BODY WEIGHT CONTROL

Obesity  Obesity is the state of excess body fat stores.  Energy Intake > Energy consumption.  WHO states 1.5 billion obese population U.S. 68% obese ( Largest Market ) 2

Classification of Overweight and Obesity 3

NOT All Overweight people are Obese but All Obese are Overweight !!! 4

Summary 5

Body Weight Control 1- Non-Medication Control 2- Anti-Obesity Drugs Low Caloric Deit. Physical Exercises. A-Synthetic B-Natural Life Style Modifications. 3- Surgery Fat absorption Appetite Inhibitors Suppressor 6

Strategy for body weight control 7

1- Hypertension 2- NIDDM (Type 2) 3- Dyslipidemia 4- Heart Diseases 8 obesity-related health complications

9 “There is no magic pill for obesity, The best effect you're going to get is with a concerted long-term regimen of diet and exercise. If you choose to take a drug along with this effort, it may provide additional help.” says David Orloff, Director of the FDA's Division of Metabolic and Endocrine Drug Products.

A-Synthetic Anti-obesity Medications 10

11 1- Orlistat ( Xenical ) Approved by the FDA in Only drug approved by FDA for long term use. Approved by FDA for over-the-counter sale in Feb M.O.A. Reduces intestinal fat absorption ( lipase Inhibitor ). S.E. Steatorrhea -Intestinal discomfort-diarrhea-flatulence Interfere absorption of fat-soluble vitamins & cyclosporine. Improve lipid profiles & glucose control.

2- Phentermine M.O.A. (appetite suppressant) Act on brain hypothalamus stimulating adrenal glands to release norepinephrine  reducing hunger. S.E. increased blood pressure - palpitations – arrhythmia (FDA) recommended that phentermine used short-term (up to 12 weeks). 12

3- Sibutramine (Meridia) M.O.A. Anorectic, serotonin & NE levels in brain. S.E. Increased bl. Pressure & Heart Rate - dry mouth - constipation-headache-insomnia. Approved by the FDA in Withdrawn from U.S. & Canadian markets in Its risks (M.I. and stroke) more than the benefits. Not used in patients with history of stroke - heart disease - bl. Pressure - arrhythmias – MOA inhibitors (SRI) 13

14 4- Diethylpropion One of the safest noradrenergic appetite suppressants Used in patients with mild to moderate HTN or angina.

5- Metformin (Glucophage) Reduce weight limit the amount of glucose produced by the liver and increases muscle consumption of glucose. 15

6- Exenatide (Byetta) Long-acting analogue of GLP-1 hormone. GLP-1 promotes a feeling of satiety. Some obese people are deficient in GLP-1. Used for ttt of DM type 2.  Exenatide is currently being tested in non-diabetics as a treatment for obesity. 16

7- Pramlintide (Symlin) Synthetic analogue Amylin hormone. Amylin promotes a feeling of satiety. Used along with insulin by Type 1 and Type 2 diabetics.  Symlin is currently being tested in non-diabetics as a treatment for obesity. 17

N.B. Orlistat is moderately effective produce average weight loss of 5 to 22 pounds over a 1 year period. Response to Anti-obesity medications, some people experience more weight loss than others. Some people lose >10% of body weight, Reduce the risk of high blood pressure, diabetes and other obesity-related health complications. Patients experience max. weight loss within 6 months. 18

Anti-obesity Medication withdrawn from market 1- Fen-phen (Fenfluramine + Phentermine ).  Due to valvular heart disease and pulmonary HTN. 2- Redux (Dexfenfluramine)  Due to Cardiovascular side-effects reports 19

Anti-obesity Medication NOT Approved 1- Rimonabant Cannabis smokers often experience hunger !!! Thus, blockade of the endocannabinoid system decreasing appetite. NOT approved Due to psychiatric Hazards. 2- Amphetamines Appetite Suppressant NOT approved Due to powerful stimulant & addictive potential. 20

21 1- Lorcaserin (approved June 28, 2012 ) 2- Qsymia (formerly Qnexa) (approved July 17, 2012)

22 1- Lorcaserin Appetite suppressor,affecting levels serotonin. patients lost about 4 % of their body weight. For obese people and overweight people having at least one weight-related health condition. In combination with a healthy diet and exercises. S.E. Headache – dizziness – fatigue – nausea - dry mouth - constipation.

2- Qsymia Combination of two FDA-approved drugs: 1- Phentermine appetite suppressant. 2- Topiramate anticonvulsant drug treat migraines & epilepsy, has weight-loss side effects. In combination with a healthy diet and exercises. help patients lose about % of their body weight. S.E. heart problems - birth defects -cognitive effects such as mental disturbance or lack of concentration. 23

B- Herbal / Natural Products 24

1-Glucomannan Glucomannan is a water-soluble polysaccharide. (FDA) has not approved any product containing glucomannan for the treatment of these medical conditions. MOA : Glucomannan dietary fibers interfere with the motility and absorption of nutrients from the gut. 25

2-Green Tea (caffeine) Anti-oxidant rich – Noradrenergic. Have weight-loss-promoting effects, such as speeding up your metabolism and suppressing your appetite. Drinking more than five cups a day may lead to caffeine-related side effects Headache - nervousness - sleep problems - irregular heartbeat 26

3-Chitosan chitosan  limiting fat absorption, which would make it useful for dieting Adverse effects 1- Constipation 2- upset stomach 3- reduce absorption of essential nutrients (including calcium and vitamins A, D, E & K) 27

4- Chromium Picolinate Insulin simulator, aid glucose & fat metabolism, managing the breakdown of glucose and fat. Adverse effects behavioral changes - irregular heartbeat 28

Antiobesity drugs not cure -all, must be combined with physical exercises & healthy diet over long time. Some people experience more weight loss than others. Some people lose >10% of body weight, Reduce the risk of high blood pressure, diabetes and other obesity-related health complications 29

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