1. OBESITY WORKSHOP

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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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)

9. 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)

10. 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)

11. 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

12. 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

13. 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

14. 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

15. 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

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

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

18. CLINICAL MONITORING OUTLINE
Procedure for managing obesity
Clinic Level
Clinic Level

19. THANK YOU…