presentation CLN413 B2.pdf

Medications & Dietary Supplements for Overweight/Obesity, Physical Activity Recommendations Group B2: Fawatim Alkhamis Lujain Albahrani Rehaf Albaqami Table of contents 01 Medication for overweight/obesity 1. Short-term versus long-term use of drugs, according to FDA standards. 2. The mechanism o...

Medications & Dietary Supplements for Overweight/Obesity, Physical Activity Recommendations Group B2: Fawatim Alkhamis Lujain Albahrani Rehaf Albaqami Table of contents 01 Medication for overweight/obesity 1. Short-term versus long-term use of drugs, according to FDA standards. 2. The mechanism of action, effectiveness, safety, and approved duration of medications approved for obesity 3. Identify whether diabetes medications may cause weight loss, weight gain, or are weight neutral. 03 02 Dietary Supplements for Overweight/Obesity 1.Supplements categories 2.Suplement description 3.Summary of recommendation Physical activity for overweight/obesity 1. benefits of physical activity 2. 6 cardiovascular benefits of physical activity 3. 8 improvements in physical and psychological well-being caused by physical activity 4. 12 behavior management strategies for promoting physical activity in patients. 5. the Activity Pyramid’s recommendations. 01 Medication for overweight/obesity Introduction There are two groups of approved drugs that can be used to manage weight in patients with obesity: ‫األدوية التي تؤثر على وزن الجسم للمرضى الذين يعانون من السمنة املفرطة والذين‬ .‫يعانون من مضاعفات السمنة ويتلقون هذه األدوية إلدارة األمراض املزمنة‬ 1-Medications approved for obesity 2-Medications that affect body weight for obese patients who have complications from their obesity and are receiving these medications for chronic disease management. Examples: diabetes, depression, or psychiatric disorders. For each disorder, some drugs produce weight gain, others are weight neutral, but the best choice for these patients is the combination of drugs that treat the underlying condition and also produce weight loss. Short-term versus long-term use of drugs, according to FDA standards. •Short-term use of medications: refers to approved for a limited duration, typically up to 12 weeks, for the treatment of obesity. These medications are often sympathomimetics, with phentermine being the most widely used. •Long-term use: refers to medications approved for extended periods for the treatment of obesity. These medications include orlistat, lorcaserin, and the combination of phentermine and topiramate as an extended-release formulation. They are intended for prolonged use and are approved by the FDA for long-term treatment of obesity. Medications approved for obesity 1- Orlistat (brand name Alli) 2- Lorcaserin (Belviq) 3- Phentermine/topiramate ER (Qsymia) 4- Naltrexone/bupropion (Contrave) 5- Phentermine Medications approved for obesity •Drug name/ Duration of use: Orlistat (Alli), Long-term use ‫مثبط قوي وانتقائي للليباز البنكرياسي الذي‬ .‫يقلل من هضم الدهون في األمعاء‬ •Mechanism of action: A potent and selective inhibitor of pancreatic lipase that reduces the intestinal digestion of fat. •Effectiveness: -Weight loss A study sample of orlistat-treated group achieved a mean weight loss during the first year of more than 11% below baseline. •Safety Side effects related to the blockade of triglyceride digestion in the intestine Side effects: Fecal fat loss, related GI symptoms are common initially. It cause small but significant decreases in fat-soluble vitamins. •Caution: Avoid High fat meals when taking Alli Medications approved for obesity •Drug name/ Duration of use Lorcaserin (Belviq), Long-term •Mechanism of action Serotonergic drugs for weight loss targets the serotonin-2C receptor, and not 2B serotonin receptors that were involved in the heart damage. When the serotonin-2C receptor is activated in the hypothalamus, food intake is reduced. ‫تستهدف أدوية هرمون السيروتونني لفقدان الوزن مستقبالت‬ ‫ التي كانت‬2B ‫ وليس مستقبالت السيروتونني‬،2C- ‫السيروتونني‬ 2C-‫ عندما يتم تنشيط مستقبل السيروتونني‬.‫متورطة في تلف القلب‬ .‫ ينخفض تناول الطعام‬،‫في منطقة ما تحت املهاد‬ •Effectiveness -Improvements in cardiovascular risk factors -Mean HbA1c decreased -Mean fasting glucose decreased -Weight loss and maintenance -Reduced energy intake -Reduced hunger ratings Medications approved for obesity •Safety Lorcaserin is well tolerated. Adverse events in clinical trials that are mild and resolved quickly were: headache, nausea, dizziness, fatigue, dry mouth, and constipation. •Caution: the drug should not be used with selective serotonin reuptake inhibitors (SSRIs) Or with monoamine oxidase inhibitors (MAOIs), because of the risk of serotonin syndrome A conditions result when there is too much of neurotransmitter serotonin in the body. Medications approved for obesity •Drug name/ Duration of use: Phentermine/topiramate ER (Qsymia), Long-term ‫يعمل فينترمني على تقليل الشهية من خالل زيادة النورإبينفرين في منطقة ما‬ ‫ وقد تكون آلية تقليل الشهية في التوبيرامات من خالل تأثيره على‬،‫تحت املهاد‬ .(GABA) ‫مستقبالت حمض جاما أمينوبوتيريك‬ •Mechanism of action: Phentermine acts to reduce appetite through increasing norepinephrine in the hypothalamus, and topiramate’s appetite-reducing mechanism, may be through its effect on (GABA) gamma-aminobutyric acid receptors. Medications approved for obesity •Effectiveness: -Weight loss with (Qsymia) is accompanied by improvements in most risk factors. - Improvements in: blood pressure, glycemic measures, HDL cholesterol, and triglycerides. -Reduce the severity of symptoms from sleep apnea. •Caution: •Safety Commonly observed side effects in the clinical trials were: paraesthesia(tingling), dizziness, dysgeusia (altered taste), insomnia, constipation, and dry mouth. Within 14 days of treatment with MAOIs Contraindicated with: Pregnancy, causing oral cleft and acute glaucoma. Stop it in positive pregnancy. Hyperthyroidism. Patients with hypersensitivity to any of the ingredients in the medication. Medications approved for obesity •Drug name/ Duration of use: Naltrexone/ bupropion (Contrave), Long-term. Not yet on the market •Mechanism of action: Bupropion reduces food intake by acting on adrenergic and dopaminergic receptors in the hypothalamus. Naltrexone is an opioid receptor antagonist with minimal effect on weight loss on its own. It block inhibitory influences of opioid receptors activated by the beta-endorphin that is released in the hypothalamus and stimulates feeding. Allowing the activity of alpha-melanocyte stimulating hormone (alpha-MSH), which inhibits food intake. ‫ إنه يمنع‬.‫النالتريكسون هو مضاد ملستقبالت املواد األفيونية وله تأثير ضئيل على فقدان الوزن من تلقاء نفسه‬ ‫التأثيرات املثبطة للمستقبالت األفيونية التي ينشطها بيتا إندورفني الذي يتم إطالقه في منطقة ما تحت املهاد ويحفز‬ .‫ والذي يمنع تناول الطعام‬،(alpha-MSH) ‫ السماح بنشاط الهرمون املحفز للخاليا الصباغية ألفا‬.‫التغذية‬ Medications approved for obesity •Effectiveness Its effectiveness somehow conflicting, and not proven yet.. Because bupropion increases pulse and both bupropion and naltrexone increase blood pressure in the studies, the FDA has required a premarketing study of the combination drug with assessment of cardiovascular outcomes. Weight loss with the NB combination at 1 year was intermediate to that of PHEN/TPM ER and lorcaserin. •Safety There are some tolerability issues, chiefly nausea on initiating the drug, and potential issues with SSRIs or MAOIs Do you think that Diabetes medications may cause weight loss, weight gain, or are weight neutral? Can you give an example? Diabetes medications effects on the body weight 02 Dietary Supplements for Overweight/Obesity Weight-loss supplements ● Absorption blockers Block the absorption of fat and carbohydrates . ● Stimulants Increase the metabolism and the total amount of energy expended ● Nutrient partitioning Change either fat or carbohydrate metabolism ● Appetite suppressants Increase satiety and decrease hunger. Absorption Blockers Phaseolus vulgaris ( a-amylase inhibitor) Increase fat loss (~2.5 kg) • Chitosan ( Fat binder) Small but significantly great weight loss (~1.7 kg) • Both cause: GI distress, flatulence but generally safe Little research to support the efficacy of these supplements. • Stimulants Caffeine (Increases thermogenesis ) Studies show increases metabolic rate in the short term Side effects: insomnia, irritability, heart palpitations, and anxiety • Ephedra ( Increase metabolism and appetite suppression.) Effective when combined with caffeine, small increase in weight loss (~1 kg/month) Side effects : HTN, stroke, serious heart problems • Stimulants ‫خصائص التحلل الدهني‬ Bitter orange ( increase metabolism and have lipolytic properties) Bitter orange usually combined with other compounds for more benefit Side effects: increased HR, HTN, angina, ischemic colitis, and seizures. ● Green tea (Reduced adipocyte lipogenesis, decreased fat absorption, ) Decrease body weight less than 2kg Can lead to liver damage, product safety is not assured. ● All have little research to support the efficacy. ● Nutrient Partitioning Calcium (Increases fecal fat excretion) 4 RCT show weight loss with energy-restricted diet (~2–4 kg) Safe, May only be beneficial for those who consume a low-Ca diet (<600 mg/day). ● Conjugated linoleic acid (Reducing adipocyte differentiation and metabolism.) Limited data supporting decreases in fat mass (1–2 kg) GI distress, increase blood insulin, and reduce insulin sensitivity. Effects only in animals. ● Nutrient Partitioning Chromium picolinate (Hypothesized to increase lean mass and promote fat loss.) Studies indicates no benefit on weight loss or gain of muscle-mass No UL, Cr+6 is a human carcinogen and toxin Supportive evidence is minimal ● Appetite Suppressants Soluble fiber (hold water and increase satiety and fullness. SCFA can influence production of satiety hormones) Associated with lower body weight (1–2 kg). Side effects: GI upset, bloating, and gas. ● Hoodia Gordonii (Appetite suppression attributed to a plant compound) No scientific fundings, safety, evidence. ● Summary of recommendations There is no strong research evidence indicating that one specific supplement will produce significant weight loss (~2–4 kg), especially in the long term. 03 Physical activity for overweight/obesity Benefits of physical activity: 01 02 03 Weight Loss: Total Fat Content: Body Fat Distribution: Physical activity facilitates weight loss by burning calories and boosting metabolism. Regular exercise contributes to the reduction of total fat content through improved fat metabolism. It promotes a healthier body fat distribution by encouraging muscle development. Comparison the benefits with dieting. ● ● While dieting controls caloric intake and cause initial weight loss, physical activity offers additional benefits. Improved cardiovascular health, increased muscle mass, and holistic well-being are notable advantages of exercise Combining a balanced diet with regular exercise leads to more sustainable and comprehensive results for weight management. 6 Cardiovascular benefits of physical activity Cardiovascular benefits of physical activity 01 02 03 Improved Heart Health: Reduced Blood Pressure: Blood Sugar Control: Regular physical activity strengthens the heart muscle, Reductions in cardiovascular morbidity and mortality in patients who are overweigh. Exercise helps lower blood pressure, decreasing the risk of hypertension and related complications. Physical activity aids in regulating blood sugar levels, reducing the risk of diabetes and insulin resistance Cardiovascular benefits of physical activity 04 05 Enhanced Blood Circulation: Optimized Cholesterol Levels: Lowered Risk of Stroke: Regular exercise contributes to a favorable lipid profile ↑ "good" HDL cholesterol ↓"bad" LDL cholesterol. Engaging in regular physical activity is associated with a decreased risk of stroke. Physical activity improves blood flow, ensuring efficient transport of oxygen and nutrients throughout the body. 06 Improvements in physical and psychological well-being caused by physical activity. improvements in physical well-being Weight Management: Physical activity supports weight control by burning calories and increasing metabolism. Muscle Strength and Endurance: Regular exercise enhances muscle strength and endurance, may improve the mobility, functional abilities, and quality of life in obese persons. Increased cardiorespiratory fitness: Exercise improves heart health, reducing the risk of cardiovascular diseases. improvements in psychological well-being Enhanced Cognitive Function Mood Regulation physical activity, it increases blood flow to the brain, delivering more oxygen and nutrients. This can enhance the cognitive abilities Exercise positively influences mood, reducing symptoms of depression and anxiety. Improved Sleep Quality Stress Reduction 12 behavior management strategies for promoting physical activity in patients. Behavior management strategies for promoting physical activity in patients: 1. Readiness to Change Assessment: Assess patient readiness to change and identify variables associated with successful weight loss, tailoring interventions accordingly. 2. Realistic Expectations: Help patients set achievable goals, correcting overly pessimistic or optimistic expectations to ensure sustainable progress 3. Patient-Selected Goals : Allow patients to choose their own goals, providing guidance for setting flexible, shortterm objectives to enhance motivation. 4. Rewards System: Query patients about effective rewards, incorporating positive reinforcement to motivate adherence to physical activity. 5. Environmental Cues: Use cues or stimuli in the environment to serve as reminders, helping patients stay committed to their exercise routine. 6. Routine Exercise Times and Places: Establish consistent exercise schedules and locations, fostering the development of a regular exercise habit. 12 behavior management strategies for promoting physical activity in patients: 7.Behavior Contracts: Develop and sign behavior contracts to formalize and strengthen the commitment to regular physical activity. 8.Advantages and Disadvantages Discussion: Discuss the pros and cons of exercise, helping patients understand the benefits and potential barriers. 9.Social Support Emphasis: Emphasize the importance of social support, encouraging patients to involve friends or family in their exercise routine. 10.Self-Reinforcement: Encourage self-reinforcement, emphasizing increased self-esteem and recognition of health benefits as rewards for consistent exercise. 11.Preparation for Relapse: Prepare patients for situations that may lead to a relapse, equipping them with strategies to overcome challenges. 12.Coping Strategies: Discuss coping strategies to prevent a complete relapse, empowering patients with effective tools for maintaining their exercise routine. the Activity Pyramid’s recommendations. The Activity Pyramid, developed as a model to facilitate public and patient education for the adoption of a progressively more active lifestyle, It encourages individuals to spend less time being physically inactive and to become more physically active. Thanks! Do you have any questions? References: 1. 2. 3. Abray, G. A., & Ryan, D. H. (2014). Update on obesity pharmacotherapy. Annals of the New York Academy of Sciences, 1311(1), 1-13. Available from: https://nyaspubs.onlinelibrary.wiley.com/doi/full/10.1111/nyas.12328 MM; M. Dietary supplements for improving body composition and reducing body weight: Where is the evidence? [Internet]. U.S. National Library of Medicine; [cited 2023 Dec 18]. Available from: https://pubmed.ncbi.nlm.nih.gov/22465867/ Mcinnis KJ, Franklin BA, Rippe JM. Counseling for physical activity in overweight and obese patients [Internet]. American Academy of Family Physicians; 2003 [cited 2023 Dec 18]. Available from: https://www.aafp.org/pubs/afp/issues/2003/0315/p1249.html Let’s assess your knowledge!