Your SlideShare is downloading. ×
0
<ul><li>OBESITY </li></ul><ul><li>Dr. Gopalrao Jogdand, M.D. Ph.D. </li></ul><ul><li>Professor & Head </li></ul><ul><li>De...
Definition
Magnitude of the Problem <ul><li>Prevalence of obesity BMI 30.0. </li></ul><ul><li>Currently the world is facing obesity e...
 
 
 
Classification of Overweight and Obese by Body Mass Index <ul><li>  BMI (kg/m 2 ) </li></ul><ul><li>WHO guidelines  Propos...
Waist-to-hip ratio Ratio =  WAIST HIPS TO FIND RATIO Waist: Measure at narrowest point with stomach relaxed Hips: Measure ...
Co-morbidities risk associated with different levels of BMI and suggested waist circumference in adult Asians <ul><li>Clas...
Obesity – An imbalance in energy intake and energy expenditure Proteins (20%) BMR (60-65%) ENERGY INTAKE ENERGY EXPENDITUR...
Role of hypothalamus in mediation of hunger and satiety Thalamus Paraventricular HO conserv Oxytocin rel. 2 Anterior hypot...
Classification of obesity as per fat distribution <ul><li>Android (or abdominal or central, males) </li></ul><ul><li>Colle...
Diseases and conditions for which obesity is a risk factor <ul><li>Coronary artery disease** </li></ul><ul><li>Type II Dia...
Prevalence of overweight and obesity in different income groups of Delhi (Nutrition Foundation of India Study) <ul><li>Pre...
The Five City Study <ul><li>n=3257; aged 25-64 yrs </li></ul><ul><li>Cities: Moradabad (n=902), Trivandrum (n=760), Calcut...
Treatment goals <ul><li>Prevention of further weight gain </li></ul><ul><li>Weight loss to achieve a realistic target BMI ...
 
Approaches to obesity management Diet Activity Drugs VLCD Surgery BMI 23-25 No risk factors DM/CHD/HT/HL     -  BMI  ...
How much weight loss is significant? <ul><li>A 5-10% reduction in weight (within 6 months) and  </li></ul><ul><li>weight m...
Advantages of weight loss <ul><li>Weight loss of 0.5-9 kg (n=43,457) associated with 53% reduction in cancer-deaths, 44% r...
Drug therapy  <ul><li>Appetite suppressants </li></ul><ul><li>Adrenergic agents  (e. g. amphetamine, methamphetamine, phen...
Sibutramine inhibits serotonin and noradrenaline reuptake Noradrenaline Serotonin
STORM Study : Effect of sibutramine on weight loss 98 104 102 100 96 94 92 90 0 12 22 24 20 18 16 14 10 8 6 4 2 Placebo Si...
STORM Study: Mean Weight Loss at Two Years Mean Weight Loss (Kg)
STORM Study : Proportion of patients maintaining at least 5% and 10% weight loss 100 20 40 60 80 0 6 12 18 24 6 12 18 24 5...
STORM Study: Effect on Waist Circumference and Waist/Hip Ratio Decrease in waist circumference (cm) Change (a) Waist Circu...
STORM Study : Effects on lipids 5 0 -5 -10 -15 -20 -25 Placebo Sibutramine Triglycerides % c h a n g e 0 0 24 18 12 6 5 0 ...
STORM Study : Effects on lipids  (Contd.) 18 0 24 12 6 25 20 15 10 5 0 HDL cholesterol % c h a n g e Sibutramine Placebo M...
STORM Study : Effect on Insulin and HbA 1c Month of Assessment Placebo Sibutramine Lancet 2000; 356:2119-2125 % Change HbA...
STORM study: Other metabolic effects <ul><li>Variable   Baseline   Month 6    Month 24 </li></ul><ul><li>SIB PLAC   SIB  P...
STORM study: Conclusions <ul><li>Almost all patients who persist with a weight management program consisting of sibutramin...
Sibutramine vs. Dexfenfluramine - 3.2 - 4.5 -5 -4.5 -4 -3.5 -3 -2.5 -2 -1.5 -1 -0.5 0 Weight loss (kg) Sibutramine 10 mg D...
Adverse effects occurring in >5% of patients treated with Sibutramine compared with placebo <ul><li>Sibutramine % Placebo ...
Sibutramine: Safety <ul><li>Discontinuation rates: 9% with placebo and 7% with sibutramine </li></ul><ul><li>Has been asso...
STORM Study : Withdrawals due to BP increase <ul><li>Dose of Sibutramine % patients who  withdrew due to  increase in BP <...
Indications & Dosage <ul><li>Recommended for obese patients with a BMI  >  30 kg/m 2  or  >   27 kg/m 2  in the presence o...
Prevention and Control <ul><li>Weight reduction: Initial goal is to reduce the weight by 5-10% in 6 months period </li></u...
 
 
Thank You
Upcoming SlideShare
Loading in...5
×

Obesity

1,479

Published on

0 Comments
2 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
1,479
On Slideshare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
101
Comments
0
Likes
2
Embeds 0
No embeds

No notes for slide

Transcript of "Obesity"

  1. 1. <ul><li>OBESITY </li></ul><ul><li>Dr. Gopalrao Jogdand, M.D. Ph.D. </li></ul><ul><li>Professor & Head </li></ul><ul><li>Department of community Medicine </li></ul>
  2. 2. Definition
  3. 3. Magnitude of the Problem <ul><li>Prevalence of obesity BMI 30.0. </li></ul><ul><li>Currently the world is facing obesity epidemic. </li></ul>Country Age range Obesity prevalence Male Obesity prevalence Female U.S.A. 22-74 years 19.7% 24.7% Germany 25-69 years 17% 19% England 16-64 years 15% 16.5% Kuwait 18 + 32% 44% India 16-64 years 19.3% 25.6%
  4. 7. Classification of Overweight and Obese by Body Mass Index <ul><li> BMI (kg/m 2 ) </li></ul><ul><li>WHO guidelines Proposed Asia Pacific guidelines Underweight < 18.5 < 18.5 </li></ul><ul><li>Normal 18.5-24.9 18.5-22.9 </li></ul><ul><li>Overweight 25.0-29.9 > 23 </li></ul><ul><li>At risk - 23-24.9 </li></ul><ul><li>Obesity 30-34.9 (Class I) 25-29.9 (Class I) </li></ul><ul><li>35-39.9 (Class II) > 30 (Class II) </li></ul><ul><li>Extremely Obese > 40 (Class III) - </li></ul>BMI = Weight (kg) [Height (m)] 2
  5. 8. Waist-to-hip ratio Ratio = WAIST HIPS TO FIND RATIO Waist: Measure at narrowest point with stomach relaxed Hips: Measure at fullest point Desired Ratio Women : < 0.8 Men : < 1.0 Risk increases if waist circumference is >94 cm in men and >80 cm in women
  6. 9. Co-morbidities risk associated with different levels of BMI and suggested waist circumference in adult Asians <ul><li>Classification BMI Risk of co-morbidities </li></ul><ul><li> Waist circumference </li></ul><ul><li> < 90 cm (men) > 90 cm (men) </li></ul><ul><li> < 80 cm (women) > 90 cm (women) </li></ul><ul><li>Underweight < 18.5 Low Average </li></ul><ul><li>Normal range 18.5-22.9 Average Increased </li></ul><ul><li>Overweight > 23 </li></ul><ul><li>At risk 23-24.9 Increased Moderate </li></ul><ul><li>Obese I 25-29.9 Moderate Severe </li></ul><ul><li>Obese II > 30 Severe Very severe </li></ul>
  7. 10. Obesity – An imbalance in energy intake and energy expenditure Proteins (20%) BMR (60-65%) ENERGY INTAKE ENERGY EXPENDITURE Carbohydrates (55%) Physical activity (25-30%) Fats (25%) Thermic effect of food (10%)
  8. 11. Role of hypothalamus in mediation of hunger and satiety Thalamus Paraventricular HO conserv Oxytocin rel. 2 Anterior hypothalamic Body temp Optic tract Arcuate Neuroendocrine Fornix Rage, Hunger Supraoptic Vasopresin rel. Dorsomedial GI stimuli Periventricular Neuroendocrine Ventromedial Satiety Lateral hypothalamic Hunger, thirst
  9. 12. Classification of obesity as per fat distribution <ul><li>Android (or abdominal or central, males) </li></ul><ul><li>Collection of fat mostly in the abdomen (above the waist) </li></ul><ul><li>apple-shaped </li></ul><ul><li>Associated with insulin resistance and heart disease </li></ul><ul><li>Gynoid ( below the waist, females) </li></ul><ul><li>Collection of fat on hips and buttocks </li></ul><ul><li>pear-shaped </li></ul><ul><li>Associated with mechanical problems </li></ul>
  10. 13. Diseases and conditions for which obesity is a risk factor <ul><li>Coronary artery disease** </li></ul><ul><li>Type II Diabetes Mellitus*** </li></ul><ul><li>Hypertension** </li></ul><ul><li>Dyslipidemia*** </li></ul><ul><li>Respiratory disease*** </li></ul><ul><li>Gout** </li></ul><ul><li>Reflux disease </li></ul><ul><li>Psychological problems </li></ul><ul><li>Gallbladder disease*** </li></ul><ul><li>Osteoarthritis** </li></ul><ul><li>Infertility* </li></ul><ul><li>Venous circulatory disease </li></ul><ul><li>Increased anaesthetic risk* </li></ul><ul><li>Low back pain* </li></ul><ul><li>Polycystic ovary disease* </li></ul><ul><li>Cancer* (ovarian, breast, endometrial, gallbladder, prostate, colon) </li></ul>
  11. 14. Prevalence of overweight and obesity in different income groups of Delhi (Nutrition Foundation of India Study) <ul><li>Prevalence (%) </li></ul><ul><li>Slums Middle-Class Total </li></ul><ul><li>Overweight (BMI > 25) </li></ul><ul><li>Males ND ND 19.6 Females ND ND 44.5 </li></ul><ul><li>Obesity (BMI > 30) Males 1 32.3 ND Females 4 50 ND </li></ul><ul><li>Abdominal obesity Males ND 49.7 ND Females ND 34.9 ND </li></ul><ul><li>ND: Not determined </li></ul>http://www.nutritionfoundationin.org/NEW/OBESITY.HTM
  12. 15. The Five City Study <ul><li>n=3257; aged 25-64 yrs </li></ul><ul><li>Cities: Moradabad (n=902), Trivandrum (n=760), Calcutta (n=410), Nagpur (n=405), Bombay (n=780) </li></ul><ul><li>Social Class BMI>27 WHR>0.85 Sedentary life style </li></ul><ul><li>I (n=985) 21.2% 96.9% 92.2% </li></ul><ul><li>II (n=790 16.4% 57.2% 71.4% </li></ul><ul><li>III (n=674) 8.9% 39.3% 42.3% </li></ul><ul><li>IV (n=602) 3.0% 11.9% 14.9% </li></ul><ul><li>V (n=206) 3.8% 8.7% 8.7% </li></ul><ul><li>Int J Cardiol 1999;69:139-147 </li></ul>
  13. 16. Treatment goals <ul><li>Prevention of further weight gain </li></ul><ul><li>Weight loss to achieve a realistic target BMI </li></ul><ul><li>Long-term maintenance of a lower body-weight </li></ul>
  14. 18. Approaches to obesity management Diet Activity Drugs VLCD Surgery BMI 23-25 No risk factors DM/CHD/HT/HL     -  BMI 25 – 30 No risk factors DM/CHD/HT/HL      (consider)  BMI > 30 No risk factors DM/CHD/HT/HL        ( in  severe )  ( conside r  in severe )
  15. 19. How much weight loss is significant? <ul><li>A 5-10% reduction in weight (within 6 months) and </li></ul><ul><li>weight maintenance should be stressed in any weight </li></ul><ul><li>loss program and contributes significantly to </li></ul><ul><li>decreased morbidity </li></ul>
  16. 20. Advantages of weight loss <ul><li>Weight loss of 0.5-9 kg (n=43,457) associated with 53% reduction in cancer-deaths, 44% reduction in diabetes-associated mortality and 20% reduction in total mortality </li></ul><ul><li>Survival increased 3-4 months for every kilogram of weight loss </li></ul><ul><li>Reduced hyperlipidemia, hypertension and insulin resistance </li></ul><ul><li>Improvement in severity of diseases </li></ul><ul><li>Person feels ‘fit’ and mentally more active </li></ul><ul><li>  </li></ul>
  17. 21. Drug therapy <ul><li>Appetite suppressants </li></ul><ul><li>Adrenergic agents (e. g. amphetamine, methamphetamine, phenylpropanol amine, phentermine) </li></ul><ul><li>Serotonergic agents (ex.. fenfluramine, dexfenfluramine, SSRIs like sertraline, fluoxetine) </li></ul><ul><li>Thermogenic agents </li></ul><ul><li>ephedrine, caffeine </li></ul><ul><li>New ones </li></ul><ul><li>Sibutramine ; Orlistat </li></ul><ul><li>STORM: Sibutramine trial on obesity reduction and maintenance. </li></ul>
  18. 22. Sibutramine inhibits serotonin and noradrenaline reuptake Noradrenaline Serotonin
  19. 23. STORM Study : Effect of sibutramine on weight loss 98 104 102 100 96 94 92 90 0 12 22 24 20 18 16 14 10 8 6 4 2 Placebo Sibutramine Month Weight loss Weight maintenance Bodyweight (kg) Lancet 2000; 356:2119-2125
  20. 24. STORM Study: Mean Weight Loss at Two Years Mean Weight Loss (Kg)
  21. 25. STORM Study : Proportion of patients maintaining at least 5% and 10% weight loss 100 20 40 60 80 0 6 12 18 24 6 12 18 24 5% responders 10% responders Sibutramine Placebo Lancet 2000; 356:2119-2125 Proportion of patients (%)
  22. 26. STORM Study: Effect on Waist Circumference and Waist/Hip Ratio Decrease in waist circumference (cm) Change (a) Waist Circumference (b) Waist/Hip Ratio
  23. 27. STORM Study : Effects on lipids 5 0 -5 -10 -15 -20 -25 Placebo Sibutramine Triglycerides % c h a n g e 0 0 24 18 12 6 5 0 -5 -10 -15 -20 -25 Placebo Sibutramine VLDL cholesterol 18 0 24 12 6 % c h a n g e Lancet 2000; 356:2119-2125
  24. 28. STORM Study : Effects on lipids (Contd.) 18 0 24 12 6 25 20 15 10 5 0 HDL cholesterol % c h a n g e Sibutramine Placebo Month of assessment Weight loss Weight maintenance Lancet 2000; 356:2119-2125 30
  25. 29. STORM Study : Effect on Insulin and HbA 1c Month of Assessment Placebo Sibutramine Lancet 2000; 356:2119-2125 % Change HbA 1c . Month of Assessment Placebo Sibutramine % Change Insulin
  26. 30. STORM study: Other metabolic effects <ul><li>Variable Baseline Month 6 Month 24 </li></ul><ul><li>SIB PLAC SIB PLAC SIB PLAC </li></ul><ul><li>Uric acid 0.32 0.33 0.29 0.30 0.30 0.32 </li></ul><ul><li>Glucose 5.20 5.11 5.07 5.01 5.13 5.17 </li></ul><ul><li>Insulin 17.7 16.7 12.7 12.4 13.8 16.2 </li></ul><ul><li>C-peptide 3.21 3.05 2.54 2.46 2.38 2.69 </li></ul><ul><li>HbA 1c 5.86 5.75 5.56 5.50 5.56 5.66 </li></ul>
  27. 31. STORM study: Conclusions <ul><li>Almost all patients who persist with a weight management program consisting of sibutramine, diet and exercise can achieve at least a 5% weight loss with sibutramine </li></ul><ul><li>Over half can lose more than 10% weight within 6 months </li></ul><ul><li>Weight loss was sustained in most patients continuing therapy for two years </li></ul>
  28. 32. Sibutramine vs. Dexfenfluramine - 3.2 - 4.5 -5 -4.5 -4 -3.5 -3 -2.5 -2 -1.5 -1 -0.5 0 Weight loss (kg) Sibutramine 10 mg Dexfenfluramine 30 mg n=226; 12 wks Int J Obes 1995; 19. Suppl 2: 144
  29. 33. Adverse effects occurring in >5% of patients treated with Sibutramine compared with placebo <ul><li>Sibutramine % Placebo % Adverse Effects Incidence (n=2068) Incidence (n=884) </li></ul><ul><li>Headache 30.3 18.6 </li></ul><ul><li>Dry Mouth 17.2 4.2 </li></ul><ul><li>Anorexia 13.0 3.5 </li></ul><ul><li>Constipation 11.5 6.0 </li></ul><ul><li>Insomnia 10.7 4.5 </li></ul><ul><li>Dizziness 7.0 3.4 </li></ul><ul><li>Nausea 5.9 2.8 </li></ul><ul><li>Nervousness 5.2 2.9 </li></ul><ul><li>Dyspepsia 5.0 2.6 </li></ul>Ann Pharmacother 1999;33:968-978
  30. 34. Sibutramine: Safety <ul><li>Discontinuation rates: 9% with placebo and 7% with sibutramine </li></ul><ul><li>Has been associated with a mean increase in BP and heart rate of approximately 1-3mmHg and 4-5 beats/min </li></ul><ul><li>Cardiac side effects viz. hypertension, tachycardia and palpitations < 2.6% vs 0.6-0.9% in placebo group </li></ul><ul><li>Caution to be exercised in patients with history of hypertension and should not be given to patients with uncontrolled or poorly controlled hypertension </li></ul><ul><li>Not associated with cardiac valve abnormalities or primary pulmonary hypertension </li></ul>
  31. 35. STORM Study : Withdrawals due to BP increase <ul><li>Dose of Sibutramine % patients who withdrew due to increase in BP </li></ul><ul><li>10 mg 1% </li></ul><ul><li>15 mg 2% </li></ul><ul><li>20 mg 3% </li></ul>Lancet 2000; 356:2119-2125
  32. 36. Indications & Dosage <ul><li>Recommended for obese patients with a BMI > 30 kg/m 2 or > 27 kg/m 2 in the presence of other risk factors (e.g. hypertension, diabetes, dyslipidemia) </li></ul><ul><li>In Indian patients, sibutramine could be considered in patients with BMI > 25 kg/m 2 or those with BMI of 23 kg/m 2 with co-morbid conditions </li></ul><ul><li>Recommended starting dose is 10 mg once daily. </li></ul><ul><li>If there is inadequate weight loss, the dose may be titrated after four weeks to a total of 15 mg once daily. </li></ul><ul><li>The 5 mg dose should be reserved for patients who do not tolerate the 10 mg dose. </li></ul><ul><li>Surgical intervention: Measures like liposuction. </li></ul>
  33. 37. Prevention and Control <ul><li>Weight reduction: Initial goal is to reduce the weight by 5-10% in 6 months period </li></ul><ul><li>Dietary changes: Low calorie diet is recommended, calorie intake is modeled to 1000 Kcal/day diet </li></ul><ul><li>Increased physical activity to burn the excess body fat. </li></ul>
  34. 40. Thank You
  1. A particular slide catching your eye?

    Clipping is a handy way to collect important slides you want to go back to later.

×