Home' Australian Pharmacist : Australian Pharmacist January 2015 Contents Australian Pharmacist January 2015 I ©Pharmaceutical Society of Australia Ltd.
CONTINUING PROFESSIONAL DEVELOPMENT
in those patients with upper body
and abdominal obesity.
mechanism by which this occurs is not
over-activation of the renin-angiotensin-
aldosterone system, increased activity of
the sympathetic nervous system leading
to effects on the kidneys, and inhibition
of natriuretic peptide system affecting
vasodilation and natriuresis.
Foundation Guide to management of
hypertension recommends advising
patients to reduce energy intake together
with increasing physical activity when
recommending weight loss.8
A meta-analysis of 25 randomised
controlled trials was conducted by
Neter, et al. with a total of 4,874
patients to assess the effects of weight
loss on blood pressure.9 Half of the
patients had hypertension according
to the definition of blood pressure
over 140/90 mmHg.
Mean initial body
weight was 88.3 kg and mean initial BMI
was 30.7 kg/m2
Average weight loss
across all patients was 5.1 kg which was
either by energy restriction, exercise
or a combination of both.9 Patients
using energy restriction in their diet
achieved an average of 6.7 kg weight
loss, those undertaking physical activity
as an intervention achieved an average
3.1 kg weight loss and those patients
combining exercise with dietary energy
restriction achieved an average 6.2 kg
weight loss.9 There was a significant
average reduction in both systolic and
diastolic blood pressure of 4.44 mmHg
and 3.57 mmHg respectively with the
greatest reduction in blood pressure
seen with the combined intervention
of physical activity and dietary energy
of the patients in this trial were taking
antihypertensive medicines and these
patients experienced a greater reduction
in blood pressure than those patients not
taking antihypertensive medicines.9
Type 2 diabetes mellitus
Obesity leads to an alteration in the
hormones secreted by adipose tissue,
termed adipokines, with an increased
secretion in the amount of adipokines
that cause insulin resistance and a
decreased secretion of those adipokines
that improve insulin sensitivity.
Adipokines undergo a number of other
roles including lipid metabolism, blood
pressure regulation and angiogenesis.
Increased mass effect due to visceral
obesity together with free fatty acid
mobilisation from visceral fat cells into
the portal vein combine to elevate portal
free fatty acid levels, contributing to
Weight loss can lead
to a reduction in insulin resistance.
A small retrospective cohort study of
72 patients with type 2 diabetes mellitus
analysed the effect of intentional weight
loss on HbA1c. In patients with baseline
mean BMI of 35.1 kg/m2 and mean
baseline HbA1c of 8.6% (70 mmol/L),
it was found that mean weight loss
proportions of body weight of 4.5%, 8.7%
and 10.3% generated mean reductions
in HbA1c of 0.5%, 1.0% and 1.5%
The investigators adjusted
for the effects of anti-diabetic medicines
and concluded that a reduction of body
weight by 10% has the potential to
reduce HbA1c of 0.81%.
Osteoarthritis (OA) commonly occurs
in the knees and ankles of overweight
and obese patients.
It also occurs
more commonly in non-weight bearing
joints in those patients with excess
weight compared to patients with
It is thought that the
load under which cartilage is placed
from patients that are overweight or
obese signals mechanoreceptors at the
surface on chondrocytes, leading to
expression of cytokines, growth factors,
and metalloproteinases and possibly
prostaglandins and nitric oxide leading
to cartilage damage.
there is an increase in osteoarthritis in
non-weight bearing joints in those with
excess weight, another mechanism must
be responsible by which excess weight
It is suggested that damage
to joints may be caused by systemic
factors such as through adipose tissue
which releases cytokines as well as
adipokines (e.g. leptin), tumour necrosis
factor-alpha and interleukin-1.
Four randomised controlled trials were
part of a meta-analysis conducted by
Christensen, et al. containing 454 patients
with osteoarthritis of the knee.
417 patients, pain and self-reported
disability were measured.
regression analysis, it was concluded
that self-reported disability could be
significantly improved when weight
was reduced by more than 5% of body
Obesity is strongly linked to airways
disease including obstructive sleep
apnoea, COPD, and asthma.
An increase in BMI has resulted in lower
forced expired volume in 1 second (FEV1)
and forced vital capacity in longitudinal
and cross-sectional studies.
obesity has been associated with
declining lung function and respiratory
symptoms as well as inhibition of
diaphragm movement and reduction
in lung expansion during inspiration.
Obesity causing excess anterior chest
wall weight sees increased work of
breathing and airway resistance, which is
particularly apparent when patients are in
the supine position such as during sleep.
Inflammation is an important component
of COPD and in some patients with
COPD there are increased systemic
levels of pro-inflammatory mediators.
The ECLIPSE study found that while
only some patients had persistent
systemic inflammation, these patients
had more excess weight with a mean
BMI of 29.4 kg/m2 compared to a BMI of
25.6 kg/m2 in patients without persistent
As with the
aforementioned diseases, there is an
increase in cytokine and adipokine
proportions in obese patients with
However, in patients with COPD,
recommendations for weight loss should
be considered carefully as low weight is
a risk factor for poor COPD outcomes.
This is particularly important in patients
with severe airways limitation.
recommended that where weight loss
is required, strategies, which promote
weight loss without loss of lean body
mass be undertaken.
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