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Referral and warning signs
When to refer
Refer to Nutritionist/Dietitian. Refer to Physician/Specialist for comorbidities or consideration of pharma/surgical options.
Red flags
- Rapid unintentional weight gain.
- Symptoms suggesting severe complications.
- Signs of underlying endocrine cause.
Signs and symptoms
- Excess body weight/fat.
- Shortness of breath on exertion.
- Joint pain (knees/hips).
- Poor sleep / Snoring / Sleep apnoea.
- Low self-esteem.
- Symptoms of complications (HTN, DM).
Risk factors
- High intake energy-dense foods (fat, sugar).
- Low intake fruits/veg/fibre.
- Sedentary lifestyle.
- Genetics.
- Medical conditions (hypothyroid, Cushing's, PCOS).
- Medications (steroids, antidepressants).
- Socioeconomic/Psychological factors.
Diagnosis
Clinical assessment
- Assessment of weight/height (BMI/Z-score). Waist circumference (adults).
Investigations
- Anthropometry (Wt, Ht, BMI, Waist Circ, WFH Z-score).
- Assess complications: BP, Blood Glucose, Lipid Profile.
- Consider TSH.
Diagnostic criteria
Adults: Overweight BMI 25-29.9, Obesity BMI >=30. Children(5-19): Overweight BMI-for-age >+1SD, Obesity >+2SD. Children(<5): Overweight WFH >+2z, Obesity >+3z.
Management
Non-pharmacological management
- Lifestyle Modification (Cornerstone):
- - Dietary Changes (Reduce calories, fat, sugar; Increase fruits/veg/fibre; Portion control).
- - Physical Activity (Increase regular activity: >=150min/wk moderate adult; >=60min/day child).
- - Behavioural Changes (Self-monitoring, goal setting, triggers).
- - Environmental Changes.
- Referral to Nutritionist/Dietitian.
Pharmacological treatment
- Not first-line. Specialist consideration if lifestyle fails + high risk (Orlistat etc).
- Treat comorbidities.
Surgical Management
- Bariatric Surgery: Considered for severe refractory obesity (BMI >=40 or >=35+comorbidities). Specialist.
Monitoring
Monitor weight/BMI/waist. Monitor BP/glucose/lipids. Assess lifestyle changes. Provide ongoing support.
Complications
- Cardiovascular disease (HTN, HD, Stroke).
- Type 2 Diabetes.
- Dyslipidemia.
- Osteoarthritis.
- Certain Cancers.
- Obstructive Sleep Apnoea.
- NAFLD/NASH.
- Gallstones.
- Infertility/PCOS.
- Psychosocial problems.
Prevention
- Promote healthy diet from early life.
- Encourage regular physical activity.
- Supportive environments.
- Healthy food policies.
- Early ID of weight gain trends.
Patient education
- Explanation of overweight/obesity and health risks.
- Realistic weight loss goals.
- Healthy eating principles.
- Physical activity importance.
- Behavioural strategies.
- Long-term management.
- Avoiding fad diets.
- Managing associated conditions.
Uganda-specific notes
Increasing prevalence ('double burden'). Linked to dietary transition/reduced activity. Focus on lifestyle counseling with local examples.
References
- Uganda Clinical Guidelines (UCG) 2023
Chapter 19, Section 19.2.4