The document discusses obesity, including its definition, classification, prevalence, causes, comorbidities, and treatment approaches. Some key points include: - Obesity is defined as a BMI of 30 or higher and is classified based on BMI levels. It affects over 19% of adults in the US and over 32% in Kuwait. - Factors contributing to obesity include an energy imbalance where calorie intake exceeds energy expenditure. Hypothalamus plays a role in regulating hunger and satiety. - Obesity is associated with increased risk of diseases like heart disease, diabetes, hypertension, and certain cancers. - Treatment involves lifestyle changes like diet and exercise, as well as potential drug therapies or surgery for

2. Definition

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

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%)

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

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 )

22. Sibutramine inhibits serotonin and noradrenaline reuptake Noradrenaline Serotonin

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

24. STORM Study: Mean Weight Loss at Two Years Mean Weight Loss (Kg)

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 (%)

26. STORM Study: Effect on Waist Circumference and Waist/Hip Ratio Decrease in waist circumference (cm) Change (a) Waist Circumference (b) Waist/Hip Ratio

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

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

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

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

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