Category: Topic Loops

The readiness to change model

The Readiness to Change model can be used to assess if someone is ready to lose weight.

Questions to ask the patient

  1. In the past month, have you been actively trying to lose weight? Y/N
  2. In the past month, have you been actively trying to keep from gaining weight? Y/N
  3. Are you seriously considering trying to lose weight to reach your goal in the next 6 months? Y/N
  4. Have you maintained your desired weight for more than 6 months? Y/N

Stages of change pie chart

Waist circumference

  • Waist measurement is another way to determine fat distribution. Abdominal fat distribution increases the risk of developing heart disease, hypertension and Type 2 Diabetes.
  • Waist circumference should be used as an additional measure in people with a BMI less than 35 kg/m2.
  • Increased risk is identified in waist measurements over:
    • 94cm – European men
    • 90cm – Asian men
    • 80cm – Women

BMI

  • BMI is used as an indicator of health risk.
  • Based on weight and height (weight in kg/height in m2) it categorises risk as follows:
Healthy 19 – 24.9
Overweight 25 – 29.9
Obese 30 – 39.9
Morbidly obese over 40
  • BMI may not always be a good indicator of body fat as muscular people may have a high BMI but not a high fat level.

Assessing risk

It is important to recognise if a person has an increased risk of developing obesity.

The National Obesity Forum suggest the following measurements and investigations are carried out to assess risk:

  • Body Mass Index (BMI) calculated using a person’s height and weight
  • Waist circumference
  • Blood Pressure
  • Fasting blood glucose
  • Fasting lipid profile
  • Thyroid function

Health and weight

Introduction

  • Obesity is a major public health concern in Scotland and levels continue to rise.
  • Being overweight increases your risk of ischaemic stroke by 22% and being obese by 64%.
  • The aim of a weight management plan is to achieve a weight loss of 0.5-1kg per week.
  • This weight loss can be achieved by consuming a diet that has a 600 kcal/day deficit (an achievable and sustainable target).
  • Weight management programmes should include advice on increasing physical activity that is appropriate and sustainable.

Key points about headache after stroke

  • Occurs in nearly one quarter of patients with acute ischaemic stroke
  • Generally worst on day of stroke onset
  • Often on the same side as the stroke lesion
  • More common in posterior circulation stroke
  • Stronger association with younger age, female sex, and history of migraine
  • Severity is not related to the size of the stroke lesion
  • There is no association between headache and outcome

Some practical points for clinical practice

  • The medication Modified Release Dipyridamole is used much less now but important to enquire about it since frequently causes headache
  • Movement and cough can exacerbate headache after stroke
  • It is important to exclude other stroke complications which can cause headache, notably arterial dissection
  • It is useful to include possible headache as a specific question on admission to the acute stroke unit to ensure it is not overlooked

Headache after stroke

photo portrait of Angela

CT scan showing haemorrhage

Overall prevalence 25 – 60%

  • Ischaemic stroke 25 – 30%
  • Haemorrhagic stroke 34 – 60%

Headache after stroke or TIA is often overlooked by clinicians as a result of concentrating on clinical signs and stroke management

Which strokes most commonly cause headaches?

More often associated with:

  • Haemorrhage (see picture below) than infarct
  • TIA than stroke
  • Cortical than deep white matter strokes
  • Thrombotic than embolic stroke
  • Venous than arterial stroke

Approaches to treatment

Giant Cell Arteritis is usually treated with steroid medicine. Treatment should begin as soon as possible to prevent sight loss.

  • High dose prednisilone (e.g. 60mg daily) for several weeks and then reduced over a period of years
  • Unfortunately prednisilone will raise blood pressure and blood sugar and thus worsen the risk factor profile
  • Antiplatelet drugs may reduce risk of embolism from damaged vessels – but may worsen indigestion caused by steroids

For more information on giant cell arteritis (temporal arteritis) visit NHS UK.