obesity ...... a global epidemic disease.......


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a global epidemic disease........... which is running very fast in this century between us.

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obesity ...... a global epidemic disease.......

  1. 1. Presented by- ROHIT BISHT M. Pharmacy( Pharmacology)
  2. 2. OBESITY It may be the illness where the health is adversely affected by excess body fat. Abnormal growth of the adipose tissue due to enlargement of Fat cells (hypertrophic) or an increase in fat cell number (hyperplastic) or a combination of both. A metabolic disorder that is primarily induced and sustained by an over consumption or under utilization of caloric substrate.
  3. 3. STORAGE OF FATFat is stored as triglycerides in adipose tissues and thedistributed mainly under skin in Abdomen Breast Buttocks Thighs
  4. 4. Android(Abdominal)obesity – fat distributed in & around abdomen.Gynoid obesity – fat distributed evenly & peripherally.
  5. 5. EPIDEMIOLOGICAL DETERMINANTS ObesityAge: Increasing ageFemales(specifically after menopause)Genetic factorsSedentary life, low physical activityIllnessJunk Food, eating frequently , sweets , refined foodsEndocrine disorder ( cushing’s syndrome ,GH defi. )Illiteracy in affluent societiesAlcoholDepression, anxiety, frustration, lonelinessEconomic statusDrugs: Corticosteroids, OCPs, Insulin, Beta blockers
  6. 6. EPIDEMIOLOGICAL DETERMINANTS1. Age -Increasing age -one third obese from childhood2. Sex -women have higher propensity -after menopause obesity risk3. Genetic factors - amount of fat is influenced by genetic factors
  7. 7. 4. Less Physical activity- No energy expenditure through physical activity.- To burn 1 kg fat: 8000 kC required (approx.)5. Socio-economic status - high in affluent society6. Eating habits -Junk food -Extra 100 Kcal/day consumption :5 kg wt gain/year
  8. 8. 7. Psychological factors -depression, anxiety, frustration, loneliness overeating8. Endocrine disturbances -Cushing’s syndrome, GH deficiency9. Alcohol- increases fat in man (due to regular intake of alcohol liver become fatty)
  9. 9. 10. Education -inverse relation in affluent societies11. Ethnicity -affluent people of industrialized countries at risk12. Drugs - Corticosteroids, contraceptives, insulin, ß blockers promotes weight gain
  10. 10. Medications That Can Cause WeightGain Psychotropic medications  Diabetes medications  Tricyclic antidepressants • Insulin  Monoamine oxidase inhibitors • Sulfonylureas (glipizide / glucotrol)  Specific SSRIs • Thiazolidinediones  Atypical antipsychotics (pioglitazone )  Lithium  Tamoxifen (anti-estrogen)  Specific anticonvulsants  Steroid hormones -adrenergic receptor blockers • Glucocorticoids
  11. 11. MEASUREMENT OF OBESITY1. BY BODY WEIGHT:• Mass Index (Quetelet’s Index): Weight(kg)/(Height) 2(m2) [ 18.5-24.99kgm-2]• Broca Index - (Ideal Body Weight) = {Height(cm) 100}• Lorentz Formula: {Height(cm) 100} {Height(cm) 150}/ 2(women) or 4(men)• Corpulence Index- (Actual Weight/Desirable Weight) ≤1.2• Ponderal Index- Height(cm)/ (Weight)1/3
  12. 12. 2. Skin fold Thickness: Mid-triceps+ mid-biceps+ sub scapular + suprailiac = 50mm in women or 40 mm in men. It Impossible in Extreme obesity Poor repeatability3.Waist Circumference: For Men: <90cm  Low 90-102 High >102 Very High For Women: <80 Low 80-88 High >88 Very High4. Waist hip ratio: WHR : ≤1 (Men) and ≤ 0.85 (Women)5.Measurement of Total Body Water, Total Fat Cells.
  13. 13. Below 18.5 Underweight18.5 – 24.9 Normal25.0 – 29.9 Overweight Monitor for risk30.0 -40.0 Obese Increased health risk40.0 and above Severely obese Major health risk
  14. 14. Etiology is complex and incompletely understood involved by many other factors. Three mechanism are expressed, Which are• The efferent system, which generates signals from various sites. Its main component are leptin (adipose tissue), insulin (pancreas), gherlins (stomach), peptide Y (ileum and colon). Leptin reduces food intake, gherlin secretion stimulates appetite and it may function as a meal initiating signals. Peptide Y, which is released postprandial by endocrine cells in the ileum and colon , it is a satiety signals.
  15. 15.  The hypothalamus processing system known as the central melanocortin system, which integrates different type of afferent signals and generates efferent signals. The efferent system that carries the signals generated in the hypothalamus, which controls food intake and energy expenditure.
  16. 16. PATHOPHYSIOLOGY OF OBESITY ENERGY BALANCE Energy stores will increase imbalance between intake and expenditure. Low Rates of Fat Oxidation. Low Metabolic Rate. Low Plasma Concentration of Leptin. Low Physical Activity. PERIPHERAL STORAGE AND THERMOGENESIS Adipose tissue generally is divided into two major types, white and brown. The primary function of white adipose tissue is lipid manufacture, storage, and release. and brown have a ability to dissipate energy via process of uncoupled mitochondrial respiration.
  17. 17. Role of Brain Neurotransmitters Neurotransmitters govern the body’s response to starvation and dietary intake. Decreases in serotonin and increases neuropeptide Y are associated with an increase in carbohydrate appetite. Neuropeptide Y increases during deprivation; may account for increase in appetite after dieting. Cravings for sweet high-fat foods among obese and bulimic patients may involve the endorphin system.
  18. 18. HORMONAL REGULATION OF BODY WEIGHT Norepinephrine and dopamine—released by sympathetic nervous system in response to dietary intake. Fasting and semistarvation lead to decreased levels of these neurotransmitters—more epinephrine is made and substrate is mobilized.
  19. 19. Hormones and Weight Hypothyroidism may diminish adaptive thermo genesis. Insulin resistance may impair adaptive thermo genesis. Leptin is secreted in proportion to percent adipose tissue and may regulate (decrease) appetite.
  20. 20. Effects of Various Neurotransmitters, Receptors,and Peptides on Food Intake
  21. 21. PROBLEMS ENHANCING AFTER THE OBESITY Short-term problems Obesity causes day-to-day problems such as:• breathlessness• increased sweating• snoring• difficulty sleeping• inability to cope with sudden physical activity• feeling very tired every day• back and joint pains Long-term problems• Obesity can also cause changes you may not notice, but that can seriously harm your health, such as:
  22. 22. • high blood pressure (hypertension)• high cholesterol levels (fatty deposits blocking your arteries)• Both conditions significantly increase your risk of developing a cardiovascular disease, such as:• coronary heart disease, which may lead to a heart attack stroke, which can cause significant disability and can be fatal. Another long-term problem that can affect obese people is type 2 diabetes. Psychological problems In addition to the day-to-day problems of obesity, many people may also experience psychological problems such as:• low self-esteem• low confidence levels• feeling isolated in society• These can affect relationships with family members and friends and may lead to depression.
  23. 23. GENERAL APPROACH FOR TREATMENTNon pharmacological treatment Behavior Modification-The primary aim is to help patients choose lifestyles that are conducive to safe and sustained weight loss. Most such programs use self-monitoring of diet and daily exercise both to increase patient awareness of behaviour, and as a tool for the clinician to determine patient compliance as well as patient motivation.
  24. 24.  DIET- Numerous diet or nutrition plans exist to aid in weight loss should low calorie intake..Surgery- Surgery remains the most effective intervention for the treatment of obesity.• its related morbidity and mortality, this intervention is reserved for those with BMI greater than 40 kg/m2 or 35 kg/m2 .• 60−62 Surgical procedures either reduce the stomach volume and/or reduce the absorptive surface of the alimentary tract, resulting in some degree of malabsorption. Currently, the three major types of procedures are: stapled gastroplasty, adjustable gastric banding, and conventional Roux-en-Y gastric bypass.
  25. 25.  A combined intervention of behavior therapy, dietary changes and increased physical activity should be maintained for at least 6 months before considering pharmacotherapy.
  26. 26. PHARMACOLOGICAL THERAPY LIPASE INHIBITORS Orlistat- Gastrointestinal (gastric, pancreatic, and carboxylester) lipases are essential in the absorption of the long-chain triglycerides commonly found in Western diets. Orlistat is minimally absorbed and selectively inhibits gastrointestinal lipases. Lipase inhibition results in decreased formation of free fatty acids from dietary triglyceride. Orlistat induces weight loss by a persistent lowering of dietary fat absorption. clinical trials demonstrate that orlistat effectively increases the amount of weight lost and decreases the amount of weight regained during medically supervised weight loss programs.
  27. 27.  NORADRENERGIC-SEROTONERGIC AGENTS Sibutramine- increase synaptic concentrations of serotonin, norepinephrine (NE), and dopamine via reuptake inhibition. 1 to 30 mg daily dose having a good result. Recommended starting dose 10 mg daily. Dry mouth, anorexia, insomnia, constipation, appetite decrease, dizziness, nausea adverse effect, they also increase systolic and diastolic B P. It should not be used in patients with a history of coronary arteries disease, stroke, C H F, arythmiasis, and patient who receive M A O inhibitor.
  28. 28.  NORADRENERGIC AGENTS Phentermine- similar to Amphetamine, has less severe CNS stimulation and lower abuse potential. Its M/A is related to enhance NE and dopamine neurotransmitter. A single dose of 30 mg daily in the morning provide effective suppression. Divided dose of 8 mg immediately prior to meal. other similar drugs having same M/A respectively Amphetamine > methamphetamine > phentermine > mazindol > diethylpropion Ephedrine in combination with caffeine has enhanced appetite suppression and thermo genesis.
  29. 29.  Oral doses of 20 mg ephedrine and 200 mg caffeine up to three times daily have good effect . Side effects are tremor, agitation, nervousness, increased sweating, and insomnia; palpitations and tachycardia have also been reported. SEROTONERGIC AGENTS Serotonin is an important neurotransmitter involved in many human physiological systems. Sleep-wake cycles, sensitivity to pain, blood pressure, mood, and eating behaviors have links to serotonin activity. Increasing central serotonin levels decreases the amount of food consumed and prolongs the time between food intake.
  30. 30.  Antidepressants: Selective Serotonin Reuptake Inhibitors fluoxetine (60 mg/day) demonstrate initial weight loss of up to 2 to 4 kg. sertraline (200 mg/day) as an adjunct to help maintain weight lost with a very-low-calorie diet. Fenfluramine and Dexfenfluramine- Both agents increased synaptic serotonin concentration via reuptake inhibition and possibly by increasing serotonin release.
  31. 31.  PEPTIDES- Multiple different endogenous peptides, which play a role in the regulation of food intake. Leptin originates in the adipocyte and is proposed to function as a peripheral feedback messenger with respect to fat storage. NPY and galanin are two CNS peptides that appear to similarly stimulate food consumption, but have differing effects on preference of carbohydrate or fat, as well as substrate metabolism. NPY and galanin are thought to exert minimal effects on protein intake. Galanin activity, centering in the lateral pera ventricular nucleus and medial preoptic areas, increases both carbohydrate and fat intake with preferential effects on fat
  32. 32.  NPY and galanin modulate the release of insulin, corticosterone, and vasopressin, further affecting nutrient intake behaviors and substrate metabolism. NPY is associated with increased levels of insulin, corticosterone, and vasopressin, where as decreases are seen with galanin. The macronutrient intake, energy use, and endocrine effects of NPY are most consistent with those seen in chronic obesity.
  33. 33. MISLLENOUS DRUGS Rimonabent- it is selective cannabinoid receptor-1 (CB-1) antagonist which is newer used as antiobesity drug. It blocks hunger promoting action of cannabis to Decrease appetite and help in weight reduction by obese. psychiatric disorder are the adverse effect of this drug. B3 Agonists- B3 receptor generally present on adipose tissue where selective agonists of B3 BRL 373 44 are being developed as potential antiobesity drugs. Olestra – it is a sucrose polyester which can be used as a cooking medium in place of fat but is neither digested nor absorbed,
  34. 34. Herbal/Natural Products and FoodSupplements Used for Weight Loss