Obesity

Obesity is a disease that can get anyone. In the process of evolution by natural selection, it used to act in the direction that the species that obtained advantage could store fat as a source of energy. Due to this they are able to spend it in the circumstances of stress, during starvation and therefore consume increased amount of energy.

During obesity, regardless of its origin, typical changes are observed:

• increased formation of triglycerides and hypertrophied fat cells
• increased lipolysis in adipose tissue and intake of fatty acids in the liver, which leads, in its turn, to the increased synthesis of triglycerides and VLDL
• increasing the overall synthesis of cholesterol (although some scholars believe that 1 kg of body weight does not increase cholesterol synthesis)
• reduced tolerance to carbohydrates and fat cells sensitivity to insulin due to receptor and postreceptor changes
• there is a compensatory hyperinsulinemia (which again leads to a decrease in glucose utilization by reducing the number of insulin receptors)
• increased utilization of fatty acids as an energy substrate
• reduced growth hormone levels in the blood and increases the production of glucocorticoids
• reduced activity of T-cell immunity
• increased tendency to thrombosis
• increasing transformation of androgens into estrogens in adipose tissue and intestinal excretion of cholesterol
• reduced level of thyroid hormones.

According to the studies, less than 10% of children are obese if both parents do not have excess body weight, 50% are obese if one parent is obese, and 80% of children are overweight if both parents are obese. Obesity of adults is characterized by a even distribution of fat on the upper part of the body, leaving the limbs free.

Total type of obesity usually begins in childhood, with more or less even distribution of fat in the extremities, abdomen, and body.

Obesity is a serious medical, social and economic problem of modern society. The relevance of obesity is determined primarily by its high prevalence. Obesity affects 7% of the population of the globe. In most countries of Western Europe from 9 to 20% of adults are obese (BMI> 30) and more than a quarter – overweight (BMI> 25), in the U.S. – 25% and 50% respectively. In recent years, in most countries there is a significant increase in the prevalence of obesity among both adult and child population. In many industrialized countries over the past decade, the prevalence of obesity has doubled in size. According to experts, WHO, if current growth rates of incidence in 2025 in the world there will be more than 300 million of obese people.

Even in developing countries, which have traditionally characterized by poor nutrition, obesity among the urban population is becoming a threat to public health.
Until now, medical methods of treating obesity have been limited. Behavioral therapy, which consists mainly of the patient’s motivation to reduce calorie intake and increasing physical activity, is often accompanied by low compliance with medical recommendations.)

The use of drug therapy facilitates compliance with the guidelines on nutrition and promotes more rapid and intense weight loss.

According the mechanism of action, all the drugs to treat obesity can be divided into three groups:

1. Reducing food intake: phentermine, sanorex, fenfluramine (Minifazh), Isolipan, sibutramine (Meridia), fluoxetine (Prozac), phenylpropanolamine (Trimex)
2. Increasing energy consumption: sympathomimetic thermogenic ephedrine / caffeine, sibutramineReducing the absorption of nutrients: Xenical.

Indications for drug therapy of obesity:

BMI> 30 kg/m2,

BMI> 27 kg/m2 in conjunction with:

• abdominal obesity
• a hereditary predisposition to type 2 diabetes, cardiovascular diseases

Risk factors or comorbidities (dyslipidemia, hyperinsulinemia, type 2 diabetes, hypertension, etc.)

Drugs for weight loss are introduced for patients with BMI> 30, as well as patients with a BMI> 27 and abdominal obesity, or with risk factors or comorbidities. Drug therapy is prescribed in combination with a hypocaloric diet and increased physical activity.

Percentage of people in the world who suffer from overweight is approaching the critical point. Obesity is a kind of complication for a person being overweight. The formation of excess fat cells clearly entails more serious problems for the human body, than just a psychological discomfort and change of clothing size. Abdominal obesity, in fact, is the treatment of abdominal obesity and the struggle against this phenomenon – a pressing social problem of human society.

Today there is a long list of drugs for to treat obesity. Drug therapy facilitates problem in compliance with recommendations on nutrition and promotes more intense and rapid weight loss. Also, it helps (but it is not guaranteed!) to keep intact achieved body weight and at the same time to prevent the re-gaining weight.

Group of drugs prescribed for the treatment of obesity:

• Medications of the central action – they suppress appetite, have an effect directly on the central nervous system (sibutramine, fluoxetine, anorectics);
• Medications of peripheral actions – they block the absorption of the gastro-intestinal tract of certain substances (acarbose, orlistat);
• Medications of the central and peripheral actions – they increase thermogenesis, that is the body’s ability to produce heat to maintain a constant body temperature and ensure the normal operation of their systems (thyroid hormones, ephedrine and caffeine, growth hormone).

Prominent place in the medical treatment of obesity took anorectics. Using this type of drugs primarily aims to decrease appetite. But these tools cause a considerable number of side effects. For example, they can increase blood pressure or increase the number of heartbeats. Anorectics, particularly used to treat obesity amongst children, can not provide a permanent eating behavior. If the patient stops taking them, he immediately returns to his/her former eating habits and, consequently, to excessive weight. When choosing a pill to treat obesity, it should be remembered that the drugs prescribed for it, have approximately the same efficiency. And, then, the choice of a particular drug is empirical and is based on the assessment of the patient’s general condition, the list of contraindications for use, concomitant diseases, treatment costs and, eventually, the preferences of the patient.

Among the pharmacological treatment of obesity, used to fight it, we can distinguish biostimulators that are designed to enhance the flow of energy.