What happens if you lose 10 kg weight?
15% decrease in LDL cholesterol levels
8% increase in HDL cholesterol.
In fact, blood pressure increase with increasing BMI, for every 10 kg of weight gain, blood pressure goes up 2-3mm Hg. By contrast, if weight loss decreases blood pressure, and typically, for every 1% reduction in weight, blood pressure decreases 1-2mm Hg. Q ue is even greater if accompanied by exercise
What are the objectives in the treatment of obesity in recent years?
The first step: The evidence that modest weight loss, 10% or maybe even 5% of body weight is enough to control, or at least improve, the majority of the complications of obesity. The second development: Changing the goal of increasing loss by maintaining the new weight, reaching the best possible in the context of overall health.
What are the options for the TX and control of obesity?
It has been shown that the loss of 10% of excess weight and provides beneficial effects on health.
AlimentacióProgramas diets and exercise programs
Changes in behavior and lifestyle
How do you classify the drugs used in the tx of obesity?
Its mechanism of action:
Drug That Reduces Power Consumption. (Appetite)
2) Drugs that decrease the absorption of nutrients. Orlistat (Xenical)
3) drugs that increase energy expenditure. Ephedrine and xanthines such as caffeine, theophylline and thyroid hormone
5) Drugs that reduce the size of fat cells and fat molecules transformed into energy through the oxidation of fatty acids.
When you use the surgical Tx?
In people with morbid obesity, very severe (BMI> 40) and in those with a less severe obesity and serious complications or life threatening, where treatments based on diet, exercise and medications are ineffective in the long term, Surgical procedures are the treatment of choice. Can result in great loss of weight that usually remain well for> 5 years. The only long-term effective treatment for these patients is surgery.
What is needed for the absorption of fats?
For the absorption of fat possible, lipases must convert triglycerides to fatty acids.
What are the lipolytic enzymes and what is most important?
Humans have four lipolytic enzymes, lipase, involved in concert sequential enzymatic digestion of lipids are:
Pancreatic lipase is by far the most important digestive lipase
What is orlistat?
Orlistat is a drug that was approved in early 1999 by the FDA (Food and Drug Administration) for use in weight reduction treatments.
Orlistat, also known as tetrahidrolipostatina, a drug to treat obesity. Its main function is to prevent the absorption of fat in the human diet, thereby reducing caloric intake.
What is its mechanism of action?
Is a potent, specific, irreversible and long-acting gastrointestinal lipases. It exerts its therapeutic effect in the stomach and in the light of the small intestine. Orlistat blocks the action of lipase and thus prevents the conversion of triglycerides to fatty acids and thereby obtain a 30% reduction in systemic absorption of fats contained in a diet that has a normal fat percentage (30% of Total Calories).
How is the systemic absorption of orlistat?
In general, after a long-term treatment with therapeutic doses, detection of Orlistat unchanged plasma was sporadic and concentrations were extremely low (<10 ng / mL) with no evidence of accumulation which is consistent with negligible systemic absorption.
How is the elimination of orlistat?
The major route of elimination of unabsorbed drug is fecal excretion.
97% is excreted in the feces, and this, the
83% as unchanged orlistat.
Renal excretion was <2% of the administered dose.
What is% of fat excretion with orlistat, according to the dosage?
In healthy volunteers showed that the percentage of fecal fat excretion was dose-dependent but reached a maximum of 30% of excretion, 360 mg. / Day of drug. Higher doses did not produce a significant increase in the percentage of fat excreted in feces
Mentioned weight loss with orlistat vs. Only diet
The weight loss of 10% or more was achieved in 60% of patients who used orlistat and only 33% of patients with exclusive diet.
Why is it important and appropriate early management of obesity in adolescents?
Excess weight in adolescents eventually brings health effects, notably increased risk of high blood pressure, high cholesterol, and the development of type 2 diabetes. Obesity in children and adolescents is closely linked with early mortality in adults. "
When approving the use of orlistat in adolescents?
For the first time in December 2003, the Food and Drug Administration (FDA) in U.S.. UU. Approved the use of a prescription drug for weight loss, orlistat in adolescents 12 to 16 years.
What are the effects of orlistat on glucose metabolism?
Obesity is a modifiable risk factor most important in the pathogenesis of type 2 diabetes mellitus. UKPDS26 data show that 1% decrease in glycosylated hemoglobin (HbA1c) is associated with:
35% reduction in microvascular complications,
18% decrease in the incidence of myocardial infarction
Decrease of 25% of deaths related to diabetes.
With respect to efficacy studies of orlistat in preventing diabetes mellitus summarizes the results
In 2004, the XENDOS study. In this study, orlistat, along with changes in lifestyle, provided a lower risk of developing type 2 diabetes 37%, according to the evaluation of all patients.
Apart from weight loss what other factors explain the glycemic control?
Have been described at least two other effects of orlistat that may explain its action against hyperglycaemia:
Decreased circulating free fatty acids
Enhancing incretin secretion of the digestive tract, in particular peptide 1, similar to glucagon (GLP-1, glucagon-like peptide-1).
What is the effect of orlistat in diabetic patients than weight reduction?
It also improves other cardiovascular risk parameters: fasting blood glucose decreased significantly when orlistat was added to the changing lifestyles and the same happened with the HbA1c.
What are the effects of orlistat on blood pressure?
Modest reductions in weight lead to improvement in blood pressure in obese, which is still greater if accompanied by exercise. Also, the weight loss in obese individuals with hypertension can reduce the need for antihypertensive medication.
What are the effects of orlistat on markers of inflammation associated with metabolic syndrome?
Samuelsson et al. There was a reduction of cytokine levels after weight loss and increased TNF-α decreased in the group treated with orlistat.
Hsieh et al.
Decreased C-reactive protein
Also showed greater decrease in the values of leptin and adiponectin increased
With respect to postprandial lipemia What are the effects of orlistat?
Orlistat by blocking lipase and hinder the absorption of 30% of dietary fat, reduces postprandial hyperlipidemia. In addition, by interfering with the formation of micelles, orlistat interferes indirectly with the absorption of cholesterol, since the micelles are necessary to bring the cholesterol molecules to the surface of enterocytes.
Derosa et al. Noted that obese patients treated with orlistat had a significant decrease in levels of total cholesterol and LDL cholesterol,
How does the effect of orlistat on waist circumference (abdominal fat)?
The reduced flow of lipids and fatty acids from the intestine has been associated with a reduction of visceral fat by 44% higher than appreciated for the same weight loss without orlistat.
What is L-carnitine?
Is an amino acid derivative, is low molecular weight, is uncofactor in the metabolism of fatty acids. As the L-carnitine is synthesized by the body from 2 amino acids (methionine and lysine).
Describe the mechanism of action of L-carnitine
With the L-Carnitine free fatty acids are transported into the mitochondria of cells within fat chains involved in the metabolic process called beta-oxidation of fat where the chains are broken and transformed into groups receiving Acetyl CoA name, so enter the process called the Krebs cycle where the result is ATP (energy).
What benefit is the use of L-carnitine supplement (exogenous)?
Exogenous carnitine increases systemic and hepatic carnitine. This can lead to increased utilization of free fatty acids thereby increasing the available energy flow, preserving muscle protein while fasting or exercising vigorously.
How can the L-Carnitine support weight control?
Taking supplements can help achieve optimal fat oxidation and thus to promote a healthy body weight. Thus, the L-carnitine supplements may help support weight loss programs that include a calorie reduction and exercise.
What are the benefits of L-carnitine on exercise?
Among its benefits are the following:
Improve exercise capacity and oxygen consumption
Improve muscle conditioning.
How does the L-carnitine on cardiovascular health?
The L-Carnitine is one of the most important nutrients and safer to maintain cardiovascular health. The human heart gets about 70% of the energy used in the breakdown of fats. Clinical data indicate that L-carnitine supplements may benefit muscle and healthy heartbeat and increase the viability of heart muscle.
What is the pharmaceutical form and formulation of Aliduet?
Each capsule contains:
Orlistat ... ... ... ... ... ... ... ... ... ... ... ... ... 60 mg
L-Carnitine Tartrate ... ... ... ... .... ... 600 mg
Excipient cbp ... ... ... ... ... ... ... ... ... .. 1 capsule
Each capsule contains:
Orlistat ... ... ... ... ... ... ... ... ... ... ... ... ... 120 mg
L-Carnitine Tartrate ... ... ... ... .... ... 600 mg
Excipient cbp ... ... ... ... ... ... ... ... ... .. 1 capsule
Mentioned therapeutic indications
In the TX in conjunction with a hypocaloric diet plan for obese or overweight patients including those with risk factors associated with obesity, enables effective long-term control of weight (reducing maintenance and prevention of weight gain). TX to improve risk factors and conditions associated with obesity and hypercholesterolemia, glucose intolerance, type 2 diabetes and hypertension hyperinsulinemia and visceral fat reduction
What are the contraindications Aliduet?
Contraindicated in patients with:
Chronic malabsorption syndrome.
Known hypersensitivity to any component of the formula.
What precautions should have with Aliduet?
May increase the possibility of experiencing gastrointestinal events when Orlistat / Carnitine is administered with a diet high in fat. Daily fat intake should be distributed over three main meals.
In type 2 diabetes may allow or require reduction in dosage of oral hypoglycemic medication (eg sulfonylureas)
There has been a reduction in cyclosporine plasma levels with coadministration of Orlistat / Carnitine
Orlistat showed a 25-30% reduction in systemic exposure to amiodarone and desetilamiodarona
List the major side effects and adverse
They are mainly gastrointestinal in nature and are related to the pharmacological effect that prevents the absorption of dietary fat.
Commonly observed oily spotting, oily or fatty stools, gas with fecal discharge, fecal urgency, oily evacuation, increased defecation and fecal incontinence.
These gastrointestinal adverse events were generally transient.
What is the dose and route of administration Aliduet
Route of Administration: Oral
Standard adult dosage: The recommended dose of orlistat 120 mg / Carnitine 600 mg capsule is a main meal (during or up to one hour after the meal).
If you omit any foods containing fat or not is immaterial to the corresponding dose.
Aliduet presentations mentioned
Box of 30, 60, and 90 capsules
What is obesity?
Obesity is a chronic disease characterized by excessive accumulation of body fat to a level that impairs health, "says the World Health Organization (WHO)
What is its impact on Mexico?
The 2006 National Health Survey of the Health Ministry reported:
About 70% of the population over age 20 are overweight or obese, of which 30% meet the criteria for the diagnosis of obesity.
What is the etiology of obesity?
When energy intake exceeds expenditure, excess calories are deposited in adipose tissue, and yes this positive balance is maintained, obesity occurs: therefore, there are two components to weight balance and any anomalies of one (intake or expenditure) can lead to obesity. In a sense, the cause of obesity is simple: spend less energy intake.
Describe what are the factors causing obesity?
1. Heredity. 2. Age. 3. Sex. 4. Environment and eating habits. 5. Lack of physical activity. 6. Pregnancy. 7. Childhood obesity. 8. The night eating syndrome. 9. Endocrine factors. 10. Drugs.
What is pediatric and adolescent obesity?
Pediatric and adolescent obesity, Onset before age 18. Predictive of adult obesity. Overweight children are more likely to be obese in adulthood. In turn obese adults who have a history of pediatric and adolescent obesity obesity will suffer longer.
What is the adult obesity?
Post Top 18. In this type of obesity as a mechanism predominates cell hypertrophy and is most frequently associated with obesity and therefore abdominovisceral its metabolic complications.
Describe What is hypertrophic obesity.
Hypertrophic obesity. This is typical of adults, is characterized by a large amount of fat in the adipocytes with no increase in the number of fat cells. These individuals tend to be thin or maintain their average weight to 30 or 40 years of age, at which point weight gain begins. This may be associated with an imbalance between caloric intake and use. Hypertrophic obese people usually have a central fat distribution, this problem tends to be more easily treated.
Describe what is Hyperplastic Obesity?.
This corresponds to a long-term clinical form in which the number of adipocytes is increased and the amount of fat they contain. These individuals tend to be obese as children and have a significant weight gain during adolescence. After this age, the number of adipocytes is maintained throughout life. In this form of obesity, fat distribution is central and peripheral. The treatment is considerably more difficult.
How do I get the body mass index?
Is obtained by dividing weight in kilograms of a person between the square of their height in meters (kg/m2). For example, an adult weighing 70 kg and whose height is 1.75 m will have a BMI of 22.9 kg/m2.
How do you classify overweight and obesity according to BMI?
Normal weight BMI between 28 and 25 kg/m2
Grade I overweight with a BMI between 25 and27 kg/m2
Grade II overweight (pre-obesity) with BMI between 27 and 30 kg/m2
Grade I obesity, BMI between 30 and 35 kg/m2
Grade II obesity, BMI between 35 and 40 kg/m2
Obesity class III and IV, BMI ≥ 40 kg/m2 and obesity and extreme
How Classification of obesity according to its distribution?
Fat distribution: apples and pears
Abdominovisceral or visceroportal obesity.
Gluteal-femoral obesity gynecoid,
Describes how to obtain the waist-hip?
E l waist / hip ratio (calculated by dividing the measurement in centimeters from the waist between the hip measurement in inches).
WAIST SIZE IN INCHES / CENTIMETERS AS HIP
What is abdominovisceral or android obesity?
Those with an android fat distribution (often called a "apple"), which means that most of their intra-abdominal body fat and accumulates in the stomach and chest, and supposed to be at greater risk of developing obesity-related diseases.
What is gluteal-femoral obesity or ginecoide?
Commonly known as "pear", which means that most body fat is accumulated in the hips, thighs and buttocks, and assumes that mechanical problems may occur (joints, inner thighs) in extreme cases
When can we say that there is excess abdominal fat?
If the waist circumference exceeds 90 cm. in the case of men and 84 cm. in women, it means that there is excess abdominal fat, which can pose a greater risk for health problems, even if your BMI is normal.
What is the incidence of overweight and obesity in children and what factors are involved?
40% of children in our country is overweight and obesity. This is due to the change of life that society has had both in their eating habits and physical activity are important factors. These factors together with the genetics of the Mexican influence the development of overweight.
What parameters are used to measure obesity in children and when is it diagnosed?
One of the best parameters for assessing overweight or obesity is the body mass index. One child (6 to 19 years) is considered obese when their weight exceeds 20% over ideal weight for their age, height and sex.
How to influence visceral fat in insulin resistance?
Excessive visceral fat, resulting in a risk of cardiovascular disease. The main consequence is that there is an increase of the contribution of free fatty acids into the bloodstream and liver, resulting in an increase in triglycerides, blood glucose and insulin. Moreover, these acids have toxic effects on the muscle and cause insulin resistance.
What are the main health problems associated with obesity and overweight?
Type 2 Diabetes
Cardiovascular disease and hypertension
Respiratory diseases (sleep apnea)
Raising the levels of LDL ("bad cholesterol")
Are elevated triglyceride levels.
Reduced levels of HDL or "good cholesterol."
Increase the risk of certain cancers, including endometrial cancer, breast cancer, prostate cancer and colon cancer.
Mentioned the main symptoms and signs of obesity.
Cancer and obesity
Influence on tissues from free fatty acids
Free fatty acids play an important role in the development of insulin resistance in skeletal muscle, liver and endothelial cells, and the alteration of insulin secretion by pancreatic β cells,
Why visceral fat cells are different from other parts of the body?
Abdominal fat cells more easily sent fatty acids into the bloodstream and flow directly from the abdominal tissues to the liver and fatty acids increase the production of glucose from the liver, it is easy to understand how abdominal fat might counteract the action insulin in the liver and increasing glucose production.
How fatty acids alter the activity of insulin?
The fat cells produce hormones that go into the bloodstream. At least two of these hormones (tumor necrosis factor) are able to block the effect of insulin in other tissues. The more fat cells there, and the greater their fat load, more of these hormones are produced.
How does the inflammatory process in adipose tissue and substances act?
Initially increases inflammation in adipose tissue as a result there is a discharge of free fatty acids and adipokines.
Among the markers of inflammation are
Interleukin 6 (IL-6) and
Tumor necrosis factor alpha (TNF-α)