OBESITY WORKSHOP

CONTENTS  FACTS  Assessment / Diagnosis  Consequences  Treatment Outline  Clinical Monitoring Outline

FACTS Obese among women by races (Ismail et al 1995) 16.5% India, 8.6% Malay, 4.3% Chinese Obese among men/women in Urban-rural differences (Ismail et al 1995) Men 5.6% Urban, 1.8% Rural Women 8.8% Urban, 2.6% Rural

FACTS Obese among chidren by age/gender/races(Ismail & Tan 1998) 6.6% of 7 years old, 13.8% of 10 years old 12.5% among 7-10 years old boys, 5% among 7-10 years old girls 10% Malay boys, 11% both Indian & Chinese

CONSEQUENCES Health risks associated with obesity (WHO 1998) Greatly increased Type 2 diabetes Gallbladder diseases Dyslipidaemia Matabolic Syndrome Breathlessness Sleep Moderately increased Coronary heart disease Hypertension Osteoarthritis (knees & hips) Hyper and gout Mildly increased Cancer (breast cancer in postmenopausal women, colon cancer) Reproductive hormone abnormalities Impaired fertility Low back pain Increased anaesthetic risk Foetal defects associated with maternal obesity

TREATMENT OUTLINE 1 - Goals of obesity therapy Criteria Reduction of excess weight Maintenance of BMI Blood pressure Glycaemic control Other risk factors Treatment success 5-6 kg or 10% of initial body weight < 23 kg/m any reduction any improvement

TREATMENT OUTLINE 1 - Goals of obesity therapy 2 - Lifestyle approaches 3 - Overall approach to treatment 4 - Dietary measures 5 - Physical activity 6 - PHARMACOTHERAPY 7 - Very low calorie diets 8 - Surgery

TREATMENT OUTLINE PHARMACOTHERAPY Weight loss drugs and the side effects Drug Action Adverse effects Development stage Sibutramine Centrally acting via serotoninergic and noradrenegic pathways, not reccommended for those with severe hepatic disease Increase in blood pressure and heart rate, nausea, insomnia, dry mouth, constipation Approved by FDA (Nov 1997)

TREATMENT OUTLINE PHARMACOTHERAPY Weight loss drugs and the side effects Drug Action Adverse effects Development stage Phentermine Centrally acting via noradrenegic pathways Increase in blood pressure, insomnia, nervousness Approved by FDA (Nov 1997) & licensed in the UK, but only reccommended for short-term use (12 weeks)

TREATMENT OUTLINE PHARMACOTHERAPY Weight loss drugs and the side effects Drug Action Adverse effects Development stage Mazindol appetite depressant Increase in blood pressure, insomnia, constipation, dry mouth Approved by FDA and the Japanese government, available in Australia, but reccommended only for short-term use (12 weeks)

TREATMENT OUTLINE PHARMACOTHERAPY Weight loss drugs and the side effects Drug Action Adverse effects Development stage Amfepromona Appetite suppressant Increase in blood pressure, insomnia, nervousness

TREATMENT OUTLINE PHARMACOTHERAPY Weight loss drugs and the side effects Drug Action Adverse effects Development stage Fluoxitene (Prozac) Anti-depressant, appetite depressant and a selective re-uptake inhibitor Anxiety, drowsiness, insomnia, nervousness Approved by FDA as the treatment for depression, bulimia and obsessive-compulsive disorder, not specifically approved for weight loss

TREATMENT OUTLINE PHARMACOTHERAPY Weight loss drugs and the side effects Drug Action Adverse effects Development stage Metformin May be useful in managing obesity in the Type 2 diabetic patients, although efficacy is not proved or licensed for obesity

TREATMENT OUTLINE PHARMACOTHERAPY Weight loss drugs and the side effects Drug Action Adverse effects Development stage Ephedrine and Caffeine Has anorectis properties and some thermogenic effects Hypertension, wakefulness, Available in Denmark

TREATMENT OUTLINE PHARMACOTHERAPY Weight loss drugs and the side effects Drug Action Adverse effects Development stage Orlistat Peripherally acting pancreatic lipase inhibitor, decreases fat absoprtion Loose stools, malabsorption of fat-soluble vitamins Approved by FDA

CLINICAL MONITORING OUTLINE Procedure for managing obesity Clinic Level Classes on food and diet Fitness activities i.e. aerobic Follow-up

CLINICAL MONITORING OUTLINE Procedure for managing obesity 3-6 months Clinic Level

CLINICAL MONITORING OUTLINE Procedure for managing obesity Clinic Level Clinic Level

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