Strategies in Weight Management

Transcription

1 Strategies in Weight Management Pharmaceutical Society of Jamaica The 28 th Annual Pharmaceutical Retreat Sunset Jamaica Grande Hotel June 21 23, 2013 Mr. Bryan Peart

2 Images of Obesity

3 Objectives Identify the implications of obesity. Discuss the growing body of evidence related to physiologic neuroendocrine mechanisms that mediate appetite regulation and energy balance. Discuss the relationship between obesity and related comorbidities. Describe strategies for physical activity environments to reduce, prevent, and treat obesity. Evaluate current and emerging strategies for weight reduction Describe the steps of intervention of healthcare professionals.

4 Definition: Obesity is defined as having a Body Mass Index (BMI) of 30 or more. How is BMI calculated? Weight in kilograms divided by square of height in meters. BMI = Weight in Kg (Height in meters) 2

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6 Body Mass Index International accepted Obesity Task Force (IOTF) classification as modified by World Health Organization (1997). Values are age-independent and the same for both sexes.

7 Classification of Overweight and Obesity Classification* BMI (kg per m 2 ) Risk of comorbidities Underweight < 18.5 Low Normal range 18.5 to 24.9 Average Overweight 25.0 to 29.9 Mildly increased Obese 30.0 Class I 30.0 to 34.9 Moderate Class II 35.0 to 39.9 Severe Class III 40.0 Very severe

8 Body Mass Index Chart.

9 COMORBIDITY A comorbidity is a disease or condition that coexists with a primary disease but also stands on it's own as a specific disease. Source: National Digestive Diseases Information Clearinghouse (NDDIC) USA

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11 Comorbidities Related to Obesity RESPIRATORY - Obstructive sleep apnea, greater predisposition to respiratory infections, increased incidence of bronchial asthma, and Pickwickian syndrome (obesity hypoventilation syndrome) MALIGNANT - Association with endometrial, prostate, colon, breast, gall bladder, and possibly lung cancer PSYCHOLOGICAL - Social stigmatization and depression CARDIOVASCULAR - Coronary artery disease, essential hypertension, left ventricular hypertrophy, obesity-associated cardiomyopathy, accelerated atherosclerosis, and pulmonary hypertension of obesity

12 Comorbidities SURGICAL - Increased surgical risk and postoperative complications, including wound infection, postoperative pneumonia, deep venous thrombosis, and pulmonary embolism PELVIC - Stress incontinence GASTROINTESTINAL (GI) - Gall bladder disease, nonalcoholic fatty liver disease, and reflux esophagitis ORTHOPEDIC - Osteoarthritis, coxa vera, slipped capital femoral epiphyses and chronic lumbago CENTRAL NERVOUS SYSTEM (CNS) - Stroke, idiopathic intracranial hypertension, and meralgia paresthetica

13 Comorbidities OBSTETRIC AND PERINATAL - Pregnancy-related hypertension, fetal macrosomia, and pelvic dystocia METABOLIC - Type 2 diabetes mellitus, prediabetes, metabolic syndrome, and dyslipidemia REPRODUCTIVE (in women) - Anovulation, early puberty, infertility, and polycystic ovaries (in men) - erectile dysfunction CUTANEOUS - Intertrigo (bacterial and/or fungal), hirsutism, and increased risk for cellulitis and carbuncles EXTREMITY - Venous varicosities, lower extremity venous and/or lymphatic edema

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15 Apart from total body fat mass, the following aspects of obesity have been associated with comorbidity: Fat distribution Waist circumference Age of obesity onset Intra-abdominal pressure 5

16 Fat Distribution Accumulating data suggest that regional fat distribution substantially affects the incidence of comorbidities associated with obesity. Android obesity, in which adiposity is predominantly abdominal, is strongly correlated with worsened metabolic and clinical consequences of obesity.

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18 Waist circumference and Cardiovascular risks MEN with waist circumferences of greater than 94 cm (37 in) & waist-to-hip ( waist/hip) ratios of greater than 0.95 WOMEN with waist circumferences of greater than 80 cm (31.5 in), waist-to-hip ratios of greater than 0.8 in women. Circumferences of 102 cm (40 in) in men and 88 cm (35 in) in women indicate a markedly increased risk requiring urgent therapeutic intervention. Asian populations greater than 90 cm in men greater than 80 cm in women

19 Age of Obesity Onset An elevated BMI during adolescence (starting within the range currently considered normal) is strongly associated with the risk of developing obesity-related disorders later in life, independent of adult BMI. Increases in BMI during early adulthood (age ) are associated with a worse profile of biomarkers related to obesity than are BMI increases during later adulthood.

20 Intra-Abdominal Pressure Apart from the metabolic complications associated with obesity, a paradigm of increased intra-abdominal pressure has been recognized. This pressure effect is most apparent in the setting of marked obesity (BMI 50 kg/m 2 ) and is espoused by bariatric surgeons. Findings from bariatric surgery and animal models suggest that this pressure elevation may play a role (potentially a major one) in the pathogenesis of comorbidities of obesity.

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22 Pathophysiology: Hypertrophic vs. hypercellular obesity Hypertrophic obesity, characterized by enlarged fat cells. Hypertrophic obesity usually starts in adulthood Responds quickly to weight reduction measures. Hypercellular obesity, the number of fat cells are increased. Hypercellular obesity usually occurs in early or middle childhood but may also occur in adult life. Difficult to lose weight through nonsurgical interventions.

23 PREVALENCE OF OBESITY

24 W.H.O. THE WORLD HEALTH STATISTICS 2012 REPORT Dr Ties Boerma, Director of the Department of Health Statistics and Information Systems at WHO. Obesity doubled world wide between 1980 and Today, half a billion people (12% of the world s population) are considered obese. The highest obesity levels are in the WHO Region of the Americas (26% of adults) and the lowest in the WHO South-East Asia Region (3% obese). World-Wide, women are more likely to be obese than men.

25 MEDIA HEADLINES

26 Media Headlines Obesity high among young children Dr. Leslie Gabay Jamaica Daily Gleaner : Monday July 7, 2008 High-Calorie Diet Killing Jamaicans Obesity Soars As Consumers Gulp Down Fast Foods Erica Virtue, Sunday Gleaner published: December 16, 2012

27 Media Headlines MONDAY, July 27, 2009 (HealthDay News) Obesity in the United States now carries the hefty price tag of $147 billion per year in direct medical costs, just over 9 percent of all medical spending.

28 Major cause of obesity Eating more calories than you burn in daily activity and exercise

29 Other Common Causes of Obesity : Eating a poor diet Having a sedentary (inactive) lifestyle Not enough sleep Genetics Growing older Pregnancy

30 Common Causes of Obesity cnt d: Certain medical conditions Prader-Willi Syndrome Cushing s Syndrome Hypothyroidism

31 Risk Factors for Obesity Genetics Environment and Community Psychological and Other Factors Depression Quitting smoking Medications

32 Treatment Diet Physical activity Behavior modification Medication Surgery

33 Diet A low-calorie diet Feeling full on less Drink more water Adopting a healthy-eating plan Be wary of quick fixes.

34 Physical Exercise Exercise -- Increase your daily activity

35 Behavior Modification/Therapy A behaviour modification program can help to make lifestyle changes, lose weight and keep it Counselling Support groups 9/19

36 Medication Some obese people have difficulty losing weight through diet and activity alone.

37 Medication Currently, the 3 major groups of drugs used to manage obesity are as follows: Medications that increase energy expenditure 8 Medications that act peripherally to impair dietary absorption 10 Centrally acting medications that impair dietary intake. 11

38 Protein Shakes

39 Bios Life Slim (Fiber)

40 Medication

41 New Medication

42 NEW MEDICATION

43 New Medication 11

44 New Medication 6

45 Surgery Roux-en-Y gastric bypass Adjustable gastric banding Gastric sleeve surgery 24

46 Roux-en-Y gastric bypass

47 Starr Jones before and after

48 Adjustable gastric banding

49 Gastric sleeve surgery

50 Call for pharmacist s role in obesity fight GPs should work side-by-side with pharmacists to help tackle the growing obesity epidemic. Clinical director of the National Obesity Forum (NOF). ---Dr David Haslam European Conference of Obesity, Geneva 2008

51 Pharmacist intervention A European survey of 300 pharmacists, 50 of who work in the UK, revealed that 94 per cent believe they should be offering advice on weight loss medication and healthy eating. European Conference of Obesity, Geneva 2008

52 Why should Pharmacist intervene Expert on Drug therapy management Trusted member of health care team Easy access by patients (without appointment)

53 "Oh, I'm happy the way I am, and skinny people can kiss my big fat aspiration."

54 Interventions Educate Patients Monitor Patient Drug Profile Weight Loss Counseling 21-23

55 Educate to make better choices

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58 Sources The Tohoku journal of experimental medicine (2005) Volume: 207, Issue: 1 Medical Management of Obesity American Family Physician Jul 15;62(2): Jamaica Primetime (online magazine) Online Gleaner