| Q1. How is obesity defined? |
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Ans. Obesity means there is an excess of body fat. It is a serious medical condition diagnosed by a physician and is clinically defined by a measurement of weight relative to height called Body Mass Index (BMI).
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| BMI, also known as Quetelet’s index, is calculated by dividing a person’s weight in kilograms by their height in metres squared, i.e.
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BMI = Weight (kg)
[Height (m)]2 |
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| Example Weight 100 kg (15 stone 10 pounds), Height 1.71m (5 feet 7 inches) |
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BMI = 100kg = 34 (kg/m2)
1.71m2 |
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| A BMI of greater than 30 is associated with a significantly increased health risk and should be managed by a physician.
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The medical risks from obesity are particularly pronounced if excess fat is distributed around the middle of the body and around the internal organs. This is called central obesity (visceral obesity). Obesity is associated with metabolic changes that can lead to life-threatening diseases such as heart disease and Type II diabetes. |
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| Q2. How serious a problem is obesity? |
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Ans. With prevalence having doubled in the US and the UK over the last decade, and greatly increased in the rest of Europe, obesity is one of the most serious public health problems facing both developed and developing countries today. This is despite public awareness campaigns encouraging people to follow a healthy lifestyle by eating a balanced diet and exercising regularly. New, effective long-term management strategies for treating this condition are clearly needed.
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| Q3. What are the benefits of losing weight? How can they be measured? |
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| Ans. A decrease in body weight of between 5 -10%, which is maintained in the long term, can have a major effect on associated risk factors.
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For example, studies have shown that sustained moderate weight loss in patients with existing obesity-related diseases halves their risk of dying from obesity-related cancers and reduces diabetes-related deaths by over a third.
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| More immediate benefits include the easing of back and joint pain, a reduction in breathlessness and an improvement in the patient’s quality of life.
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| Q4. Isn’t obesity just a case of eating too much?
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| Ans. No. Obesity is a serious medical condition, associated with the body’s inability to balance energy intake and energy expenditure. While there are a whole host of reasons why people become obese, it is the interaction between genes and the environment which causes the problem. |
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| Q5. Obesity is just a behavioural condition isn’t it? How can you justify long-term therapy? |
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| Ans. Obesity is a serious chronic medical condition and there are many reasons why a person may become obese. As with other serious chronic medical conditions, such as hypertension and diabetes, obesity requires long-term management.
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| Q6. Are drug treatments for obesity worth the risk? |
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Ans. Obesity is a serious medical condition which leads to the development of a range of life-threatening diseases. The health benefits versus potential risks must be evaluated for each individual patient by their physician. We believe that in appropriate patients, the benefits of pharmacotherapy as part of an integrated weight-management programme significantly outweigh the risks.
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| Q7. What is sibutramine? |
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Ans. Sibutramine is a new dual-acting anti-obesity agent providing a reliable and easy to use approach to effective long-term weight-management for the obese patient. It is the first in a new class of weight-management agents, the serotonin and noradrenaline re-uptake inhibitors (SNRIs), which can help obese people lose weight and maintain their weight loss in the long term when used as part of an integrated weight-management programme.
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| Q8. How does sibutramine work? |
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Ans. Animal studies show that sibutramine induces weight loss by a dual mode of action: increasing the feeling of fullness and enhancing thermogenesis.The amount of food we eat and the energy we use up is controlled by the brain. Two important chemical messengers involved in this process are noradrenaline and 5-HT. Animal studies show that sibutramine works by preventing the re-uptake of these messengers thereby prolonging their actions. By potentiating the function of these two neurotransmitters in the brain, sibutramine reduces food intake and increases energy expenditure.
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| Q9. What class does sibutramine belong to? |
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| Ans. Sibutramine is the first in a new class of weight- management agents, the serotonin and noradrenaline reuptake inhibitors (SNRIs).
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| Q10. Is sibutramine the same as the fenfluramines? |
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Ans. No. Sibutramine is different. Sibutramine is a serotonin and noradrenaline reuptake inhibitor (SNRI), working predominantly on two chemical messengers, noradrenaline and 5-HT, to enhance natural mechanisms of weight regulation.
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Sibutramine works outside the endings of nerve cells to inhibit these chemical messengers from being reabsorbed into the nerve endings thereby prolonging their actions. It does not get inside these cells, nor does it provoke the release of the chemical messengers from these nerve cells.
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In contrast, the fenfluramines were releasing agents, which work non-physiologically inside the nerve cells to release one chemical messenger, 5-HT. This action can deplete the cell’s stores of 5-HT and has been associated with primary pulmonary hypertension (PPH) and cardiac valve disease in humans and neurotoxicity in animals.
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| Q11. Is sibutramine the same as phentermine? |
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Ans. No. Sibutramine is different. Sibutramine is a serotonin and noradrenaline reuptake inhibitor (SNRI), working predominantly on two chemical messengers, noradrenaline and 5-HT to enhance natural mechanisms of weight regulation.
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Sibutramine works outside the endings of nerve cells to inhibit these chemical messengers from being reabsorbed into the nerve endings thereby prolonging their actions. It does not get inside these cells, nor does it provoke the release of the chemical messengers from these nerve cells.In contrast, phentermine is a releasing agent, working non-physiologically inside the nerve cells to release several chemical messengers, including catecholamines and 5-HT.
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| Q12. Is sibutramine an appetite suppressant? |
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Ans. No. Unlike appetite suppressants which reduce hunger, or the desire to start eating, animal studies show that sibutramine does not alter meal patterns, i.e. how often you eat. Instead it reduces food intake by increasing satiety (the feeling of fullness or the desire to stop eating).
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| Q13. Who will sibutramine be suitable for? |
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| Ans. Sibutramine is indicated as adjunctive therapy within a weight management programme for:
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- Patients with alimentary obesity and a body mass index (BMI) of 30 kg/m2 or higher
- Patients with alimentary excess weight and a BMI of 27kg/m2 or higher, if other obesity related risk factors such as Type 2 diabetes or dyslipidaemia are present |
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