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Cycles rides, walks around Salford Quays, cooking tips and free health checks are on the agenda for a Salford event aimed at encouraging healthier lifestyles.
Healthy Salford Day is led by Obesity Awareness, Support and Information Group (Oasis-GB), which has representatives from a range of different Salford and Greater Manchester agencies including Salford Royal, Salford City Council, Salford Community Leisure, ABL Health, Salford CVS and the University of Salford.
The event, on Saturday, October 13 from 11am-3pm outside The Lowry Theatre, Salford Quays, is aimed at people of all ages with activities focusing on obesity prevention such as exercise, nutrition and behaviour change. Activities will include mini health checks, physical exercise tasters including Zumba and tai-chi, nutritional awareness with chef demonstrations and free offers from leisure services and local sports clubs. It follows World Health Organisation’s World Obesity Day on Thursday, October 11.
Oasis-GB was formed in 2015 and aims to create a network of medical professionals, prevention agencies and patients to share expertise, resources and knowledge to help tackle the issues of physical inactivity and obesity in the region.
Professor Siba Senapati, Chairman and founder of OASIS-GB and a Consultant Bariatric Surgeon at Salford Royal, said: “The current obesity epidemic is on the rise and we have to tackle it with a multi-pronged approach as the cause of obesity is multifactorial. The aim of OASIS-GB is to act as a lead and link to different organisations focussed on tackling obesity.
“Plenty of great work is already underway across the region and OASIS-GB will complement that by developing an ever growing network of people to address this problem head-on. This includes bringing together health professionals to share our knowledge and expertise so that we can ultimately create a healthier population.â€
OASIS-GB Co-Chair and voluntary athletics coach Jack Carney said: “We are delighted to host this event and we’ve been so generously supported by lots of other organisations who share our desire to encourage collaboration to tackle obesity and to change attitudes and support people to make lifestyle changes.
“It’s a serious topic but we’ve designed the event to be fun and interactive with walks, cycle rides and lots of food and exercise advice. We look forward to seeing people there.â€
Healthy Salford Day will be opened by Councillor Rob Sharpe, Executive Support Member for Adult Social Care and Mental Health. Councillor Sharpe commented: “It’s great to see organisations coming together to offer support and advice. I think lots of people have good intentions to lose weight and become fitter but sometimes getting this kickstarted can feel difficult or people simply don’t know where to start. Healthy Salford Day should give visitors to the event some inspiration for how they can start to do that.â€
John Williams lost 18 stone with the support of Salford Royal and specialist weight management services in the north-west. At his heaviest, John was 36 stone. When he first met the bariatric team in Salford in 2015, he was told he was still too heavy for surgery, so he dieted for nine months and lost eight stone with the help of Salford Royal’s dieticians and specialist nurse. Since having surgery in February 2016, he has stayed healthy and is a keen runner and active member of the Oasis Obesity Awareness and Support group.
He stressed the importance of people seeking advice and support to lose weight, adding: “Losing weight isn’t an overnight thing, there is a lot of time between my ‘before’ and ‘after’ pictures – but look at where I am now! In the past I have experienced people shouting insults at me in the street and feeling like I couldn’t go out without people staring at me. I had pain in my back and knee when I tried to do anything and now that has gone.
“My life has completely changed, and I’ve got the confidence to do things I would never have imagined before. I’m studying at the University of Salford to become an occupational therapist, I run 5k twice a week and have just completed the Wigan 10k!
“Getting support to lose weight can make such a big difference – I feel physically and mentally healthier and am able to enjoy life again.â€
Impact of Obesity on Health Study Day
Miss Yan Mei Goh, Dr Akheel Syed and Mr Siba Senapati
Salford Royal University Teaching Hospital
Obesity is on exponential  rise in our society over the last few decades. This has major implications to our health and well-being and the economy as well as its impact on the NHS. Analysis by the Government’s ‘Foresight report for tackling obesity’ shows that over half the UK population could be obese by 2050 and the NHS costs attributable to being overweight and tackling obesity are projected to double to £10 billion per year by 2050.
The advent of this obesity endemic has led to various studies being carried out to identify causative factors and its impact on the wider population. It has long been posited that obesity is a result of the imbalance between energy intake and expenditure, both of which are easily influenced by our inherent physical and psychological drivers in favour of weight gain. Obesity not only leads to multiple comorbidities such as diabetes, sleep apnoea, metabolic syndrome, cardiovascular disease, stroke, arthritis and increased risk of cancer but also results in poor quality of life and impacts longevity. This has guided the development of the Government’s approach in building the foundation laid down in the White Paper, “Healthy Lives, Healthy Peopleâ€. Hence there is an urgent need for awareness and action at every level including the medical fraternity.
Event:
In association with the British International Doctors’ Association (BIDA) and Doctors Academy and with support from healthcare industries, Impact of Obesity on Health study day was structured to increase awareness and to review the current evidence and practice in the management of obesity. The day featured the establishment of a voluntary organisation, Obesity Awareness, Support and Information Services of Great Britain (www.OASIS-GB.com) inaugurated by Mr Robert Armstrong, Chairman of Wigan, Wrightington and Leigh NHS Trust. The aim and focus is to share information and knowledge with a view to develop strategies to tackle the obesity epidemic. There were 13 hugely informative and captivating talks on the day that succinctly summarised the far-reaching consequences of obesity on health as well as addressing ways to overcome this ongoing problem. It also featured Patient Champions offering the patient’s perspective of their struggles with weight gain and the support from healthcare professionals who aided them in their journey of weight loss and improved health.
This study day commenced with a Welcome and Introduction by Mr Siba Senapati, the organising President and Chairman of OASIS-GB, who highlighted the current obesity epidemic and how we need to tackle this with full support from all the medical and allied health fraternity along with voluntary sectors. Â Dr Akheel Syed, Consultant in Diabetes & Endocrinology and Obesity Medicine, described the trends in adult and childhood obesity and its close association with diabetes.
Whilst the consequences of obesity on health are well known, the management and understanding of its social and psychological impact are less so. Dr Basil Isa, Consultant in Diabetes & Endocrinology, described the metabolic effects of obesity and its impact on the individual, family and society. Dr Naveed Younis, Consultant in Diabetes & Endocrinology, provided an overview of the prevalence of diabetes in the ethnic minority population in the UK, the relationship between diabetes, BMI and cardiovascular disease in these ethnic groups as well as their cultural differences that can cause barriers to treatment adherence. Mr Joshi George, Consultant Neurosurgeon and Specialist Spinal Surgeon, highlighted the impact of obesity on the spine and brain and Mr Muthu Jeyam, Consultant Orthopaedic Surgeon, addressed alterations in the musculoskeletal systems, weight-bearing surfaces and the associated disease process as a consequence of increased weight.
Obesity is an independent cardiovascular risk factor that is also partly mediated by other conventional cardiovascular risk factors such as diabetes mellitus, hyperlipidaemia and hypertension. Dr Nik Abidin, Consultant Cardiologist, addressed the linear relationship between weight and cardiac comorbidities and its evidence base.
Dr Chris Bundy, Senior Lecturer in Behavioural Medicine at the University of Manchester, gave an alternative view of obesity from a psychosocial perspective. Dr Bundy highlighted cognitive behavioural approaches that influence eating and eating disorders in the population. Meanwhile, Dr Chandra Kanneganti, National Chair of BIDA, identified the long-term consequences of obesity on the individual and the person from a GP perspective. He highlighted the need for understanding of obesity as a multi-factorial problem with far reaching repercussions that must be addressed holistically.
Management of obesity has long been recognised to require a multidisciplinary approach. Dr Syed spoke about the available pharmacotherapy, and rational therapy to combat “diabesity†as well as the use of weight-friendly anti-depressants and mood stabilisers in obese patients with depression. Mr Senapati addressed the evolution of various bariatric surgical procedures, appropriate patient selection and outcomes from the National Bariatric Surgical Outcomes and the international published literature. Ms Fiona Chan, specialist weight management dietitian, described the integrated and multidisciplinary approach to understanding a patient’s eating behaviour and lifestyle. She addressed the need for dietary education and approaches for weight loss, e.g., the calorie deficit approach, meal replacement, low carbohydrate diet and pharmacological interventions available. As a dietician, she has a major role in addressing weight loss prior to bariatric surgery and re-establishing a new relationship with food and eating habits in a sustainable manner.
Mr Don Robertson, Patient Champion, described his story before and after bariatric surgery. He shared his experience and struggle with obesity, the psychological barriers he had to overcome to seek help and then adhere to his new eating regime and diet. This was followed by talks from two more patients who also shared their experiences and called for expansion of services to reach more patients affected by obesity.
Abstracts
Current State of Obesity Epidemic
Dr Akheel Syed, Consultant Endocrinologist, Salford Royal NHS Foundation Trust
Obesity is arguably the greatest public health concern of our times. The prevalence of clinical obesity (BMI, body mass index ≥ 30 kg/m2) has risen inexorably in recent decades and today a quarter of all adults in the UK are clinically obese. Data from the Health Surveys for England show the prevalence of obesity rises with age and poorer socio-economic status, amongst other factors. The obesity epidemic has fuelled an increase in weight-related co-morbidities, particularly type 2 diabetes. Five times as many adults with obesity have diabetes compared to adults with a normal BMI. Five times as many men and three times as many women with a high waist circumference have diabetes compared to people with slim waistlines. The healthcare costs due to obesity and associated co-morbidities are amongst the highest in the NHS.
Metabolic effects of obesity
Dr B G Issa , Consultant Endocrinologist, University Hospital of South Manchester
Obesity is on the increase globally with more than 1.9 billion adults being overweight in 2014 and 13% were obese. The situation is similar in the UK. Worryingly obesity is becoming more prevalent amongst children. It is well known that obesity is associated with a number of co-morbidities including Type 2 diabetes, gall bladder disease, coronary heart disease, hyperlipidaemia, hypertension and osteoarthritis amongst others. Using a case study and evidence from epidemiological and cross sectional data the link between obesity and Type 2 diabetes was demonstrated. Also it was shown that glycaemic control was worse in obese patients with type 2 diabetes and that weight loss improves life expectancy in these patients. Evidence was also shown for the relationship between obesity and fatty liver, hypertension and hyperlipidaemia. The Look Ahead study demonstrated that weight loss is associated with a significant improvement in these metabolic parameters. The aetiology of obesity involves an interplay within a complex homeostatic network that regulates energy stores and energy expenditure.
Culture, Ethnicity and Diabetes
Dr Naveed Younis, Consultant in Diabetes and Endocrinology, University Hospital of South Manchester
Black and ethnic minorities (BME) have worse health outcomes compared to Caucasian populations. The BME groups are more likely to report ill health at a younger age, are less physically active and have poor diets often lacking essential vitamins and nutrients. In particular the BME groups have a higher incidence of Type 2 Diabetes and Cardiovascular disease compared to the Caucasian population. South Asian men are 50% more likely to have a CHD and Afro- Caribbean are 50% more likely to have a stroke. Furthermore the South Asian population are more likely to have insulin resistance and central obesity. Conventional cut-off levels for classifying obesity are different for those from the south Asian populations and a lower cut of limits should be used. Even at birth insulin resistance is more prevalent and adopting a westernised diet and relative inactivity may explain the epidemic of diabetes and obesity in the BME groups.  This also implies that diabetes therapies that target obesity or have minimal impact on weight gain such as GLP-1 and SGLT2 therapies may be more favourable in these groups. Focusing future treatments on prevention in the BME group is urgently needed.
Impact of Behaviour and Psychology on Obesity
Dr Chris Bundy, Senior Lecturer, University of Manchester
We are living with an obesity epidemic. Obesity is associated with a range of health problems including diabetes, cardio-vascular disease, stroke, cancers and inflammatory conditions such as inflammatory arthritis and psoriasis. People with the least resources: lower socio-economic groups; socially unstable groups; and those with mental health problems are most affected by obesity. Parents who are obese, especially mothers, are more likely to have overweight children, who are also more likely to be inactive, thus perpetuating a cycle of obesity and inactivity thereby increasing the future risk of illness. In addition, we live in an obesogenic society where food companies and advertising companies bombard people with images of food and in particular high fat, high sugar food and drinks. Subtle psychological messages are paired with images of food and drink and people are sold a lifestyle that is inconsistent with the foods being advertised. The amount of spend on research and / or services to manage obesity compared with the cost to the tax-payer of living with the associated health problems is very small. This needs to change. The answer to the complex problem of obesity lies in a multi-level strategy that addresses: food regulation and legislation so that healthy food messages are as common as images and messages about unhealthy options; the influence of ‘social norms’ by skilled approaches to change what is acceptable in specific social groups; the individual person – giving people access to skilled support to help people change lifestyle / behaviour. Health psychologists and behavioural medicine practitioners have such expertise and should be incorporated into existing weight management services which should be expanded to address this ongoing epidemic.
Obesity and the brain and spine
Mr Joshi George, Consultant Neurosurgeon, Salford Royal Hospital
Obesity can cause gray matter loss with risk of future cognitive decline and episodic memory deficits. There is also evidence of diminished structural and functional brain connectivity. There is evidence of increased susceptibility to immediate rewards in obese patients.
Deep brain stimulation works by disrupting abnormal oscillations in brain signaling and restoring normal synchronization and coupling between various areas of the brain. The lateral hypothalamic area is a promising target for treating obesity with deep brain stimulation. The risks of brain surgery however remains a challenge.
Musculoskeletal conditions associated with obesity include osteoarthritis, Low Back Pain,Diffuse idiopathic skeletal hyperostosis,Gait disturbance,Osteoporosis, fibriomyalgia and rheumatoid arthritis
Obesity predisposes to spine degeneration . Spine surgery becomes more technically difficult and dangerous in the obese patient. Minimally invasive spine surgery is now becoming the norm for treating obese patients who need spinal surgery.
Effects of obesity on bone and Joints
Mr M Jeyam, Consultant Shoulder and Upper Limb Orthopaedic Surgeon, Salford Royal Hospital
The effect of obesity on the bone: The effects of obesity on bone can be stratified according to age. In children, obesity increases bone mass, bone dimension and bone maturation. It can lead to pathologic conditions such as Blount’s disease, which results from growth disturbance of the proximal tibia
In women of postmenopausal age it is thought that obesity could actually play a protective role with regards to bone loss.
In all ages obesity is thought to increase the incidence of fractures and may lead to disuse bone atrophy over a period of time.
Effect of obesity on the musculoskeletal system: Obesity is associated with a number of musculoskeletal disorders including low back pain, osteoporosis, connective tissue disorders, Diffuse Idiopathic Skeletal Hyperostosis (DISH / Forestier’s disease), gait disturbances and fibromyalgia. Obesity increases the incidence of osteoarthritis affecting all joints, particularly weight bearing joints such as the knees, hips and ankles. The deleterious effect of obesity on joints is highlighted when one considers that for each additional pound of weight, there are an additional 4 pounds of weight transferred through the knee joint. This results in early wear and tear of the articular cartilage and menisci, which normally help with load bearing across the joint.
Surgical challenges in an obese patient: There are numerous factors to consider when an obese patient is planned for surgery. These include technical challenges such as patient positioning, anaesthetic considerations, access during surgery, special instrumentation to address adequate access, intra-operative complications, higher post-operative infection rates, prolonged recovery and rehabilitation. These may lead to poorer functional outcomes, higher complication rates and an overall; increase in morbidity and mortality. A multidisciplinary team approach is mandatory in managing these patients.
The key message is that prevention obesity is paramount if we are to mitigate against the risks and adverse effects of obesity on the health of the individual and the nation.
Medical management of obesity
Dr Akheel Syed, Consultant Endocrinologist, Salford Royal Hospital
Lifestyle, dietary and behavioural changes remain the cornerstones of successful weight management. Options of pharmacotherapy for weight loss are limited. Many obese people suffer from co-morbid conditions, the treatment of which can itself exacerbate obesity. In the exemplar patient with type 2 diabetes, sulphonylureas and insulin frequently contribute to weight gain. On the other hand, metformin, glucagon-like peptide-1 receptor agonists, sodium glucose co-transporter-2 inhibitors and dipeptidyl peptidase-4 inhibitors have a favourable effect on body weight. Similarly, in the obese patient with painful diabetic neuropathy duloxetine, which tends to be weight-neutral, may be preferable to therapies that often promote weight gain such as amitriptyline, gabapentin or pregabalin. Whilst tricyclic and tetracyclic antidepressants and mood stabilisers such as lithium and valproate induce carbohydrate-craving and weight gain, the selective serotonin reuptake inhibitors and the serotonin-norepinephrine reuptake inhibitors and topiramate have a better pharmacological profile for the obese patient with depression. A rational choice of drug therapy tailored to the obese person’s clinical co-morbidities would be of greater value than the mere addition of (sometimes ineffectual) weight loss medications.
Surgical management of obesity: What procedure, on whom and when?
Mr Siba Senapati, Consultant Upper GI and Bariatric Surgeon, Salford Royal Hospital
Obesity is a chronic disease of excessive accumulation of fat leading to multiple comorbidities, impacts on quality of life and reduces life span. At present there is no effective medical therapy as evidenced in the literature including various meta-analyses. Since the inception of the concept of weight loss surgery in 1950’s there has been extensive evidence across the globe with excellent outcome from bariatric surgery. It not only helps to loose, the excess weight but also resolves or improves the associated comorbidities like Type 2 Diabetes, sleep apnoea, arthritis, cardiovascular risks, etc. and even risk of cancer. It also improves the quality of life and the obese can be productive to the society rather than burden to society. Outcomes of the bariatric surgery as evidenced by the various bariatric registries in the world show that they are effective and safe. The common bariatric procedures are Gastric bypass, sleeve gastrectomy and gastric banding. Patient selection is crucial to obtain the best outcome especially in resolving diabetes or curing sleep apnoea in addition to other comorbidities. The decision to choose the right procedure is made with a multidisciplinary approach with the patient being in the centre of decision making.
Weight management from a dietetic perspective: Can obesity be treated with diet?
Ms Fiona Chan, Senior Dietician, Salford Royal Hospital
NICE has published clinical guidance on assessment and treatment of obesity (CG189), which recommends that weight management services need to be multidisciplinary strategically and is multicomponent, taking into consideration the needs and preferences of individuals. Therefore the role of a dietitian within a weight management service contributes towards a holistic approach for weight loss.
Salford Royal NHS Foundation Trust has a consultant led tier 3 specialist weight management service with a focus on multidisciplinary working. Dietitians assess the current intake of the clients in relation to their energy balance, medical history and nutritional management. Dietetic input remains an integral part of the weight management service in providing medical weight management care as well as pre-surgical education for bariatric surgery. They are responsible in educating, empowering and negotiating with the clients in not only dietetic interventions to reduce energy intake; but also support for behavioural change towards food and weight, such as emotional eating.
Medical interventions for weight loss include lifestyle and pharmacological interventions which lead to a calorie deficit overall to induce weight loss. Support for surgical interventions include education in the pre-operative liver reduction diet and stages of recovery diet post operatively as well advice for both short and long term complications management such as vomiting, dumping syndrome and weight regain.
A patient’s story
Mr Don Robertson
I believe my obesity became a serious threat to my life. The increase in weight began due to lack of exercise and comfortable lifestyle; nearing a weight of 31stone and was wearing size 6XL clothing. I was a mess, the only things keeping me alive was the love of my partner and family along with my CPAP machine.
Everything became increasingly difficult. I had to buy super king size bed, re adapt my bathroom as I could not get in my old one to bathe.
The journey to obtain funding for surgery is very hard and lengthy; I do not understand that from the initial request by a GP as to why it can take up to twelve months to be accepted for surgery.
Having had a gastric sleeve in March 2014 carried out at Salford, I have lost nearly twelve stones and I am enjoying life to the best I can. No longer have my breathing aid (CPAP Machine) and previous medications like blood pressure tablets have been stopped.
The journey after surgery is not always easy; doctors do not fully understand you. I have experienced hair loss, feeling very cold most of the time; however I am secure in the knowledge that I have the support and care of the bariatric team two years after. I attended regular support group meetings and I give potential surgery hopefuls as much help and advice as I can, giving up my free time as a thanks to the bariatric team at Salford Royal for saving my life.
On the whole, this was a very rewarding and educational day that received excellent feedback from delegates. The delegates very much enjoyed the varied agenda and had a much clearer understanding of the impact of obesity on the individual, the need for a multidisciplinary approach towards tackling this ongoing problem. It is envisaged that similar events will be run in the future to tackle the problem of obesity.
A selection of delegate feedback can be found below:
“Gained knowledge of up to date information on obesity and prevention.â€
“Very informative day. Talks not too long so your attention was held. A very diverse day with lots to think about. An excellent day. â€
“The whole day was superbly organised, well-paced and thought provoking. Very exciting to hear of the cross-sector working possibilities.’
“Good conference having input that is holistic and not just medical. Recognising and acknowledging 
behavioural, social, economic, ethic and lifestyle factorsâ€
Figure 1: Organising Committee. From left to right: Ms Fiona Chan, specialist weight management dietitian; Mr Jack Carney, former Principal of The Manchester College and Founding Member of Obesity Awareness, Support and Information Service of Great Britain (OASIS-GB); Mr Siba Ranjan Biswal, Technology Advisor; Mr Siba Senapati, consultant bariatric surgeon and Founding Member of OASIS-GB; Dr Akheel Syed, consultant physician and Founding Member of OASIS-GB; Mr Khurshid Akhtar, consultant bariatric surgeon; Mr Hamish Clouston, specialist registrar in surgery; Ms Kara Zaman, specialist weight management dietitian; Dr Yan-Mei Goh, general surgical trainee; Mr K Gajanan, Associate specialist in plastic surgery and Prof., Stuart Enoch, Â Chairman of Doctors Academy.
Figure 2: Chief Guest, Mr Robert Armstrong, Chairman of the Wrightington, Wigan and Leigh NHS Foundation Trust, flanked from left to right by Mr Jack Carney, Mr Siba Senapati, Dr Akheel Syed and Mr Khurshid Akhtar.
Figure 3: Welcome and Introduction to the Study Day by Mr Siba Senapati, Organising President and Chairman of OASIS-GB.
Figure 4: Mr Robert Armstrong, Chairman of the Wrightington, Wigan and Leigh NHS Foundation Trust inaugurating Obesity Awareness, Support and Information Services of Great Britain (www.OASIS-GB.com)
Figure 5: Delegates at the Impact of Obesity on Health Study Day
Figure 6: Delegates interacting with speakers at the Study Day
Figure 7: Dr Handrean Soran (right), speaking on effects of bariatric surgery on lipoproteins and microvascular complications of diabetes
Figure 8: Mr Jack Carney, Retired Principal of The Manchester College and Co-chair of OASIS-GB speaking on the role of volunteer sector in tackling obesity
