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Obesity PowerPoint Presentation

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Description : Obesity and related disorders

Tags : Obesity, pickwikian syndrome

Published on : Jan 28, 2021 | Views : 7191 | Downloads : 63

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obesity Moderator: Dr A K Das Presented by: Dr Pooja Kumari
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INTRODUCTION Obesity is a state of excess adipose tissue mass In 2016, more than 1.9 billion adults, were overweight, 650 million were obese. 39% of adults were overweight in 2016, and 13% were obese.
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Classification of Weight Status based on BMI and Disease Risk BMI  Grade1 BMI of 25-29.9kg/m2 ( Overweight ) Grade 2  BMI of 30-39.9 kg/m2 ( Obesity ) Grade 3  BMI of ≥ 40 kg/m2 ( Morbid Obesity )
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Ethnic-Specific Cutpoint Values for Waist Circumference
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Bioelectrical Impedence Analysis
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SPECIFIC DISORDERS ASSOCIATED WITH OBESITY Cushing’s syndrome Hypothyroidism Insulinoma Craniopharyngioma Genetic disorders: PRADER-WILLI LAURENCE-MOON-BIEDL AHSTROM’S COHEN’S CARPENTER’S
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PATHOGENESIS OF OBESITY An increased intake of energy-dense foods that are high in fat and sugars; An increase in physical inactivity due to the increasingly sedentary nature of many forms of work, changing modes of transportation, and increasing urbanization.
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PATHOLOGICAL CONSEQUENCES OF OBESITY Insulin resistance and type 2 DM Reproductive disorders Cardiovascular disease Pulmonary disease Hepatobiliary disease Cancer Bone , joint and cutaneous disease
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Symptoms and diseases directly or indirectly associated with obesity
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PICKWIKIAN SYNDROME Obesity hypoventilation syndrome A condition in which an individual with a body mass index >30 kg/m 2 develops daytime alveolar hypoventilation that cannot be attributed to other pathologies. Complications: Right heart failure Pulmonary hypertension Respiratory failure
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Steps in evaluation of obesity A focused obesity related history A physical examination to determine the degree and type of obesity Assessment of comorbid conditions Determination of fitness level Assessment of the patient’s readiness to adopt lifestyle changes Rule out the other organic cause of obesity
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TREATMENT GOAL OF THERAPY Improve obesity related comorbid conditions Reduce the risk of developing future comorbidities. Setting weight loss goal of 8-10 % over 6 months and its maintanance LIFESTYLE MANAGEMENT Diet therapy Physical activity therapy Behaviour therapy PHARMACOTHERAPY ( BMI ≥ 30 kg/m2 or BMI ≥ 27kg/m2 with obesity related diseases ) Appetite suppressants Gastrointestinal fat blockers Reduce the fat absorption. SURGERY
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DIET Hypocaloric diet limit energy intake from total fats and carbohydrates shift fat consumption away from saturated fats to unsaturated fats and elimination of trans fatty acids increase consumption of fruits and vegetables, and legumes, whole grains and nuts limit the intake of free sugars and salt
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PHYSICAL ACTIVITY PHYSICAL ACTIVITY At least 40 minutes of regular, moderate-intensity physical activity on most days a daily calorie deficit of 500–600 kcal through combined diet and moderate intensity activity is required for weight loss in overweight and obese adults weekly duration for moderate intensity activity of up to 150– 300 min
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Exercise Prescription Factors for customising an exercise prescription resting heart rate, exercise intensity achieved during a baseline evaluation of patients Karnovens formula for MHR = 220 – age Heart rate reserve = MHR – resting heart rate 60-80% of HRR= training zone (Example age 35, RHR=70 MHR =220-35=185 HRR=185-70=115 If 60% is the target intensity of training zone 60% of HRR =60 % 115 = 69 Then training zone will be at 70+69=139 beats per min) Aerobic zone=70 to 80% Anaerobic zone =80 to 90% Warm up and cool down= 50 to 60%
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Pharmacotherapy ANOREXIANT Centrally acting anorexiant medication Act on ventromedial and lateral hypothalamic regions. LORCASERIN NALTREXONE SR/ BUPROPION SR PHENTERMINE / TOPIRAMATE LIRAGLUTIDE GASTROINTESTINAL FAT ABSORPTION BLOCKER ORLISTAT
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LORCASERINE Selective 5-HT2c receptor agonist Dose- 10mg BD or 20 mg OD BLOOM and BLOSSOM trial Increased risk of cancer C/I – Glaucoma, Hyperthyroidism
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BUPROPION SR/ NALTREXONE SR Naltrexone  Opioid antagonist Bupropion  Mild reuptake inhibitor of dopamine and norepinephrine COR-I, COR-II, COR BMOD trials Dose : 90mg/8mg , 2 tab BD Target ≥ 5 % weight loss in 4 months C/I – h/o seizure disorder, uncontrolled HTN
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PHENTERMINE / TOPIRAMATE Phentermine – Catecholamine releaser Nor-epinephrine in the hypothalamus Increased leptin concentration Appetite suppression Topiramate- Anticonvulsant Increases GABA, antagonism of Glutamate, Carbonic anhydrase inhibition 3.75 mg/23 mg, 7.5mg/46 mg, 11.25mg/69 mg, 15mg/92 mg EQUIP and CONQUER and SEQUEL trial C/I – Glaucoma, Hyperthyroidism
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LIRAGLUTIDE GLP-1 analogue Stimulate glucose induced insulin release Inhibits glucagon secretion and gastric emptying Stimulate GLP-1 receptor in arcuate nucleus of hypothalamus to reduce feeding. Dose- 0.6 mg/day s/c gradually increased by 0.6 mg/day weekly upto 3 mg/d Target weight loss - 4 % in 16 weeks SCALE , SCALE diabetes, SCALE maintenance C/I – h/o medullary carcinoma of thyroid (personal or family h/o MEN)
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ORLISTAT Decreased fat absorption Inhibition of gastric, pancreatic and carboxylester lipases, phospholipase A2, prevents triglyceride hydrolysis Dose  120 mg 8 hourly with each meal containing meal Fat soluble vitamin supplements Dose adjustment of insulin and OHA
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SURGERY BMI ≥40 OR ≥35 with serious medical condition 3 types Restrictive Laproscopic adjustable gastric banding (LAP band, REALIZE band) , Laproscopic sleeve gastrectomy Restrictive malabsorptive  Roux-en-Y gastric bypass, biliopancreatic diversion, biliopancreatic diversion with duodenal switch. Malabsorptive Biliopancreatic diversion Intraluminal gastric balloon RESHAPE AND ORBERA
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Laparoscopic adjustable gastric banding Laparoscopic sleeve gastrectomy The Roux-en-Y gastric bypass Biliopancreatic diversion with duodenal switch Biliopancreatic diversion
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60 y male, came with c/o 1 episode of nasal bleeding and dry cough off and on. H/o similar episode 3 years ago, k/c/o HTN on Tab TELMISARTAN 40 mg OD. O/E Afebrile, BP-140/90 mmhg, P-100/min, RR- 20/min, SpO2- 82 % at RA, BMI- 44.57 kg/m2 Blood R/E, RFT, LFT, Serum electrolyte,TFT, Platelet count, PT, INR, Lipid profile within normal limits Chest- Diminished breath sound in B/L lower zones (L>R) Chest xray- prominent bronchovascular markings in both lung fields, homogenous opacity in left lower lung zone USG whole abdomen grossly normal study ECHO-Mild concentric LVH, Normal LV function PFT- CECT thorax:- Left subpleural atelectasis, thin atelectatic bands in left upper and right lower lobe ABG:- PaCO2-56.6mmhg, PaO2-57.6mmhg, sO2-88 %
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REFERENCES Harrison’s Principles of Internal Medicine 20e WHO  https://www.who.int/health-topics/obesity
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THANK YOU
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