BODY WEIGHT CONTROL

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Obesity Obesity is the state of excess body fat stores. Energy Intake > Energy consumption .WHO states

1.5 billion obese population

U.S. 68% obese ( Largest Market )

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Classification of Overweight and Obesity

Acc. To BMI BMI define body weight relative to person’s height .

BMI=Ib/

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NOT All Overweight people are Obese

but All Obese are Overweight !!!

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Summary

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Body Weight Control

1- Non-Medication Control 2- Anti-Obesity Drugs Low Caloric Deit .

Physical Exercises . A-Synthetic B-Natural Life Style Modifications.

3- Surgery

Fat absorption Appetite

Inhibitors Suppressor

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Strategy for body weight control

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1- Hypertension

2- NIDDM (Type 2) 3- Dyslipidemia

4- Heart Diseases

obesity-related health complications

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“There is no magic pill for obesity,The best effect you're going to get is with a concerted long-term regimen of diet and exercise. If you choose to take a drug along with this effort, it may provide additional help.” says David Orloff, Director of the FDA's Division of Metabolic and Endocrine Drug Products.

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A-Synthetic Anti-obesity Medications

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1- Orlistat ( Xenical )Approved by the FDA in 1999 .

Only drug approved by FDA for long term use .Approved by FDA for over-the-counter sale in Feb 2007.

M.O.A.Reduces intestinal fat absorption ( lipase Inhibitor ).

S.E. Steatorrhea-Intestinal discomfort-diarrhea-flatulence Interfere absorption of fat-soluble vitamins & cyclosporine. Improve lipid profiles & glucose control .

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2- Phentermine M.O.A. (appetite suppressant)Act on brain hypothalamus stimulating adrenal glands

to release norepinephrine reducing hunger.

S.E.

increased blood pressure - palpitations – arrhythmia

(FDA) recommended that phentermine used short-term (up to 12 weeks).

3- Sibutramine (Meridia)M.O.A. Anorectic, serotonin & NE levels in brain .S.E.

Increased bl. Pressure & Heart Rate - dry mouth -constipation-headache-insomnia. Approved by the FDA in 1997.

Withdrawn from U.S. & Canadian markets in 2010 . Its risks (M.I. and stroke) more than the benefits.

Not used in patients with history of stroke - heart disease - bl. Pressure - arrhythmias – MOA inhibitors (SRI)

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4- Diethylpropion

One of the safest noradrenergic appetite suppressants

Used in patients with mild to moderate HTN or angina.

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5- Metformin (Glucophage)

Reduce weight limit the amount of

glucose produced by the liver and

increases muscle consumption of glucose .

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6- Exenatide (Byetta)Long-acting analogue of GLP-1 hormone .

GLP-1 promotes a feeling of satiety. Some obese people are deficient in

GLP-1.Used for ttt of DM type 2 .Exenatide is currently being tested in

non-diabetics as a treatment for obesity.

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7- Pramlintide (Symlin) Synthetic analogue Amylin hormone.Amylin promotes a feeling of satiety.

Used along with insulin by Type 1 and

Type 2 diabetics.Symlin is currently being tested in

non-diabetics as a treatment for obesity.

N.B.Orlistat is moderately effective produce average weight

loss of 5 to 22 pounds over a 1 year period .

Response to Anti-obesity medications , some people experience more weight loss than others.

Some people lose >10% of body weight ,

Reduce the risk of high blood pressure, diabetes and other obesity-related health complications .

Patients experience max. weight loss within 6 months.

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Anti-obesity Medication withdrawn from market

1- Fen-phen (Fenfluramine + Phentermine ) . Due to valvular heart disease and pulmonary HTN.

2- Redux (Dexfenfluramine)

Due to Cardiovascular side-effects reports

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Anti-obesity Medication NOT Approved

1- Rimonabant• Cannabis smokers often experience hunger !!! Thus ,

blockade of the endocannabinoid system decreasing appetite.

• NOT approved Due to psychiatric Hazards .

2- Amphetamines • Appetite Suppressant • NOT approved Due to powerful stimulant & addictive

potential .

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1- Lorcaserin (approved June 28, 2012 )

2- Qsymia (formerly Qnexa) (approved July 17, 2012)

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1- Lorcaserin Appetite suppressor ,affecting levels serotonin.patients lost about 4 % of their body weight.For obese people and overweight people having

at least one weight-related health condition.In combination with a healthy diet and exercises.S.E.

Headache – dizziness – fatigue – nausea - dry mouth - constipation.

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2- Qsymia Combination of two FDA-approved drugs:

1- Phentermine appetite suppressant .

2- Topiramate anticonvulsant drug treat migraines & epilepsy , has weight-loss side effects.

In combination with a healthy diet and exercises.

help patients lose about 10-12 % of their body weight.

S.E. heart problems - birth defects -cognitive effects such as mental disturbance or lack of concentration .

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B- Herbal / Natural Products

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1-GlucomannanGlucomannan is a water-soluble polysaccharide.

(FDA) has not approved any product containing glucomannan for the treatment of these medical conditions.

MOA : Glucomannan dietary fibers interfere with the motility and absorption of nutrients from the gut.

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2-Green Tea (caffeine)Anti-oxidant rich – Noradrenergic .Have weight-loss-promoting effects,

such as speeding up your metabolism and suppressing your appetite.

Drinking more than five cups a day may lead to caffeine-related side effects

Headache - nervousness -sleep problems - irregular heartbeat

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3-Chitosan

chitosan limiting fat absorption, which would make it useful for dieting

Adverse effects

1- Constipation

2- upset stomach

3- reduce absorption of essential nutrients (including calcium and vitamins A, D, E & K)

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4- Chromium Picolinate

Insulin simulator , aid glucose & fat metabolism, managing the breakdown of glucose and fat.

Adverse effects

behavioral changes - irregular heartbeat

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Antiobesity drugs not cure -all , must be combined with physical exercises & healthy diet over long time .

Some people experience more weight loss than others.

Some people lose >10% of body weight ,

Reduce the risk of high blood pressure, diabetes and other obesity-related health complications

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Conclusion BMI : Normal weight should be from 18.5 to 24.9 Kg/

Anti-obesity drugs :

a- Fat absorption inhibitors (Orlistat).

b- Appetite suppressant (Phentramine)

c- Recent medications (Qysmia & lorcaserin).

Herbal and natural products for weight loss

a- Chitosan.

b- Green tea.

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