Obesity

[object Object],[object Object],[object Object],[object Object]

Magnitude of the Problem ,[object Object],[object Object],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%

Classification of Overweight and Obese by Body Mass Index ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],BMI = Weight (kg) [Height (m)] 2

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

Co-morbidities risk associated with different levels of BMI and suggested waist circumference in adult Asians ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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%)

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

Classification of obesity as per fat distribution ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Diseases and conditions for which obesity is a risk factor ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Prevalence of overweight and obesity in different income groups of Delhi (Nutrition Foundation of India Study) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],http://www.nutritionfoundationin.org/NEW/OBESITY.HTM

The Five City Study ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Treatment goals ,[object Object],[object Object],[object Object]

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 )

How much weight loss is significant? ,[object Object],[object Object],[object Object],[object Object]

Advantages of weight loss ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Drug therapy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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 Sibutramine Month Weight loss Weight maintenance Bodyweight (kg) Lancet 2000; 356:2119-2125

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% responders 10% responders Sibutramine Placebo Lancet 2000; 356:2119-2125 Proportion of patients (%)

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

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

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

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

STORM study: Other metabolic effects ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

STORM study: Conclusions ,[object Object],[object Object],[object Object]

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

Adverse effects occurring in >5% of patients treated with Sibutramine compared with placebo ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Ann Pharmacother 1999;33:968-978

Sibutramine: Safety ,[object Object],[object Object],[object Object],[object Object],[object Object]

STORM Study : Withdrawals due to BP increase ,[object Object],[object Object],[object Object],[object Object],Lancet 2000; 356:2119-2125

Indications & Dosage ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Prevention and Control ,[object Object],[object Object],[object Object]

Obesity

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Obesity