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Mahmoud El Taweel

on 11 June 2017

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• Xenical & Chitocal: Medicinal use .

• Role of some hormone in obesity.

• Role of certain minerals in obesity

• Thermogenics and biocut drugs

• Choosing surgical treatment for weight loss

• Classification and factor of choosing type of operation

• Complication and risks

• FDA approved for devices of weight loss

• Misused drugs and their risks

• Herbal product and their effect on body weight

1-My friend is a body builder, he looks over-weight , is that a health problem?

Body builders have lean and muscular tissue with little fat "no health problem"
Q2- I am fat and I am afraid of obesity, can you help me to know the possible diagnostic methods for obesity? which one is most reliable ?
1- body fat percent :

Obese when BFP is : 30% in women 25% in men

Severely obese when BFP is : >40% in women >35% in men

Problem "impractical for routine clinical purposes"

3 - body volume index :

8 women with the same BMI rating (BMI - 30) but with different weight distribution and abdominal volume, so they have different BVI ratings.

The new BVI system automatically measures BMI, waist circumference and waist-hip ratio in addition to highly sophisticated 3D volumetric and body composition analysis.

BVI allows for differentiation between people who are assigned the same BMI rating, but who have a different body shape and weight distribution

Waist Size :

Men < 39 – 40 inches.

Women <34 – 35 inches.

Asians : Men <35.5 inches \ Women < 31.5 inches .

Waist to Height Ratio:

Goal : waist circumference < half height .

Weight Control

• Obesity and overweight

• Diagnostic methods for obesity

• Risk factors for obesity and complications of obesity

• who's not allowed to follow aggressive weight loss program unsupervised

• crash diets & its health risks

• Changing life habits to treat obesity anorectics

• Obesity drug classes

• adrenergic agonists and obesity

• effect of serotonergic drugs


Excessive accumulation of body fat “impairing health ”


Increase in body weight in relation to height "not necessarily to be fat"

2 - body mass index :

Normal : 18.5-24.9

Overweight : 25-29.9

Obese >30

Disadvantages :

1. Ignores distribution of fat in body

2. doesn't differentiate between muscles and fats

3. Ignores variation in physical Variation .

Q3 -I like to be always fit, can you tell me the different risk factors for obesity in order to avoid them ,And do Genetics play a role , What About the complications of being obese ?
1-Physiological factors :

Two centers in hypothalamus controlling eating.. satiety center and appetite center. After food ingestion satiety center works giving impulses that inhibit appetite center .

BGL decrease appetite center inhibition is reduced "increased food desire“ .

BGL increase appetite center is inhibited " decreased food desire" .

Defect in satiety center as in diabetics "over eating and obesity " .

Defect in appetite center "emaciation" .

2-Genetic factors

Genetic influence:
If one parent is obese , the child ill have 40% chance of being obese , but if both parents are obese , the chance of obesity is 80 % .

ob-gene produces protein "leptin“, the "satiety hormone” is a hormone made by adipose cells that helps to regulate energy balance by inhibiting hunger. Leptin is opposed by the actions of ghrelin, the "hunger hormone".

Both hormones act on receptors in the arcuate nucleus of the hypothalamus to regulate appetite to achieve energy homeostasis.

Obese individuals have higher circulating conc. Of leptin than normal due to higher percentage of body fat. But they show resistance to leptin due to change in leptin receptor, or reduction of it crossing to BBB and reaching obesity –relevant targets .

Social and environmental factors :

Inactivity , passive entertainment , life styles , occupations and unhealthy diets " imbalance between caloric intake and energy expenditure“.

Psychological factors :

Compulsive over-eating or mental depression " decreased physical activity "

Q4-My aunt is 50 years old and she is fat, does that predispose her to breast or endometrial cancer? How?
Yes , but just in case of being postmenopausal woman .

Breast cancer
: obese women have more fat tissue , estrogen is produced from adipose tissue in high levels , this will lead to more rapid growth of estrogen-responsive breast tumors.

Endometrial cancer
: the main cause in obesity is thought that estrogen high level has a relationship

Q5-My cousin is severely obese; he decided to follow an aggressive weight loss program without any medical supervision, what is your advice to him? And who are not allowed to do that?

He advised to follow medical supervised diet as his case is contraindicated to go on adiet without medical supervision

Q6-I am slightly fat and this makes me feel shy, do you advice me to take any medication or is it better to change my life habits?

You should never be ashamed of how you look. Your initial goal should be to improve your health, not to achieve an ”ideal weight”.
My advice is to change your life habits:

1- Follow a Healthy Eating Plan
2- Physical Activity
3- Behavioral modifications

Foods to eat: √

• Fat-free and low-fat dairy products.
• Protein foods.
• Whole-grain foods.
• Fruits (fresh, canned, frozen, or dried).
• Vegetables (fresh, canned, frozen, or dried). Eat the rainbow! (Red, Green, Orange & Yellow, Blue & Purple)

Foods to limit: ×

• Foods containing saturated & trans fat

• Foods containing Cholesterol

Sugar substitutes
1- Saccharin:
200 to 700 times sweeter than sugar May have a bitter or metallic aftertaste in some liquids Not used in cooking and baking FDA approved

2- Aspartame:

A combination of two amino acids (phenylalanine + aspartic acid) .180 times sweeter than sucrose . its sweetness when exposed to heat Contraindicated for patients with phenylketonuria (PKU) FDA approved

3- Acesulfame potassium (Ace-K):

200 times sweeter than sugar Used together with other sweeteners Heat-stable, so can be used in cooking and baking Not used in meat and poultry FDA approved

4- Sucralose:

600 times sweeter than sugar Heat-stable, so can be used in cooking and baking FDA approved

5- Neotame:

7,000 to 13,000 times sweeter than sugar. Not used in meat and poultry Heat stable Not widely used. FDA approved

6- Advantame:

20,000 times sweeter than sugar Not used in meat and poultry Heat stable FDA approved in 2014

7- Steviol glycosides:

Natural constituents of Stevia rebaudiana commonly known as Stevia. 200 to 400 times sweeter than sugar. Used as a dietary supplement (GRAS)

8- Luo Han Guo fruit extracts :

The extraxct of Siraitia grosvenorii, commonly known as monk fruit 100 to 250 times sweeter than sugar Generally Recognized As Safe


Not calorie-free Used with other sweeteners Ex: Xylitol, Sorbitol, Fructose

Fat substitutes

A fat substitute is a food product with the same functions, physical, and chemical characteristics as regular fat, with fewer calories. It allows for maintenance of the food’s original quality.
1- Simplesse:

A protein-based fat substitute, derived from egg whites and milk or whey protein. Used in ice cream, yogurt, cheese spread, mayonnaise and coffee creamer.

2- Olestra:

Olestra is a mixture of compounds comprising sucrose esterified with 6-8 long-chain fatty acids. It is not hydrolyzed by pancreatic lipase and as a result is not absorbed from the small intestine.

Side Effects:

• Abdominal spasm
• Loose stools interferes with Stool fat tests.
• Inhibits absorption of fat-solube vitamins (A,K,E,D) , beta-carotene and other nutrients.

Physical activity

Behavioral modification :
Change eating habits
Stress management
Social support

Anorectic = Appetite suppressant*

An ideal appetite suppressant should be:
• Safe for long term administration
• Produces a dose related reduction in body fat
• Spare body protein & other body tissue
• No significant side effects
• No abuse potential

Centrally acting Peripherally acting

Amphetamine Orlistat

The most ideal one to be dispensed as OTC is

A crash diet
is a diet that severely restricts caloric intake to as low as 700 calories a day. It offers the promise to lose 5 to 10 K ilograms in five to seven days and more in the weeks to come.
harmful effects

1-Mental Health Problems

2- Nutritional Deficiency

3- Vital Organ Damage

4- Osteoporosis

5- Slow down your metabolism Starvation mode
unsupervised weight control is contraindicated in some cases as :

1- pregnancy
4- people more than 65 yrs
5- severly obese people
Complications of Obesity
Diabetes Mellitus .
Skin Disorders .
Cancer .
Hyperlipidemia .
Respiratory Problems .
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