Obesity is an increasingly important public health concern; in 2017, 64% of adults in England were overweight or obese and the prevalence is increasing.1 Aside from the significant associated health issues such as an increased risk of type 2 diabetes, cardiovascular disease, and several types of cancer, there are also wider implications for health.
Women with obesity, particularly those with co-morbidities, are at significantly higher risk of pregnancy‑related complications compared with women of normal body mass index (BMI). Pregnancy planning and pre‑pregnancy optimisation of weight is therefore especially important in this group. It is essential that all women have access to appropriate contraception and related support if and when they want it.
There are, however, important considerations that need to be taken into account when prescribing a contraceptive method for women who are overweight or obese. The risks associated with raised BMI or other related co-morbidities vary between contraceptive type, making some methods more or less appropriate for this group. In April 2019, the Faculty of Sexual & Reproductive Healthcare (FSRH) published a new guideline on obesity, overweight, and contraception.
In this issue, Dr Annabel Forsythe and Valerie Warner Findlay summarise the recommendations and discuss the specific risks and benefits associated with each contraceptive type for women who are overweight or obese. Some of these risks and benefits relate directly to the woman having raised BMI, whereas others are indirect and relate to co-morbidities or other health issues where overweight and obesity are contributing factors.
The other articles in this issue cover inflammatory bowel disease, sexual health, and eczema, and are described in brief below.
Sarah Cripps discusses the new recommendations from updated NICE guidelines on Crohn’s disease and ulcerative colitis. Both Crohn’s disease and ulcerative colitis follow a relapsing-remitting pattern. Most of the new recommendations focus on maintenance or induction of remission. The article includes a useful comparison table that explains the similarities and differences between Crohn’s disease and ulcerative colitis and their disease profiles, symptoms, complications, and risk factors.
Earlier this month, the House of Commons Health and Social Care Committee published a report on sexual health. The report describes the current situation in the UK; funding cuts have led to widespread closure of genitourinary medicine (GUM) clinics and a reduced focus on prevention and health promotion. There is significant geographical variation in access to sexual health services in the UK, and antimicrobial resistance is becoming a significant problem in the treatment of some sexually transmitted infections (STIs). The report calls for a new national strategy to help providers and commissioners of sexual health services to deliver high quality services at a consistent level. But what does this mean for primary care here and now? With the closure of many GUM services, patients may present to their GP with concerns about sexual health or for routine screening for STIs.
If you would like to update your knowledge in this area, you will be interested in the final instalment of Dr Toni Hazell’s two-part top tips series on managing STIs in primary care. Dr Hazell considers clinical symptoms of various STIs and diagnosing them in primary care, treatment options, and when to review. Part one covered general history taking and chlamydia, and featured in the May 2019 issue—you can read it online at: GinP.co.uk/may19-sti.
Chronic disease consultations and medication reviews are increasingly being conducted by clinical pharmacists in general practice. There are often prescribing incentive schemes for eczema so involving a clinical practice pharmacist in managing patients with eczema can lead to both clinical and financial gains for the practice. In addition to this, many pharmacists working in general practice have a background in community pharmacy so will already have experience in supporting patients to manage their eczema.
Ruari O’Connell and Gupinder Syan describe when emollients and corticosteroids should be prescribed for eczema, how pharmacists can get involved in managing patients with the condition, and how practices can best support the clinical pharmacist to develop the relevant competencies. In doing so, pharmacists can help with the significant practice workload associated with eczema, while ensuring patients achieve their desired treatment and management outcomes.
- NHS Digital website. Statistics on obesity, physical activity and diet, England, 2019. Part 3: Adult overweight and obesity. digital.nhs.uk/data-and-information/publications/statistical/statistics-on-obesity-physical-activity-and-diet/statistics-on-obesity-physical-activity-and-diet-england-2019/part-3-adult-obesity (accessed 17 June 2019).