12

....

, 21.2.2015

20

1949

Association of overweight with increased

risk of coronary heart disease partly
independent of blood pressure and
cholesterol levels: a meta-analysis of 21
cohort studies including more than 300 000
persons.
Arch Intern Med 2007, 167(16):17201728.
:
30%
CVD

: 80%
CVD

( 5)
=


147 Billion USA 2008

Symptomatic treatment : pain

Prevention of complication : diabetes
Detection of cancer
Treatment of somatic complications:
Mechanical
Metabolic
Cardiovascular
Psychological : depression
Social : adaptation at work



SAS

,
,

EASO OMTF, Obesity Facts 2008

EASO

-

( , ,
)






Follow - Up

50%

,

AMA 2013

Guidelines 2013:

Edmonton Obesity Staging System

(Sharma & Kushner, Int J Obes, 2009)

New Obesity Guidelines

Obesity Guidance :
Part of New Advice on CVD Prevention
One of 4 new documents
Next Crucial step is Translation of
Guidelines

5 CQs ACC/AHA/TOS
CQ1:

CQ2:
BMI /
CQ3:

CQ4:


CQ5:
.

CQ1
,

,
, ;
:
2.5 5.5 Kg / 2 30 60 % 2
2 5 % / > 14 0.2 0.3 % HbA1C
- 5 - 10 % / > 1 0.6 1.0 % HbA1C
:
- 3kg 15 mg % TG
58 kg 5 mg LDL - C
2 3 mg HDL C
:
5 % 3 mm Hg SBP
2 mm Hg DBP

CQ2
BMI /

BMI /

:
1571 15 (3) publications

(IDEA study ,
Circulation 2007)

(Barry et al,
2014, Farrel et al, 2002)

CQ3

(17)

: 412 kg / 6
34 kg / 2

CQ4

: 8 kg / 6
6 12 : 1 2 kg /

CQ5
,
,

2 3 : 20 35 % (
: 14 37 %)

2 3 :

 (2013)


;

30 25 1
( ,
)

NIH/NHLBI WHO/IDF
(35 40 )

.
3%-5%

 (2013)

14 --
6
1 8%

,
,
-

( )

( 200300/), (
),

40 35
,


515%,

2,
.

3-5%
TG, Glu, HbA1c,

Look AHEAD study

: ,
.

*: 150 /
: ,
, ,

: 14

.
8%. ,
,

: (1/)

: = ,


: BMI 30 BMI 27 +
.

Orlistat

: Lorcacerin,
phentermine/topiramate er

: Bupoprion/naltrexone, liragrutide
3mg

Lorcaserin (Belviq)

Phentermine/Topiramate
(Qsymia)
Phentermine:

Topiramate:
,
,

Bupronion :

Naltrexone


POMC

 Liraglutide 3mg
SCALE study

3731

.
500cal. /.
2:1 Liraglutide 3mg vs placebo. Fu = 56

Lira. 8%
2,6% . Placebo 4,2 cm
( 2,5cm placebo)

Lira
( LDL, HDL)

ICE/ENDO 2014

 >5%
.. 3

().


J Clin Endocrinol
Metab, 2015:
Pharmacological management of Obesity

 ..


phentermine diethylpropion
lorcarserin orlistat
J Clin Endocrinol Metab, 2015:
Pharmacological management of Obesity




.. GLP-1 analogs,
SGLT-2 inhibitors

J Clin Endocrinol Metab, 2015:

Pharmacological management of Obesity



..

J Clin Endocrinol Metab, 2015:

Pharmacological management of
Obesity


Guidelines 2013:
40 35




ACC, AHA, TOS 2013

. .

Credibility ?


.



.
.
.
,

Canadian Task Force on preventive Health Care

26 January, 2015