Download Management of Obesity and Dyslipidemia

Management of Obesity and
Dyslipidemia
Presented by : Faisal Hassan Hussain
 Contents:
*health education .
*Diet therapy .
*Exercise .
*Drug .
*Surgery.
*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
*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).
*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 .
*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
*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 .
*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 .
Gastric bypass :
Gastric sleeve:
Management of Dyslipidemia
Contents:
*Diet therapy .
*Exercise .
*Drug .
*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 .
*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%.
*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 LDLC statins is most effective
drugs while high TG are preferred to be
treated by Gemifibrozil or Nicotinic acid .
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 (peroxisome
proliferator-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 .
Thank you