Management of obesity. continue. Specialist management Indications :extreme or life threatening obesity, presence of complications and associated risk factors of obesity, failure of general management 1) Drugs:
Management of obesity
Indications :extreme or life threatening obesity, presence of
complications and associated risk factors of obesity, failure of general
The classic sympathomimetic adrenergic agents (benz phetamine, mazindol, and phentermine) function by stimulating norepinephrine release or by blocking its reuptake in the ventromedial and lateral hypothalamic regions, drugs related to amphetamine have addictive potential
the fenfluramine/phentermine combination caused valvular heart disease.
These drugs have serious side effect that restricts their use in medical
Sibutramine :reduces food intake through B1 adrenoceptor and 5-HT receptor agonist activity,it increases metabolic rate via stimulation of peripheral B3 adrenocptor activity.
Orlistat :(Xenical) is a synthetic hydrogenated derivative of a naturally occurring lipase inhibitor
preconditions for drug therapy
Only used in patients of 18-75 years age
Only if the BMI >30 or >28 plus risk factors present
Other weight reduction advices already started
The patient should have lost at least 2.5 kg within the month prior to starting the drug
drug should be stopped after 3 months unless 5% of weight lost and stopped after 6 months unless 10% of weight lost.
The whole duration of treatment should not exceed 24 months
Treatment of associated depression is a problem since tricyclic antidepressant drugs increase weight gain ,5HT reuptake inhibitors (fluoxitine) avoids this side effect
Thyroid hormone replacement only used in the presence of biochemical evidences of hypothyroidism
4))Very low calorie diets
Under the supervision of experienced physician and a nutritionist
Deaths had occured, some from documented ventricular tachycardia and fibrillation.
Indicated for individuals of BMI >30 to induce a weight loss of 1.5-2.5 kg per week
Should include a protein content of 50 gm and 40 gm for male and female respectively, energy contents of 500 kcal and 400 kcal for male and female respectively
Side effects :orthostatic hypotension ,headache , diarrhea and nausea
Indications: for those with BMI of >40 or >35 plus risk factors or
life threatening co morbid diseases.
Hypertension, hyperlipidemia and diabetic glycemic control are markedly
improved but short term post operative and long term medical complications
need careful follow-up of these patients
Vertical band gastroplasty and gastric bypass procedures involve creation of
a similar small pouch but with drainage into a loop of jejunum rather than into
the lower stomach.
Jaw wiring and use of liquid food,but weight regain after unwiring is usual
Apronectomy is used for removal of overhanging abdominal fat
Jejunoileal bypass has unacceptable mortality and morbidity thus , no longer
occurs as a result of a relative or absolute deficiency of energy and protein.
It may be primary, due to inadequate food intake,
or secondary, as a result of other illness.
In children, starvation (protein-energy malnutrition, PEM) is manifest as the syndromes of kwashiorkor (malnutrition with oedema) and marasmus (malnutrition with marked muscle-wasting).
Kwashiorkor-like secondary protein–energy malnutrition occurs primarily in association with hypermetabolic acute illnesses such as trauma, burns, and sepsis.
Marasmus-like secondary protein–energy malnutrition typically results from chronic diseases such as chronic obstructive pulmonary disease (COPD), congestive heart failure, cancer, or AIDS.
The predominant form of PEM is under nutrition results from a sustained negative energy balance.
Under nutrition often leads to vitamin deficiency esp. thiamin ,folate and vit C.
Diarrhea is also seen in these patients leading to loss of sodium ,potassium and magnesium
In addition to calculation of BMI
Anaemia due to folate and iron deficiency.
Eosinophilia suggests parasitic infestation.