BY:

OBESIY

DEFINATION: OBESITY can be variously

defined as “an excess of body fat” or

„body fat that is more than 20% over the

ideal.‟‟

The persons with body mass index(BMI)

of 20-25 as termed as healthy, while with

25-30 as “overweight”, >30 as obese,

and BMI >40 as morbidly obese

.

OVERVIEW

Obesity is a multifactorial disorder of

energy balance in which chronic calorie

intake is grater than energy output.

BMI >30 significantly increases the risk of

type-2 diabetes, hypercholesterolemia,

HP, ischaemic heart diseases, gallstone

and various cancers is also included

OBESITY AS A HEALTH PROBLEM

The main determinant is a disturbance in

homeostatic mechanisms that control

energy balance, but genetic

endowment underlies the disturbance.

Other factor s like food intake and lack

of physical exercise contribute to this.

PATHOPHYSIOLOGY OF OBESITY

OBESITY is primarily an energy balance disorder, the details of which are not clear but may include the following:› Deficiencies in the genesis of, and/or response to

leptin or other fat depot sensors

› Defects in hypothalamus neuronal systems responding to leptin or other fat depot sensors

› Decreased metabolic expenditure of energy, decreased thermogenesis in adipocytes owing to reduction of β3-adrenorecptor- mediated action on lipid metabolism and or dysfunction of proteins tat uncouple that oxidative phosphorylation

› A contribution by genetic factors.

Studies indicate that about 40% to as much as 80% of the variance in BMI can be attributad to genetic factors.

So far, 200 genes, gene makers. And chromosomal regions has been associated with human obesity.

Linkage of human body to genes for other factors relevant to energy balance have been reported:› The β3 adrenorecepter; decreased function of this genes

could be associated with impairment of lipolysis in white fat or with thermogenesis in brown fat. The mutation of the gene has been found to be associated with abdominal obesity, insulin resisance and early onset of type 2 dia.

The glucocorticoid receptor: this could

be assosociated with obesity through the

premisssive effect of glucocorticoids and

several aspect of fat metabolism and

energy balance.

Fat calories per gram and it may be that

mechanisms regulating appetite react

rapidly to carb. And protein, but slowly

to fat

Adverse effect of obesity

It is now recognised that physical activity

– i.e- increased energy expentiture has

been much more effective role in

reducing fat storage and adjusting

energy balance in the obese ,

particularly if the associated with the

modification of the diet

PHSICAL EXERCISE AND OBESITY

The main treatment of obesity is suitable diet and increased exercise.

Drugs acting on gastro-intestinal tract(e.g.- ORISLAT-which causes malasbsorption of fat) are considered for severely obese individual who have lost atleast 2.5kg in the previous month by dieting additionally cardiovascular risk factors such as D.M. or H.P. treatment with orlislat is short term and combined with non-drug treatment.

SIBUTARIME is considered for adjunctive treatment of severely obese individuals. An increase in H.R. and B.P. and drug is contraindicated if cardiovascular disease is present.

Lorcaserin (Belviq). Lorcaserin is a long-term weight-loss drug approved by the FDA for adults. It works by affecting chemicals in your brain that help decrease your appetite and make you feel full, so you eat less. Your doctor will carefully monitor your weight loss while taking lorcaserin. If you don't lose about 5 percent of your total body weight within 12 weeks of taking lorcaserin, it's unlikely the drug will work for you and the medication should be stopped.

Side effects of lorcaserin include headaches, dizziness, fatigue, nausea, dry mouth and constipation. Rare but serious side effects include a chemical imbalance (serotonin syndrome), suicidal thoughts, psychiatric problems, and problems with memory or comprehension. Pregnant women shouldn't take lorcaserin.

Phentermine-topiramate (Qsymia). This weight-loss medication is a combination drug approved by the FDA for long-term use in adults. Qsymia combines phentermine, a weight-loss drug prescribed for short-term use, with topiramate, a medication that's used to control seizures. Your doctor will monitor your weight loss while taking the drug. If you don't lose at least 3 percent of your body weight within 12 weeks of starting treatment, your doctor may suggest either stopping use of Qsymia or increasing your dose, depending on your condition.

Side effects include increased heart rate, tingling of hands and feet, insomnia, dizziness, dry mouth and constipation. Serious but rare side effects include suicidal thoughts, problems with memory or comprehension, sleep disorders and changes to your vision. Pregnant women shouldn't take Qsymia. Qsymia increases the risk of birth defects.

Phentermine (Adipex-P, Suprenza). Phentermine is a weight-loss medication for short-term use (three months) in adults. Using weight-loss medications short-term doesn't usually lead to long-term weight loss. While some health care providers prescribe phentermine for long-term use, few studies have evaluated its safety and weight-loss results long term.

You need close medical monitoring while taking a prescription weight-loss medication. Also, keep in mind that a weight-loss medication may not work for everyone. If the medication does work, its effects tend to level off after six months of use like any other method of weight loss. You may need to take a weight-loss medication indefinitely. When you stop taking a weight-loss medication, you're likely to regain much or all of the weight you lost.

Some in phase III trial are: mazindol, posatireln and sertralin,

Some in phase II trial are buproprion, enteristatin, linitript, pegylated leptin

Potential target of new drugs:

Agents that reduced food intake› Reuptake inhibitors of 5-HT and non-adrenaline

at hypothalamic sites

› Antagonists at receptors for malanin-concentrating hormone(MCH), corticotrophin releasing hormone, gelenins and orexins A and B

› Binding protiens of CRB.

Agonist at receptors fer leptin, AGRP,

cholecystokininA. Glucagon-like

peptide(glp-1), bombesin.

Agents that increase energy expenditure

or enhance lipolysis

stimulators of action or expression of the

transcription factors UCP-2, UCP-3.

Agonists at the β3 adrenorecepter.

Weight-loss surgery limits the amount of food you're able to comfortably eat or decreases the absorption of food and calories, or both.

Weight-loss surgery for obesity may be considered if: You have extreme obesity, with a body mass

index (BMI) of 40 or higher

Your BMI is 35 to 39.9, and you also have a serious weight-related health problem, such as diabetes or high blood pressure

Weight-loss surgery can often help you lose as much as 50 percent or more of your excess body weight. But weight-loss surgery isn't a miracle obesity cure. It doesn't guarantee that you'll lose all of your excess weight or that you'll keep it off long term.

Weight-loss success after surgery depends on your commitment to making lifelong changes in your eating and exercise habits

WEIGHT LOSS SURGERY

Gastric bypass surgery. This is the favored weight-loss surgery because it has shown relatively good long-term results. In gastric bypass (Roux-en-Y gastric bypass), the surgeon creates a small pouch at the top of your stomach. The small intestine is then cut a short distance below the main stomach and connected to the new pouch. Food and liquid flow directly from the pouch into this part of the intestine, bypassing most of your stomach.

Laparoscopic adjustable gastric banding (LAGB). In this procedure, your stomach is separated into two pouches with an inflatable band. Pulling the band tight, like a belt, the surgeon creates a tiny channel between the two pouches. The band keeps the opening from expanding and is generally designed to stay in place permanently. LAGB is popular because it is less invasive, generally causes slow, steady weight loss and the band can be adjusted if needed. However, as with other procedures, this won't work without changes in your behavior. Results are usually not as good as with other procedures. The LAP-BAND gastric banding device has also been approved for use in people who have a BMI of 30 to 34 and have an additional health condition related to their obesity.

Gastric sleeve. In this procedure, part of the stomach is removed, creating a smaller reservoir for food. There are ongoing studies evaluating this procedure.

Biliopancreatic diversion with duodenal switch.In this procedure, most of your stomach is surgically removed. This weight-loss surgery offers sustained weight loss, but it poses a greater risk of malnutrition and vitamin deficiencies, and you require close monitoring for health problems. It's generally used for people who have a body mass index of 50 or more.

One of the best ways to prevent regaining the weight you've lost is getting regular physical activity. Keep track of your physical activity if it helps you stay motivated and on course.

You may always have to remain vigilant about your weight. Combining a healthier diet and more activity is the best way to lose weight and keep it off for the long term. If you take weight-loss medications, you'll probably regain weight when you stop taking them. You might even regain weight after weight-loss surgery if you continue to overeat or eat foods laden with fat and calories.

PREVENTING WEIGHT GAIN AFTER

OESITY TREATMENT

COMPARISON CHART

Inthis meaningfull world where, wealth is everything.. Its time to remember old phrase that “HEALTH IS WEALTH”.. WEALTH that u own as paper note will help u to climb higher in soceity as a succesfull person, but WEALTH given by god as your human body will help u to sustain in ur society

So its never to late to start any good.. Respect your body.. Respect yr soul… step forward to lead a “WEALTHY” life..

THANK YOU