Drug Treatment of Obesity Flashcards
Problems brought about by obesity
Lower life expectancy DVT Herniation Cancer DM2 Increased BP Psych: low self esteem, depression, social discrimination Limited mobility
BMI Classification
> 25: Overweight
30: Obese
BMI: kg/m2
Potential Strategies: Anti Obesity Drug Action
Decrease food intake Inhibition of nutrient absorption Increase thermogenesis Modulation of fat storage/ metabolism Modulating the central regulation of body weight
Indication for pharmacological th of obesity
Min 6 months before considering pharmacological action:
behavioural therapy + diet change + physical activity
BMI > 30
BMI > 27 with comorbidities
Drug therapy in addition to lifestyle intervention
Must demonstrate readiness for change
Diet and Lifestyle remain best option
Contraindications// Caution
Pregnancy or lactation Unstable CV disease Uncontrolled hypertension Unstable severe systemic illness Unstable psych disorder Incompatibilities with other drug th GA
Orlistat
Pancreatic lipase inhibitor–> blocks absorption of about 1/3 ingested fat
Decreases weight, plasma LDL, HbA1c in diabetics
Indications:
for those that don’t feel hungry, aren’t preoccupied with food, often eat out or order in, multiple CV diseases or risk factors present
Side Effects:
Diarrhea and steatorrhea
Malnutrition: fat soluble vitamins
Topiramate
Novel anti-epileptic drug
Mechanism for weight loss is not understood
Leptin
Naturally occurring hormone produced by adipocytes
Effect on hypothalamus–> satiety, decrease food intake
Needs to be given subcutaneously
Weight loss relative moderate
Centrally acting appetite suppressant
Sibrutamine
WITHDRAWN
CV risks outweigh benefits
New approaches
Leptin th: only in rare cases of leptin deficiency
CCK: decrease meal size but increase frequency
Other possibilities
Intragastric Balloon
Bariatric Surgery: restrictive vs malabsorptive procedure
Adjustable gastric band
