power point presentation on obesity by Rajeshwaree Netha (Doctor of pharmacy). contents included are Introduction,pathophyisiology,clinical presentation (signs and symptoms of obesity disorder) ,Treatment,goals of treatment, general approach, Pharmacological treatment, and Evaluation of therapeutic outcomes.

1. RAJESHWAREE NETHA
Doctor of Pharmacy

2. Contents
Introduction
Pathophysiology
Clinical presentation
Treatment
General approach
Pharmacologic therapy
Evaluation of therapeutic outcomes

3. INTRODUCTION
•Obesity occurs when there is an imbalance
between energy intake and energy
expenditure overtime, resulting in
increased energy storage.
PATHOPHYSIOLOGY:
•The etiology of obesity usually unknown,
but it is likely multifactorial and related to
Varying contributions from genetic,
environmental, and physiological factors.

4. •Genetic factors appears to be the primary
determinants of obesity in some individuals ,where
as environmental factors are more important in
others.
•Identification of the total no. of contributing genes
is an area of extensive research.
•Environmental factors include reduced physical
activity or work ,abundant food supply , relatively
sedentary environmental factors are more import
lifestyles, increased availability of high fat foods,
and cultural factors and religious beliefs.
•Medical conditions including Cushing disease and
growth hormone deficiency or
•Condition such as Prader-Willi syndrome can be
associated with weight gain.

5. •Medication associated with weight gain include
insulin, corticosteroids, some anti depressants,
antipsychotics, and several anti convulsants.
•Many neurotransmitters and neuropeptides
stimulate or depress the brain's appetite
Network, impacting total calorie intake.
•The degree of obesity is determined by the net
balance of energy ingested relative to energy
expended overtime.

6. •The single largest determinant of energy
expenditure is
Metabolic rate, which is expressed as resting
energy expenditure or basal metabolic rate.
•Physical activity is the other major factor that
affects total energy expenditure.
•Major types of adipose tissue are (1)white adipose
tissue, which manufactures
stores, and release lipid ,and (2)brown adipose
tissue, which dissipates energy via uncoupled
mitochondrial respiration.

7. •Adrenergic stimulation activates lipolysis in fat
Cells and increases energy expenditure in
adipose tissue and skeletal muscle.
CLINICAL PRESENTATIONS:
•Obesity is associated with serious health risks
and increased mortality.
•Central Obesity reflects high levels of intra
abdominal or visceral fat that is associated with
the development of HTN, dyslipidemia, and
cardiovascular diseases.

8. •Other obesity co morbidities are osteoarthritis
and changes in the female Reproductive system.
•Body mass index (BMI) and waist circumference
(WC) are recognized, acceptable Markers of
excess body fat that independently predict
disease risk .
•BMI is calculated as weight (kg) divided by the
square of the height (m2).
•WC, the most practical method of characterizing
central adiposity, is the narrowest circumference
between the last rib and the top of the lilac crest.

9. TREATMENT
•Goals of treatment: Weight management goals
may include losing a predefined amount of
weight, decreasing the rate of weight gain ,or
maintaining a weight-neutral status depending on
the clinical situation.
GENERAL APPROACH
•Successful obesity treatment plans incorporate
reduced caloric intake ,exercise ,behavioral
modifications with or without pharmacological the
therapy and / or surgery.

10. •Weight loss of 5 to 10% of initial weight
is are reasonable goal for obesity patients.
•Measures of success not only include pound
lost but also improvement in co morbid
Conditions including blood pressure, blood
glucose, and lipids.
•Many diets exits to aid weight loss. Regardless
of program energy consumption must be less
than energy expenditure.
•A reasonable goal is loss of o.1 to 5 kg per
week with a balanced diet in fat, carbydrate, and
Protein intake.

11. •Increased physical activity combined with reduced
calorie intake and behavior modification can
augment weight loss and improve obesity-related
co morbidities and cardio vascular risk factors.
•The primary aim of behavior modification is to
help patients choose life styles conductive to
Safe and sustained weight loss.
•Behavioral therapy of human learning which use
stimulus control and Reinforcement to substitute
desirable behavioral for learned, undesirable
habits.

12. •Bariatric surgery, which reduces the stomach
volume or absorptive surface of the alimentary
tract ,remains the most effective intervention for
obesity.
•Surgery should be reserved for those with BMI
above 35 or 40kg/m and significant co
morbidities due to the morbidity and mortality
associated with the surgical procedures.
PHARMACOLOGICAL THERAPY
•The debate regarding the role of
pharmacotherapy remains heated, fueled by the
need to treat to growing epidemic and by the
fallout from the removal of several agents from
the market because of adverse reactions.

13. •Long term pharmacotherapy have a role for
patients who have no contraindications to
approved Drug therapy.
•The National institutes of Heath Guidelines
recommend consideration of pharmacotherapy in
adults with BMI 230kg/m2 and /or W C<40 in
(102cm) for men or 35 in (9cm ) for women ,or
BMI of 10 to 30 kg/m2 with least two concurrent
factors if 6 months of diet exercise and
behavioral modification failed to achieve weight
loss.
•Orlistat (180 or 60 mg in 3 divided doses/day) is
a lipase inhibitor that induces weight loss by
lowering dietary fat absorption.

14. •It also improves lipid profiles, glucose
Control and other metabolic markers.
•Soft stools, abdominal pain or colic
flatulence, and/or incontinence occur in 80%
of individual using prescription strength are
mild to moderate in severity and improve
after 1to2 months of therapy.
•ORLISTAT is approved for long-term use .It
interferes with the absorption of fat-soluble
vitamins, cyclosporine , levothyroxine , and
oral contraceptives.

15. •LORCASERIN is a selective serotonin receptor
agonist (5-HT,) approved for chronic weight
management.
•Activation of central5-HT, receptors results in
appetite suppression leading to modest weight loss
as compared with placebo.
•Discontinue lorscaserin if 5% weight loss is not
achieved by week 12.
•Common adverse effects include dizziness,
constipation, fatigue, and dry mouth.

16. •Phentermine and diethylpropion are each more
effective than placebo in achieving short weight
loss.
•Neither should be used in patients with severe
hypertension or significant cardiovascular disease.
•Short-term therapy is not consistent with current
national
guidelines for chronic management of obesity.
•Amphetamines should generally be avoided
because of their powerful stimulant effects and
additive potential.
•Many complementary and alternative products are
promoted to weight loss.

17. •Regulation of dietary supplements are less
rigorous than that of prescription and over the
counter drug products, manufacturers do not have
to prove safety and effectiveness prior to
marketing.
•EVALUATION THERAPEUTIC OUTCOMES
•Assess progress once or twice monthly for 1or2
months, then monthly.
•Each encounter should document weight, WC,BMI,
blood pressure, medical history ,and patient
assessment of tolerability of drug therapy.

18. •Discontinue mediation therapy for 3to4 months if
the patient has failed to demonstrate weightloss or
maintenance of prior weight.
•Diabetic patients require more intense medical
monitoring and self-monitoring of blood glucose.
• Weekly health care visits for 1to2 months may be
necessary until the effects of diet, exercise, and
weight loss medication become more predictable.
•Monitor patients with hyperlipidemia or
hypertension to assess effects of weight loss on
appropriate end points.