Drug Topics - November 10, 2008 - (Page 40)

Continuing Education AN ONGOING CE PROGRAM OF THE UNIVERSITY OF FLORIDA COLLEGE OF PHARMACY AND DRUG TOPICS TABLE 1 Weighing the complications of obesity Seena Haines, PharmD, FAACP, ASSOCIATE PROFESSOR, LLOYD L. GREGORY SCHOOL OF PHARMACY , PALM BEACH ATLANTIC UNIVERSITY Secondary Causes of Obesity Hypothyroidism Cushing’s disease Cushing’s syndrome Polycystic ovarian syndrome Insulinoma Familial obesity Pseudohypoparathyroidism Prader-Willi syndrome Laurence-Moon-Biedl syndrome Drug Topics/Source: Ref. 5 Sonia E. Cherian, PharmD, ASSISTANT PROFESSOR, LLOYD L. GREGORY SCHOOL OF PHARMACY , PALM BEACH ATLANTIC UNIVERSITY O besity is a chronic condition associated with metabolic irregularities conferring risk of mortality. Globally, more than 1.6 billon adults are overweight and approximately 400 million are obese, according to the World Health Organization.1 The Centers for Disease Control and Prevention report that more than 67% of our population struggles with being overweight or obese.2 Obesity is second only to tobacco abuse as a preventable disease associated with high mortality. The National Health and Nutrition Examination Survey 2003-2004 data reveal that approximately 35% of children are overweight or already at risk.3 Obesity is a multifactorial condition involving genetics, socioeconomic, and cultural factors; psychological and behavioral inﬂuences; and metabolic, cellular and molecular factors, all leading to irregular energy balance.4-6 Therefore, secondary causes such as Cushing’s syndrome, hypothyroidism, or insulinoma should be identiﬁed initially (see Table 1)5. Excess calories and poor energy expenditure due to inadequate physical activity will promote weight gain. The National Lung and Blood Institute guidelines (NHLBI) deﬁne overweight by a body mass index (BMI) >25 kg/m2; the categories of obesity begin at a BMI >30 kg/m2.5 The sequelae associated with obesity-related diseases are signiﬁcant and affect nearly every organ system5 (see Table 2). Often practitioners treat the end-organ effects of this epidemic with pharmacotherapy, lifestyle and behavior modiﬁcation, and/or surgery. An analysis of the root cause of obesity for each patient, such as excessive caloric intake and lack of activity, needs to be addressed in order to prevent complications from manifesting. The ﬁrst step in assessing risk is to calculate the BMI.5 Dual X-ray absorptiometry and magnetic resonance imaging are examples of more sophisticated methods that directly assess excess adiposity and distribution of body fat, but these are costly and not commonly used in practice.4,5 BMI, also known as Quetelet 40 DRUG TOPICS GETTY IMAGES / BLEND IMAGES / JOSE LUIS PELAEZ INC N OV. 10, 2008 W W W.D R U GTO P I C S .C O M

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Drug Topics - November 10, 2008 Contents Up Front Up Front in Depth Letters Rx Care Government Community Practice First Responders Clinical Practice Self-Care FDA Safety Page Weighing the Complications of Obesity New Products Viewpoint

Drug Topics - November 10, 2008

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