Reduce – en forskningsklinik Universitetsparken 2, 4000 Roskilde Overlæge Søren Toubro - 1

- for OS er vægttab en udfordring 2 Læs mere på

“Livsstil- og medicinsk behandling “ - Farmakologi - Livsstil - Sociale/psykiske årsager

Fedme: behov og behandling i DK

Vægttabseffekter Pulverkur:1 – 2 kg/ uge i 8 uger, herefter ca. 1 kg/uge Kost:½ kg/uge, når fedtenergi % 10E% Motion:0 – ½ kg/uge, ved + 30 min dagligt Medicin:2 – 5 kilo efter 1 år (ud over vægttabet ved kostomlægning) Kirurgi:20 – 30 kg gastric by-pass

NON-Kirurgisk(3-5 kg) Kirurgisk(>20kg) Dødelighed ? + T2D Arteriosclerosis + ++ Hypertension + + Dyslipidemia + ++ Søvnapnøe + ++ Effekter af vægttabsbehandling

Farmakologi ‚Good news: The FDA has approved pills that help you lose weight by making you feel full. The recommended dosage is five thousand pills a day. ‛ – O’Brien

Den medicinske behandlings historie Approval/With drawelDrugSerious adverse effects 1893/Thyroid hormonehyperthyroidism 1933/Dinitrophenolcataracts, neuropathy 1937/1971Amphetamineaddiction, psycosis 1965/1972AminorexPulmunary hypertension 1973/1997Fenfluramine+phentermineCardiac valvular insuff. 1960/2000 (USA)*PhenylpropanolamineHemorrhagic stroke 2006/2009RimonabantDepression/suicidal ideation 1997/2010SibutramineCardiovascular disease 8 *Phenylpropanolamine is still available in some European countries Modified and updated after Bray 2003¹

Hvor skal den medicinske behandling virke? CNS Upper gastric Lower gastric Thermogenic Præparater i DK: 1) Xenical/Alli 2) Regenon

FDA-Approved Medications Medication Source of Data Characteristics of Study Patients Weight Loss Assessed (Weeks) Mean Weight Change in Treated Patients vs Placebo (95% CI) Sibutramine* Existing meta-analysis of 29 RCTs Mean age: years; 53%-100% women; average BMI, NA kg (-5.29 to kg) Orlistat* Authors’ meta-analysis of 22 RCTs Average age: 48 years; 73% women; average BMI, 36.7 kg/m kg (-3.31 to kg) Phentermine Existing meta-analysis of 9 RCTs Average age: NA; 78% women; average BMI, NA kg (-6.0 to -0.6 kg) Diethylpropion (amphetamine) Existing meta-analysis of 13 RCTs Average age: NA; 80% women; average BMI, NA kg (-11.5 to -1.6 kg) *FDA-approved for long-term use in weight loss. NA=not available. Li Z et al. Ann Intern Med. 2005;142:

New- potential Medications Medication Source of Data Characteristics of Study Patients Weight Loss Assessed (Weeks) Mean Weight Change in Treated Patients vs Placebo (95% CI) Lorcaserin 5-HT 2c agonist BLOOM Mean age: years; 53%-100% women; average BMI, NA kg (-5.29 to kg) ONEXA Phentermin + Topiramate Average age: 48 years; 73% women; average BMI, 36.7 kg/m kg (-3.31 to kg) Amylin Hormon inj Average age: NA; 78% women; average BMI, NA kg (-6.0 to -0.6 kg) Topiramate Average age: NA; 80% women; average BMI, NA kg (-11.5 to -1.6 kg) *FDA-approved for long-term use in weight loss. NA=not available. Li Z et al. Ann Intern Med. 2005;142:

Change in body weight (kg) Week * * p< vs. glim + met Patients lost 2/3 of weight as fat (predominantly visceral) Nauck et al. Diabetes Care 2009; 32; 84–90. (LEAD 2) Liraglutide combined with metformin leads to greater weight loss than metformin and SU Liraglutide 1.2 mg + met Liraglutide 1.8 mg + met Glimepiride 4mg + met Metformin only -2.8 kg from baseline Slide No 12

Effekten af livsstilsintervention (n=3234) DPS Placebo Year of treatment Weight loss (kg) Metformin Livsstil Diabetes Prevention Program Research Group. N Engl J Med. 2002;346:

Livsstilsintervention ± Medicin 14 Wadden et al. N Engl J Med 2005;353:

Genetik? GENETICS?

Tværsnitsdata og årsagssammenhænge HjerteStatistik - Fokus på køn og social forskelle

Omsorgssvigt - longitudinelt Klasselærerens vurdering af hjemmets interesse og støtte for barnet i 10 års alderen Viser en stærk sammenhæng med senere udvikling af fedme i ung voksenalderen (10 år senere). Børn med ringe forældreinteresse har 7 gange forøget risiko for at udvikle fedme i ung voksenalder i forhold til børn, hvis forældreinteresse er harmonisk. 17 Lissau I, Sørensen TI. Lancet 1994;343(8893):324-7.

Klinisk vejledning for almen praksis Opsporing og behandling af overvægt hos voksne Dansk Selskab for Almen Medicin i samarbejde med Sundhedsstyrelsen

“Better to walk in darkness than to follow a false light.” (Voltaire ) Tak for opmærksomheden