Obesity

Sintiya basiru (B-S1 FARMASI 2017

 Difinition
Obesity occurs when there is an
imbalance between energy intake
and energy expenditure over time,
resulting in increased energy stroge
(Dipiro et al., 2015)
 Pathophysiolog
y
 genetic factors appear to be the primary determinants of obesity in some
individuals, whereas environmental factors ore more important in others,
identifications of the tota; number of contributing genes is an area of extensive
research
 environmental factors include reduced physical activity or work, abundant food
suply, relatively sedenty lifestles, increased availability of high-fast foods, and cultural
factors and religious beliefs.
 medical conditions including cushing disease an growth hormone deficiency, or
genetic syndrome such s prader-willi syndrome can be associated with weight gain.
 the degree of obesity is determinated by the net balance of energy ingested
relative to energy expended over time. The single largest determinant of energy
expenditure is metabolic rate, which is expressed as resting energy expenditure or
basal metabolic rate. Physical activity is the other major factor that effect total energy
expenditure.
 major types of adipose tissue are (1) white adipose tissue, which manufactures,
stores, and release lipid; and (2) brown adipose tissue,which dissipates energy via
cells and increases energy expenditure in adipose tissue and skletal muscle.
Clinical manifestations
In general, clinical manifestations of obesity can be round face with
chubby cheecks and double chin, short neck, distended belly (pendulous
abdomen), and the multy-folded abdominal wall and x-shaped limbs.
(Dipiro, et al,. 2008). In addition, complications that accur in people
with obesity can cause abnormalities in the body, these problems in the
forms of :
1. heart disease
clinical manifestations of obesity can cause
hypertensions, hyperlipidemia, insulin
resistance and glucose intolerance. All
manifestations of obesity lead to heart
disease risk.
2. Ostearthritis
Ostearthritis in joints that hold weight such as
the knee, related directly with the mechanical
effects of obesity that it gives heavy burden on
the joints. Obesity can cause cartilage to
change, collagen and even bone metabolism.
Symptomps of osteoarthritis, such as pain, is a
significant barrier to physical activity

3. affects the reproductive

system
obesity can cause first menstrual
disorder in girl and hyperandrogenism,
hirsutism, and the mnstrual cycle
anovulatory in women. In some women
obesity shows up polycystic ovary
syndrome.
TREATMENT

Goals of treatment : weight management goals

may include losing a predifined amount of
weight, decreasing the rate of weight gain, or
maintaining a weight-neutral status, depending
on the clinical situation
 DIAGNOSIS

04 Weight
measurement
02 01
compared to the
standard, if body
Body mas Measurement of
weight > 120% Measurement of waist HDL-C : <40 mg/ dL
subcutaneous fat
index (BMI) standard weight is circumference (1.03 mmol/L) in men and
by measuring
called obesity <50 mg/dL (1.29 mmol/L)
skinfold thickness
skin, if a triceps in women
skind fold >85
percentile is an

05 03
indicator obesity 
DIAGNOSIS
The diagnosis of obesity can be seen from the total
clasifications, LDL and HDL cholestrol, and
trigilisercerides as follow (Dipiro, et al., 2015) :

TABEL 1. clasification of overweight and obesity by BMI

BMI (kg/m2) Clasification Disease risk (relative to normal weight and waist
obesity circumference)
Men ≤40 in (≤102 cm) >40 in (>102 cm)
Women ≤35 in (≤89 cm) > 35 in (> 89 cm)

Underweight < 18.5 - -

Normal weight 18.5-24.9 - High

Overweight 25-29.9 Increased High

obesity 30-34.9 I High Very high
35-39.9 II Very high Very high
Extreme obesity ≥40 III Extremely high Extremely high
 therapy
Farmacologi therapy Non-pharmacology Therapy

1. Lipase inhibitor (orlistat) 1. Diet

2. Non-adrenergic agent (phentermine) 2. Physical activity

3.Serotonergic agent (sibutramin)

3. Stop the smoking

4. Cannabinoid receptor agent

(Rimonobant) 4. surgery
 Case obesity

A man named mr.GN 67 years old with 95 kg weightt and 175

cm height hypertension,hypertriglyceride, and diabetes melitus.
He has a history smoking for 10 years, but it stopped a few
years ago. The drugs he consumed were
metformin,glipizide,lisinopril, and gemfibrozil.
 01 02
Settlement :
Physical examination results
 Blood pressure : 140/90 mm/hg a. Subject : (67 years old man)
 BMI =   Disease.history.:.hypertiglyceride,hypertensi
on, diabetes melitus
Treatment story : metformin,glipizide,and
 BMI = 31 KG/m2 (obesity class 1) gemfibrozil
 waist circumference : 40 inchi
b. Object
Laboratory Result Physical signs
 HBAC1 : 8.3% BMI : 31 kg/m3
 Total cholesterol : 215 mg/dL waist circumference ; 40 inchi (obesity
 Trigliserida : 400 mg/dL class1)
 HDL : 29 mg/Dl
 LDL : 135 mg/dL

Case
settlement
assesment

Assesment the petient has been known to be an actvive smoker for 20 years buth has stopped a few years
ago. Inside the cigarete there is a nicotine stimulates the production of adrenalin, noradrenalin, and other
hormones will make the heart beat harder, faster and faster. The state can cause blood preassure to rise and
increasethe heart’s nee for it oxygen. Judging from the BMI that is 31 kg/m2 and a 44 in. waist circumference
then the patient is classified as obesity class 1. the petient also has type 2 diabetes seen from trygliceride and high
values and low HDL values as well HbAc1 values above normal. Mettformin and glipizid are used to treat
diabetes patient.
Metformin is the first therapy for people with diabetes melitus accompanied hyperlipidemia and obesity
because in addition to lowering blood glucose, can also reduce cholesterol, trygliceride and LDL. When obesity is
not reduced with non-pharmacolgical therapy it is necessary to add drug therapy. The hight trygliceride values
then the patient is given gemfibrosil. Lisinopril is anthypertensive gropu ACE inhibitors which can be used as
monotherapy in stage 1 hypertension.
 plan 01
hypertligliceride therapy
gemfibrozil , with a maximum dose of 600 mg 2
The goal therapy to be achived in treatment is to decrease time daily is taken before breakfast and dinner
total cholesterol and triglyceride levels with the
expectation of weight loss to increase HDL levels,
normalize blood sugar levels and blood pressure.

02
diabetes melitus therapy
Metformin , 2x1000 mg/day taken while or
after meals and glipizide

03
hypertension therapy
Lisinopril , 20 mg once a day

04
obesity therapy
is carried out in a non-phamacological manner,
is eating with reduce fatty foods regular light
exercise
Thank you
Any question?