Management of Obesity and Dyslipidemia

1. Management of Obesity and Dyslipidemia Presented by : Faisal Hassan Hussain

2. Contents: *health education . *Diet therapy . *Exercise . *Drug . *Surgery.

3. *Health Education : 1-Clarify the diagnosis (primary or secondry ) 2-clarify the degree of Obesity by Using BMI . 3- discuss with the patient the benefit of weight reduction . 4-discuss with the patient the objective of weight reduction a-to prevent further weight gain b-to reduce your weight by 2kg/month c-to prevent co morbidities 5-discuss with patient the preferred method for weight reduction a-diet therapy b-exercise c-drugs d-surgery

4. *Diet therapy : Principle of diet therapy : 1-the total daily caloric contents of diet should be reduced 2-the total daily fat intake should be reduced <30% of total calories 3-Carbohydrates intake should represent >55% of total calories . 4- protein intake should be <15% of total calories 5-the daily cholesterol should be <300mg/day . 6-Daily fiber intake should be (20-30)g/day. 7-the initial calories intake should be reduced by 500kcal/day . 8- for the patient with BMI>35 ,the daily calories should be reduced by 500-1000 calories 9-the principle of weight reduction during the next 6 months should be about 10 kgs of the original weight (i.e.500g/week).

5. *General advice helping obese patients to reduce their weight : 1-they should not fill the stomach . 2-they should take vegetable or fruits before main meal . 3- they should not take additional meals or fast meals . 4-they should not fill the plate with large amount of foods . 5-they should eat slowly graind food well 6-they should avoid diet rich in fat 7-they should drink a glass of water before meals 8- they should not eat while watching TV or reading 9-they should not eat salty meal .

6. *Exercise therapy : Obese patients should always be prescribed exercise unless contraindicated .the type of exercise should be acceptable , suitable and desirable for patients .regular moderate exercise will tend to redce weight by 2.4%of the total body weight . e.g : 1- walking 2-3 miles for 40 min 2-playing basketball 40 min 3-swimming for 20 min

7. *Drug therapy : Drug therapy is indicated if diet and exercise therapy fail to reduce BMI to less than 30 in obese patients with other risk factors (such hypertension ,diabetes , dyslipidemia,sleep apnea , and coronary artery disease ) BMI less than 27 in those patients such risk factors. There are 2 drugs approved by FDA for weight reduction loss . These medication can reduce weight by 6-10 % of the original body weight Sibutramine : MOA: norepinephrine ,dopamine , serotonine inhibitors Dose :5,10,15 mg/oral /daily Side effects :tachycardia , HTN. Orlistat : MOA: pancreatic lipase inhibitor (decrease fat absorption) Dose: 120mg 3 times before meal Side effects : decrease absorption of fat soluble vitamins (ADEK) , soft stool , and flatus . Note : if patient taking either medication has not lost at least 2 kgs on therapy for 4 weeks , the medication should be discontinued .

8. *Surgery: Indication : Morbid obesity (BMI >40) if the medical therapy fails in reduction weight . Obesity (BMI>35) with cardiovascular risk factor . If the obese patient suffer from complication of obesity . Referral : If the behavioral and drug therapy fail to reduce weight gain If there is cardiovascular risk factor .

10. Gastric bypass :

11. Gastric sleeve:

12. Management of Dyslipidemia

13. Contents: *Diet therapy . *Exercise . *Drug .

14. *Exercise therapy: The exercise should be performed four times ,30 min at least a week unless there is contraindication . walking and swimming are the optional type of exercise . Exercise will tend to decrease BP , blood sugar , weight ,LDL,TG, and will increase HDL .

15. *Diet therapy: 1-The objective of diet therapy to reduce the LDL to less than 160 mg/dl for those without risk factor . 2-And to reduce LDL for less than 130mg/dl for those having two or more of risk factor . 3- and to reduce LDL for less than 100mg/dl for those having coronary artery disease Diet therapy will reduce LDL and TG within 6-8 weeks and should be continued for 6 moths before giving drug therapy unless there are good indication for initiation of drugs. Diet therapy will reduce LDL by 10-20%.

16. *Drug therapy : It is indicated in the following : 1-if the lipid remain elevated after six months of diet therapy (did not decrease to the target) 2- If the initial LDL>190mg/dl. 3-If the TG>1000mg/dl Choices of drug depend upon the type of the elevated lipid For high LDLCstatinsis most effective drugs while high TG are preferred to be treated by Gemifibrozil or Nicotinic acid .

17. Statins : MOA: HMG CO A reductase inhibitor . Side effects : muscle pain , high level of liver enzyme . Safety monitoring : creatinine , Kinase , liver enzyme . Gemifibrozil: MOA: Agonists of nuclear receptor PPARα (peroxisomeproliferator-activated receptor α) expressed in several types of cells such as hepatocytes, skeletal muscle fibres and macrophages . Side effects : GIT dysfunction and myosities . Safety monitoring: liver function test and coagulation profile Nicotinic acid : MOA : niacin inhibits lipase activity in the adipocytes. Side effect : flushing .hyperglycemia and hyperuricemia Safety monitoring : liver function test , uric acid , blood sugar .

18. Thank you