World Journal of Pharmaceutical research - WJPR!
Manish Gunjan World Journal of Pharmaceutical research of human and onc of the oldest documented diseases. An estimated 35 to45 percent of all U.S. women and 20 to 30 percent of all U.S. men are trying to lose weight at any given time, spending up to $40 billion each year to do so. Some of these people do not even need to lose weight. Others need to lose weight but not successful. Still others are successful. Weight- loss advice, then, does not apply equally to all overweight people. Some people may risk more in the process of losing weight than in remaining overweight. Others may reap significant health benefits with just modest weight loss. (4) The overweight problem is due to an actual increase in the fat component, or it can be due to malfunctioning glands. Today, it is estimated that there are more than 250 million obese people worldwide, equivalent to seven percent of the adult population. (5) In the United States, data from the second National Health and Nutrition Examination Survey (NHANES II) were used to define obesity in adults as a BMI of 27.3 kg/m2 or more for women and 27.8 kg/m2 or more for men. These definitions were based on the gender-specific 85th-percentile values of BMI for persons 20 to 29 years of age. The WHO classification assigns an increasing risk for comorbid conditions—including hypertension, type 2 (non-insulin-dependent) diabetes mellitus, and cardiovascular disease-- to persons with higher BMIs (see Table 1) relative to persons of normal weight (i.e., those with a BMI between 18.5 kg/m2 and 25 kg/m2).The WHO criteria for overweight is (BMI 25 kg/m 2 ) and obesity ( 30 kg/m2), 67% of men and 62% of women are overweight . (6) Food intake is modified by a multitude of factors – physiological, psychological, and social, etc. Meal size seems to be controlled by a feedback loop in which signals from the gastrointestinal tract are transmitted to the hypothalamus after relay in the brainstem. An important afferent signal is cholecystokinin – a peptide secreted by the duodenum in response to mechanical and chemical stimuli. Cholecysokinin acts locally on cholecystokinin receptors in the gastrointestinal tract, the signal being transmitted to the brainstem by the vagus. The effect is to decrease food intake. Circulating cholecystokinin does not cross the blood-brain barrier but the peptide is also a neurotransmitter and acts on cholecystokinin B receptors in the brain to function as a satiety factor. Insulin stimulates leptin release from fat cells and it enters the CNS where it can decrease food intake by affecting the actions of NPY. However, insulin may also, in some circumstances, increase food intake, presumably indirectly, by an effect on blood glucose. Thus patients with type 2 diabetes mellitus usually gain weight when treated with insulin or sulfonylureas – an effect that is clinically important. (7) Current management of obesity by pharmacotherapy includes noncentrally acting antiobesity agents such as Orlistat (Xenical), which inhibits the action of the intestinal lipase enzymes and www.wjpr.net 1251
Manish Gunjan World Journal of Pharmaceutical research hence blocks the absorption of fat in the intestines. The most common adverse events of Orlistat include oily faecal spotting, abdominal pain, and flatus with discharge, faecal urgency, fatty/oily stool, increased defecation, and faecal incontinence (8) . Another pharmacotherapy is the centrally acting antiobesity agent, namely, Sibutramine (Reductil), which produces unwanted side effects such as trouble sleeping, constipation, and dry mouth as well as increased heartbeat, increased blood pressure, awareness of the heartbeat (palpitations), headache, anxiety, or dizziness (9–11) . Consequently, the Food and Drug Administration (FDA) of the USA withdrew Sibutramine in October 2010. Surgical procedures such as gastric bypass operations are generally reserved for people with morbid obesity (BMI > 40) who instituted but failed an adequate exercise and diet program (with or without adjunctive drug therapy) or patients presenting with comorbid conditions such as hypertension, impaired glucose tolerance, diabetes mellitus, hyperlipidaemia, and obstructive sleep apnoea (12) . In addition to an increase in total body fat, a proportionally greater amount of abdominal fat compared with fat in the lower extremities or hips has been associated with increased risk for diabetes, hypertension, and risk factors for heart disease in both men and women. Current guidelines categorize men at increased relative risk for coronary artery disease, diabetes, and hypertension if they have a waist circumference greater than 40 inches (102 cm); women are at increased risk if their waist circumference exceeds 35 inches (88 cm). Thus, an overweight person with abnormal fat patterning may be at high risk for these diseases even if that person is not considered obese by BMI criteria. (13) . MATERIAL AND METHODS Respondents were interviewed face- to- face using a survey questionnaire. Respondents needed to answer questions to test their awareness on the treatment using herbal medicine and physical activity for obesity. QUESTIONNAIRE The questionnaire was developed based on a literature of other similar surveys in the region. The questionnaires were made available in English. The respondents include allopathic doctor, herbalist, physiotherapist and patients. After we went through the questionnaire we concluded that major cause of obesity is lifestyle and we proposed some treatments by using herbs and exercise. www.wjpr.net BMI = Wt (kg)/Height(m 2 ) 1252