Terapia obesit

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Terapia obesità

• Stile di vita
• Farmaci
• Chirurgia

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"Le diete" fanno ingrassare di Nazario
Melchionda ed.1997 Pagine 135 (ISBN
88-86366-47-
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• Poscia, più che 'l dolor, potè 'l digiuno
• Dante, Inferno XXXIII

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Abdominal obesity predicts vascular mortality
independently of BMI
513 men with coronary artery disease
Increasing BMI (p0.886)
Increasing waist additionallyadjusted for BMI
(p0.017)
Increasing waist additionallyadjusted for BMI,
diabetes,hypertension (p0.019)
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Odds ratio (95 CI) for vascular mortality (per 1
SD increase)
All data adjusted for age, smoking and total
cholesterol.
Hoefle G et al. Int J Obes (Lond) 200529785-91.
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Global cardiometabolic risk
Gelfand EV et al, 2006 Vasudevan AR et al, 2005
working definition
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Terapia farmacologica obesitàindicazioni

• In aggiunta a modificazioni dello stile di vita
  in soggetti con BMI
• gt 30
• gt 27, se presenti DM, ipertensione, apnee
  notturne

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Farmaco ideale antiobesità

• Induce e mantiene la perdita di peso
• Ha un rapporto rischio beneficio particolarmente
  favorevole
• Ha un costo sostenibile

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Farmaci antiobesità

• Requisito (EMEA)
• Indurre una perdita di peso (sottratta al
  placebo) di almeno il 10.
• Riduzione del 5 -10 BW
• Riduce rischio DM
• Migliora fattori rischio CV

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Studio SERENADE
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• Terapia di combinazione ?

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E possibile curare i fattori di rischio
cardiovascolari causati dalla obesità
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• POMC Two children with loss-of-function
  mutations Krude et al, 1998
• complex obesity phenotype
• absence of a-MSH
• MC4R numerous mutations have been discovered
• the most prevalent obesity gene
• involved in 14 of very obese
  individuals
• early age of onset and a trend
  for hyperphagia in infancy
  Vaisse et al, 1998 2000

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Genes causing monofactorial obesity

• LEPTIN loss of function mutations (two individ)
  (increased appetite, constant hyperphagia, and
  hypogonadism)
  Faroqi et al, 1999
• LEPTIN RECEPTOR one family identified with
  leptin receptor mutations
  Clement et al, 1998
• (a truncation of the receptor no leptin
  signaling)

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Abdominal obesity a major underlying cause of
acute myocardial infarction
Cardiometabolic risk factors in the INTERHEART
Study
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Abdominal obesity predicts the risk of CVD
beyond BMI
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PAR ()a
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10
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Hypertension
Diabetes
Abdominal obesity
Abnormallipids
aProportion of MI in the total population
attributable to a specific risk factor
Yusuf S et al, 2004
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Abdominal obesity is linked to multiple
cardiometabolic risk factors
Patients with abdominal obesity often present
with one or more additional CV risk factors (NCEP
ATP III criteria)
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Abdominal obesity is linked to an increased risk
of CHD
Waist circumference has been shown to be
independently associated with increased
age-adjusted risk of CHD, even after adjusting
for BMI and other CV risk factors
Rexrode KM et al, 1998
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MAIN FACTORS INVOLVED IN THE REGULATION OF FOOD
INTAKE
INHIBITORS
Neuropeptide Y (NPY)
Serotonin
Leptin
Insulin (central)
CRF
Cholecystokinine (CCK)
Bombesin
Catecholamines
Somatostatin