Obesity and Weigh Management: Role of Pharmacy professionals

1. Obesity and Weight
Management: Role of
Pharmacy Professionals.
1
Presented by: Tatenda Chikwetu

2. Weight Disorders
2

3. 3
• Definition : Obesity is a state of excess
adipose tissue mass.
• Obesity is a disease of caloric imbalance
that results from an excess intake of
calories above their consumption by the
body.
• The WHO definition is:
–a BMI > 25 is overweight
–a BMI > 30 is obesity.
OBESITY: What is it?

4. Stats
4
Worldwide
• >1.5 billion overweight adults.
– 300 million clinically obese.
• >1 in 3 adults has BMI > 30.
• >1 in 6 children. (WHO)
Zimbabwe
– 10.6% of women obese. (2010-2011)
– 1.8% of men obese. (2010-2011)

5. 5
• Classification of weight status NOT by
mere weight
– Muscularity & height affect weight
• Body Mass Index (BMI)
– Most widely used
– BMI= Weight(kg)
Height(mtr)2
Classification:BMI

6. BMI
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7. 7
• BMI Classification
– <18.5 Underweight
– 18.5-24.9 Normal weight
– 25-29.9 Overweight
– 30-34.9 Obesity Class I
– 35-39.9 Obesity Class II
– 40-49.9 Obesity Class III
– 50 and above Super Obesity
WHO Classification

8. BMI
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9. • Values are age independent & same for both sexes
• At similar BMI, fat content in women > men
– BMI 30 is threshold for obesity.
– BMI 25 - 30 medically significant & requires intervention
• At a given BMI, women, on average, have more body fat.
• Morbidity and mortality increase with BMI similarly for
men and women
• Risk at a given BMI can vary between populations.
• Extremes
– Highest - 205
– Lowest - 5.6
9
BMI

10. • Broca’s index = Height ( cms ) – 100
• Corpulance index = Actual weight
Desirable weight
• Ponderal index = Height ( cms )
Cube root of body weight ( kg
• Lorentz’s formula
Height ( cms ) – 100 - Height ( cms ) – 150
2(women) or 4(men)
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OTHER INDICES

11. Risk factors
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• Genetics.
– Affect the amount of body fat you store,
– Where that fat is distributed.
– Play a role in how efficiently your body converts food into energy and
– how your body burns calories during exercise.
• Family lifestyle.
– Family members tend to share similar eating and activity habits.
• Inactivity.
– With a sedentary lifestyle
– Having medical problems, such as arthritis
• Unhealthy diet.
• Medical problems.
– Prader-Willi syndrome,
– Cushing's syndrome and other conditions.
– Arthritis
• Certain medications. Antidepressants, anti-seizure medications, diabetes
medications, antipsychotic medications, steroids and beta blockers.

12. Risk factors (cont)
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• Social and economic issues.
– No safe areas to exercise.
– You may not have been taught healthy ways of cooking, or
– You may not have money to buy healthier foods. In addition, the
– People you spend time with may influence your weight
• Age.
– Hormonal changes and a less active lifestyle
– Amount of muscle in your body tends to decrease with age.
• Pregnancy.
• Quitting smoking.
– Often associated with weight gain
• Lack of sleep.
– Not getting enough sleep or getting too much sleep can cause
changes in hormones that increase your appetite.

13. Causes
Imbalance between calories
consumed and calories expended
–Poor diet.
–Lack of physical activity.
–Genetics (e.g Prader-Willi syndrome,
Leptin deficiency).
–Medical reasons.
–Psychological factors.
–Social issues.
13

14. 14

15. CAUSES: Physical Conditions
• The following physical conditions and factors
contribute to obesity:
– Genetic predetermination e.g. Prader-Willi
syndrome
– Polycystic ovary syndrome
– Sedentary lifestyle
– Hypothyroidism
– Cushing's syndrome
– Nutritional habits
15

16. CAUSES: Pharmacologic Agents
• The following pharmacologic agents are known to cause
weight gain:
– Steroids:
• testosterone,
• progesterone,
• estrogens, and
• corticosteroids
– Anticonvulsants:
• Valproic acid,
• Carbamazepine
• Psychotropic drugs : lithium
• Monoamine oxidase inhibitors
• Tricyclic antidepressants
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17. Obesity Comorbidities
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18. Comorbidities
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• T2DM
• HPT
• Coronary artery diseases and stroke
• Fatty liver – non alcoholic streatohepatitis
• Cancer (colon)
• Sleep & mood disorders
• Sexual dysfunction
• Osteoarthritis
• Fertility and Pregnancy Complications.

19. Role Of Pharmacist
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• First point of contact – easily accessible to
the patient
• Regular contact with patients
• Basic understanding of obesity related
heath issues
• Collaboration with other healthcare
professionals
• Lifestyle modification

20. Role of Pharmacist
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• Pivotal role in management of co-morbid conditions
• Essential resource for obese patients attempting to
manage their weight.
• Detect prescribed agents with potential for weight
gain
• Provide information about proper weight-loss
programs.
• Encourage patients to utilize long-term weight-
management goals rather than just some of the
quick-fix OTC products.
• Pharmacists should stress to their patients that
even a moderate amount of weight loss, can be
beneficial.

21. Management
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22. DIET
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• Cutting calories. Reducing how many calories you
take in.
• Feeling full on less. Eating larger portions of foods
that have fewer calories
• Making healthier choices.
• Restricting certain foods. Certain diets limit the
amount of a particular food group, such as high-
carbohydrate or full-fat foods.
• Meal replacements. These plans suggest that you
replace one or two meals with their products —
such as low-calorie shakes or meal bars — and eat
healthy snacks and a healthy, balanced third meal
that's low in fat and calories

23. Exercise And Physical Activity
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• Increased physical activity or exercise is an
essential part of obesity treatment
• To boost your activity level:
– Exercise.
• 150 minutes a week of moderate-intensity
physical activity
• 300 minutes or more a week as fitness
improve.
– Keep moving.
• Movement helps burn calories.

24. Behaviour changes
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• Help with making lifestyle changes for losing
weight and keeping it off.
• Include examining current habits , stresses or
situations that may have contributed to your
obesity.
• Should be tailored to address individual concerns.
• Counseling.. Therapy can help you understand
why you overeat and learn healthy ways to cope
with anxiety.
• Support groups.

25. Pharmacotherapy
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• INDICATED FOR BMI>30
• Prescription weight-loss medication
• Needs behavioural changes to work
– Your body mass index (BMI) is 30 or greater
– BMI >27, and with complications of obesity, such as diabetes, high
blood pressure or sleep apnoea.
• Commonly prescribed weight-loss medications include:
– Orlistat (Xenical), (lipase inhibitor)
– Lorcaserin (Belviq), (Appetite suppressant)
– Phentermine and topiramate (Qsymia),
– Buproprion and naltrexone (Contrave),
– Liraglutide (Saxenda).
• Without lifestyle modification, you may regain much or all of
the weight you lost when you stop taking a weight-loss
medication.

26. OTC Products/Herbal Supplements
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• Don't work for everyone
• Some claims may be false.
• Results only modest.
• They tend to work via one or more of these
mechanisms:
– Reduce appetite, making you feel more full so that
you eat fewer calories
– Reduce absorption of nutrients like fat, making
you take in fewer calories
– Increase fat burning, making you burn more
calories

27. OTC Products/Herbal Supplements
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• Garcinia Cambogia Extract
• Caffeine
• Raspberry Ketones
• Green Coffee Bean Extract
• Green Tea Extract (Camellia sinensis)
• Conjugated Linoleic Acid (CLA)
• Citrus Aurantium (Bitter Orange)
• Aloe ferox Mill. (Cape Aloe leaf)
• Apple Cider Vinegar

28. OTC Products/Herbal Supplements
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• Popular products
– Herbex range - Attack the Fat, Fat burn, Detox,
Green tea
– USN range - Phedracut XT, Ultralean,
– Biogen – Biogen Garcinia Cambogia
– Vital – Vital fat burner
– G.I Lean -

29. Weight-Loss Surgery
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• Limits the amount of food you're able to comfortably
eat or decreases the absorption of food and calories or
both.
• Considered when other methods have failed and:
– You have extreme obesity (BMI of 40 or higher)
– Your BMI is 35 to 39.9, and with comorbid conditions
– Requires commitment to the necessary lifestyle changes
• Common weight-loss surgeries include:
• Gastric bypass surgery.
• Laparoscopic adjustable gastric banding (LAGB).
• Biliopancreatic diversion with duodenal switch.
• Gastric sleeve.
• Not readily available in Zimbabwe

30. Challenges
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• Lack of resources and time
• Methods not always effective especially in
the short term – need for long term
solutions.
• Lack of reimbursement for weight control
services.
• Lack of knowledge on obesity and weight
loss programs
• Patients preference and comfort levels.

31. Challenges (Cont)
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• Pharmacy business model:
– Patients think pharmacist are motivated by
product sales.
• Patients not aware of extended role of
pharmacist.

32. Key Facts
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• Worldwide obesity has more than doubled since
1980.
• In 2015, 1.5 billion adults, 20 and older, were
overweight.
– 200 million men and
– 300 million women were obese.
• 65% of the world's population live in countries
where overweight and obesity kills more people
than underweight.
• Nearly 43 million children under the age of five
were overweight in 2010.
• Obesity is preventable.

33. REFERENCES
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• Obesity.
https://www.mayoclinic.org/diseases-
conditions/obesity/diagnosis-treatment/drc-
20375749