevention and management


Position

澳大利亚皇家学院Practition将军ers (RACGP) recognises that obesity is one of the most important health issues facing Australia and affects the health, wellbeing and productivity of many Australians.1–3肥胖是直接或间接地与许多慢性疾病,也导致显著的发病率。vwin998sport

General practice has a central role to play in the prevention and management of obesity. This role needs to be supported through improved funding of effective and evidence-based services and therapies. Funding for research into obesity prevention and management is also much needed.

Background

Obesity affects individuals, their families and/or carers and the wider community. The causes of obesity are multiple and complex, and the condition requires lifelong management.4,5

People living with obesity commonly experience stigmatisation and social inequity in daily life6– a situation compounded because systemic inequity and stigmatisation currently limit access to effective treatments.7,8

The worldwide prevalence of obesity has increased over recent decades, reflecting the significant contribution of changes in lived environments and lifestyle factors.4,9

To work effectively and equitably towards reducing obesity in our communities, we need a balanced combination of individual and public health measures.10,11

自2008年以来肥胖一直是澳大利亚国家卫生优先领域;3currently, approximately two-thirds of Australian adults have a body weight in the overweight or obese categories.1Obesity causes metabolic and hormonal changes in the individual.它也与其他慢性疾病,如糖尿病,心脏疾病,骨关节炎和某些癌症的风险增加有关。12

The causes of obesity are multiple and complex, and include epigenetics13,14(a change in the way genes are expressed) and alteration in the gut microbiome1五(生活在肠道细菌和细胞),等等。虽然肥胖的遗传已经在双胞胎研究显示16and clinical practice, only a small percentage of patients have a purely genetic cause (eg leptin deficiency)17,18or a purely medical cause (eg hypothalamic tumour) for their obesity. For the majority of patients at genetic risk of developing obesity, environmental factors (physical, social and economic)19facilitate weight gain.

尽管生活在澳大利亚的肥胖成年人的25%,据估计,<一般惯例协商的1%20centre around obesity. Of those Australian adults who qualify for bariatric metabolic surgery based on body mass index (BMI) alone, uptake of surgery is unacceptably low. This reflects barriers to access and inequities as evidenced by <12% of these surgeries being performed in the public healthcare system.21

The prevalence of obesity in Aboriginal and Torres Strait Islander communities is alarming.22Obesity is thought to contribute to 16% of the health gap between Aboriginal and Torres Strait Islander peoples and the total Australian population.22The inequity in health service access and provision for Australians with obesity is further accentuated in those from Aboriginal and/or Torres Strait Islander backgrounds.

心理健康问题的人置于肥胖的风险增加,值得特别考虑。12,23,24

重量gain may be a consequence of symptoms such as impaired motivation or self-care, insomnia, inactivity or unhealthy relationships with food.25–27

此外,许多精神药物易致体重增加和其他代谢的副作用,这是发病的一个原因显著,要求治疗医师的密切关注。28-31

General practice, as a fundamental component of primary care, has always been the foundation of management of chronic diseases in the Australian community.32人们认识到,科医师(GP)需要更好地支持帮助肥胖症患者中发挥作用。33,34

目前我们有一个“致胖”的环境不支持的人,使他们的营养和体力活动水平健康的决定。9,19Obesity prevention requires a whole-of-systems approach that includes not only the healthcare sector, but also public health safeguards, town planning, transport, nutrition and education.9,35–37

重量偏差和侮辱是影响健康和生活与肥胖的人福利的严重问题。7People with obesity may avoid healthcare if they feel shamed about their weight. Public obesity messages that focus only on weight and individual factors contribute to stigma and bias.8The emphasis should shift from loss of weight to gain in heath.

Policy response

Recognise the importance of obesity

Obesity is both a cause and consequence of many other chronic conditions and diseases. It is expected to have periods of relapse and remission and, given its progressive nature, lifelong management will be required.38Obesity represents a disturbance in normal physiology,39is detrimental to health, and is associated with many comorbidities.12The RACGP recommends increased government support for effective services, therapies and surgical procedures.

公共政策

The RACGP recognises the need for a change in public policy to support healthy environments, where healthy options are readily available and affordable. To prioritise their health, individuals increasingly must work against the environments in which they live.10,11,40The RACGP advocates that the focus of the health message be on ‘gaining health’ rather than simply ‘losing weight’, recognising that obesity is about more than body weight.41

Recognise the key role of GPs in managing obesity

The RACGP recognises that a skilled and enabled primary care workforce is essential for obesity prevention and management.33,34全球定位系统are in a unique position to bridge issues that cross primary care and public health; GPs deal with individuals day to day, but also have a deep understanding of the communities in which they work. The Department of Health has made available Medicare Benefits Schedule (MBS) provisions for GPs in this role, via the use of Chronic Disease Management Plans for the care of individuals with complex obesity.

Education and support for GPs in managing obesity

The RACGP recognises the need for more education of registrars and GPs in prevention, detection and management of obesity, and importantly the need for awareness of stigmatisation and inequity.

Many GPs have the skills required to provide professional advice to individuals at risk of developing obesity, but they need to be supported to provide effective, evidence-based management to patients with obesity.33,34

全科医生是一个多维的方法的一部分

该RACGP认识到需要一个多管齐下,包括人口范围内的公共卫生措施,和有针对性的“危险”群体接近特定。

“系统思维”正在产生令人鼓舞的结果至关重要的儿童组,并且可以适用于其他的高危人群。36,37,42

In the context of holistic health promotion, GPs are key to promoting obesity prevention by identifying patients at higher risk.

污名

The stigmatisation of obesity in our communities is a major problem, and well-intentioned but insensitive comments or policies may do more harm than good.6–8作为步骤减少肥胖的指责,该RACGP承诺使用人 - 第一语言和结束使用污蔑的图像和信息。

卫生不公平

健康是不公平的结果,并且肥胖的一个因素。11,22所有肥胖的倡议应明确说明它们是如何实现减少弱势人群,尤其是原住民和托雷斯海峡岛民社区卫生不公平的工作。该RACGP认识到,有效和公平地防止肥胖,需要的个人和上游措施的平衡组合。10

拥护

该RACGP呼吁各级政府和其他部门,包括制造业,零售和公共卫生当局,参加全科医生在处理澳大利亚的致胖环境。肥胖是肥胖个人一个严重的健康问题,并为他们的家人和照顾者。该RACGP致力于一级预防的这种危及生命的条件,以保证更好的健康结果和生活质量,为所有澳大利亚人。vwin998sport

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