Apr
3
Management of Obesity
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Unlike other medical conditions, obesity does not lend itself to the classic medical model where the doctor diagnoses the condition, prescribes a treatment and remains responsible for the treatment outcome. In obesity, the patient exerts the greatest control over the treatment outcome and the success or otherwise of any therapy.
The key aim of weight management is risk factor reduction rather than a return to an ideal of healthy weight range. The first step on this process is a combination of supervised diet, exercise and behavioural change. In children, measurement and plotting BMI is a vital step as research shows that many parents are no longer able to identify whether their children are overweight or not.
In the UK, current dietary allowances are outlined in the Eatwell Plate (www.eatwell.gov.uk) which aims to suggest a proportioned, balanced and healthy diet with a combination of different foods from five groups for children aged two years and over. It should be noted that the consumption of calorically sweetened drinks should be limited as it has been shown that they contribute to the development of obesity in children.
It is also important that children and young people achieve at least 60 minutes (moderate intensity) physical activity each day. Adults should achieve a total of at least 30 minutes on five or more days of the week. It has been shown that individuals that have a genetic mutation associated with high BMI may be able to offset their increased risk for obesity through physical activity.
Although bahavioural changes combined with diet and increased physical activity can lead to weight loss, adults with depression and eating disorders often need ongoing psychological support. Anti-obesity drugs can be considered when there has been no improvement after three to six months in the BMI or reduced markers of co-morbidity.
Anti-obesity drugs
Sibutramine
Sibutramine inhibits the reuptake of noradrenaline and serotonin in the brain and this has the effect of reducing food intake as well as attenuating the fall in metabolic rate linked with weight loss. It is not recommended for patients who are under 18 or over 65 years old. It is available as capsules (prescription needed in the UK) in 10mg and 15mg strengths marketed as Reductil.
Orlistat
The prescription strength product containing 120mg orlistat is marketed as Xenical. It is used in conjunction with a hypocaloric diet in people with a BMI of 30kg/m² or more, or with people with a BMI of 28kg/m² with other risk factors such as type II diabetes and hypertension.
The first and only non-prescription weight loss aid licensed throughout Europe launches this month. The product is called Alli and is available in the UK in capsule form containing 60mg orlistat. It is licensed for use in weight loss for adults with a BMI>28 and will be available through community pharmacies shortly.
Rimonabant
The European Medicines Agency suspended the use of rimonabant (Acomplia) in October 2008 after a review showed that any benefit was outweighed by the risk of psychiatric side-effects (particularly depression) in clinical use.
Resveratrol
It has long been known that the skins of certain fruits (grapes, blueberries and cranberries) and wine contain a compound called resveratrol, which has beneficial antioxidant properties, but that’s not all…
Recent animal and in vitro studies suggest that resveratrol can also have a positive effect on helping to maintain normal-range cholesterol levels, supporting insulin health and optimizing metabolic and immune pathways that protect cells and improve mitochondrial function. A risk free trial of Resveratrol Select Weight Loss formula is available *HERE*
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Apr
3
Anxiety Disorders
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The symptoms of anxiety
We will all experience anxiety at some point in our lives. Either before a medical examination, an interview or public presentations, most people will experience psychological feelings of worry or nervousness and occasionally, more physical symptoms, such as dry mouth, sweating, flushing or palpitations.
In these circumstances, anxiety is a normal, protective physiological response to an unpleasant or threatening situation. Mild to moderate anxiety can help to improve performance and appropriateness of action. However, excessive or prolonged symptoms can be distressing and have severe effects on normal social functioning.
Diagnosis
In general, women are twice as likely to suffer from an anxiety disorder than men. However, the ratio can vary for specific anxiety disorders.
The term ‘anxiety disorder’ includes a variety of complaints that can exist on their own or in conjunction with another psychiatric or physical illness. Symptoms may vary but generally present with a combination of the following disorders.
- dry mouth and/or difficulty in swallowing
- sensitivity to noise
- palpitations, chest discomfort and/or constriction, awareness of missed beats, breathlessness
- restlessness, tremor and muscle aches
- fearful anticipation, worry, headache, dizziness, insomnia, irritability, social avoidance
- bloating, loose bowels, frequent micturation, amenorrhoea, erectile dysfunction
To be diagnosed as an anxiety disorder, the symptoms must be prolonged, cause significant distress and impair normal social functioning.
Anxiety disorders are broadly divided into generalised anxiety disorder (GAD), panic disorder, social phobia (or social anxiety disorder), specific phobias, post traumatic stress disorder (PTSD) and obsessive compulsive disorder (OCD).
Brief description of anxiety disorders
Generalised anxiety disorder Persistent and excessive anxiety on most days lasting for at least six months. It is not restricted to any one specific situation.
Panic disorder Recurrent but unexplained surges of severe anxiety (panic attacks). Patients tend to develop a fear of repeat attacks. Often seen in agoraphobia (fear of places or situations where escape might be difficult).
Social phobia A marked, persistent and irrational fear of being observed either embarassed or humiliated in public as in public speaking or eating with others.
Specific phobia Marked and persistent fear that is excessive and/or unrealistic precipitated by the presence (or anticipation of) a specific object or situation eg flying, spiders, snakes. Sufferers will avoid the object or situation or suffer intense anxiety if confronted with the feared object.
Post traumatic stress disorder Occurs after an event or exposure to a situation that involves actual death or threatened death or serious injury to oneself or others. The person responds with intense fear, horror or helplessness. Sufferers can experience flashbacks with symptoms usually occuring within six months of the actual traumatic event.
Obsessive compulsive disorder Persistent thoughts, impulses or images that are intrusive and distressing. Sufferers try to rid themselves of these obsessions by carrying out repetitive and time-consuming behaviours or actions (compulsions) as with excessive washing and cleaning.
Two thirds of sufferers with an anxiety disorder will often present with other psychiatric symptoms, most often depression. Further, there is often not an exact cause of the particular anxiety order seen. Many medical disorders can mimic anxiety symptoms such as hypoglycaemia, hyponatraemia, alcohol or drug abuse and hyperthyroidism.
We will look at treatment options in the next article.
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