There is no doubt that both diabetes and obesity are chronic diseases that can lead to an increase in mortality rate worldwide, especially in developed countries.
Obesity is defined as accumulation of excessive fats or lipids that may impair health and can lead to other serious conditions as Diabetes, heart problems, hypertension and so on.
According to the WHO, in 2016, more than 1.9 billion adults aged 18 years and older were overweight. Of these over 650 million adults were obese.
· Difficulty in breathing
· Sweating more than usual
· Snoring and difficulty in sleeping
· Fatigue
· Joint and back pain
· Low confidence and self-esteem
· Feeling isolated
· Difficulty in performing physical activities.
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If your previous attempts failed to lose weight by diet or exercise, you may need to check your health care provider for a regular follow up and choose the perfect option for you regarding losing weight.
Using Body mass index (kg/m2)
Which defines the ratio of the patient’s weight to his height and interprets as follows:
• healthy weight: BMI 18.5 kg/m2 to 24.9 kg/m2
• overweight: BMI 25 kg/m2 to 29.9 kg/m2
• obesity class 1: BMI 30 kg/m2 to 34.9 kg/m2
• obesity class 2: BMI 35 kg/m2 to 39.9 kg/m2
• obesity class 3: BMI 40 kg/m2 or more.
Degree of central adiposity based to weight to height ratio as follows:
• healthy central adiposity: waist-to-height ratio0.4 to 0.49, indicating no increased health risks
• increased central adiposity: waist-to-height ratio 0.5 to 0.59, indicating increased health risks
• high central adiposity: waist-to-height ratio0.6 or more, indicating further increased health risks.
The doctor may recommend other laboratory investigations to exclude any underlying disease caused by obesity such as:
• Fasting blood sugar and glycated hemoglobin
• Thyroid, kidney and liver function tests.
• Calcium and vitamin D levels.
• Lack of physical activity.
• Unhealthy eating behaviour.
• Lack of good sleep.
• Stress
• Genetic factors
• Some medications as Glucocorticoids, birth control pills, beta blockers ,anti-psychotics and anti-depressants.
• Pre-diabetes or type 2 diabetes.
• Hypertension
• Increase cholesterol levels.
• Asthma
• Metabolic syndrome
• Reduce fertility.
• Gastro-esophageal reflux disease
• Sleep apnea
• Fatty liver and gall stones.
Treatment of obesity has been based on eating a well-balanced diet, physical activity and lifestyle changes, the doctor may recommend Bariatric surgery to treat people with severe obesity.
Recently FDA has approved Tirazepatide (Mounjaro) in May 2022 for Type 2 diabetes Management, it can be also used as an off-label use for obesity management.
Furthermore, products generated in our human body that stimulates beta cells of Pancreas to release insulin are called “incretins” , they are secreted from the intestine and they were early discovered in the 1970s, the most commonly known incretins are including Glucagon like peptide-1 and Glucose-dependent insulin tropic polypeptide (GLP-1and GIP), Tirazepatide (Mounjaro®) works as a GLP-1 and GIP receptor agonist in the small intestine and hence, it stimulates the pancreas to release insulin which decreases the appetite and slows down gastric emptying rate.
• Some studies proved that after four weeks of treatment with Tirazepatide (Mounjaro), it shows marked decline in HA1C levels along with post-prandial blood glucose levels.
• Appetite suppression and decrease food intake.
• Increase weight loss.
• Increase insulin secretion and improve insulin resistance.
• Increase cardio protection.
• Decrease bone reabsorption.
The adverse events most reported were nausea, vomiting, and episodes of constipation or diarrhea, which were mild to moderate and occurred mostly during the dose-escalation period.
Plan to have small frequent meals if you have the symptoms of Nausea.
• Store your pen in the refrigerator between 2-8 °C.
• It can be stored at room temperature for up to21 days.
• Don’t freeze your pen.
• Air bubbles are normal if seen in the pen.
One advantage of Tirazepatide (Mounjaro) is ensuring the adherence because it can be delivered sub-cutaneous via self-injection under the skin of the stomach, thigh, or upper arm once per week, at any time of the day.
The recommended starting dose is 2.5mg once weekly, after one month dose in increasing up to 2.5mg increment until reaching the good glycemic control, maximum weekly dose is 15mg.
Tirazepatide (Mounjaro) has shown significant and promising results for the management of obesity, don’t hesitate to ask our health care providers and our pharmacists for more details about it.
• Maintain well-balanced diet that aims to lose from 0.5-1kg per week or to reduce the caloric intake by 500 calories per day.
• A healthy diet consists of balanced amount of carbohydrates, fats and proteins from complex carbohydrates as oats and whole grains, fish, lean meat, fruits and vegetables.
• Avoid foods that contain high amounts of salt, sugar and fats.
• Avoid FAD diets that aim for cutting a whole group of foods or fasting for a long time.
• Physical activities can prevent many diseases conditions such as heart diseases, aim for aerobic exercises for 30 minutes per day.
• https://www.nice.org.uk/guidance/cg189,NICE guidelines for the management of obesity.(accessed at 3:00PM on 27/7/2023).
• Chavda, Vivek P., et al. "Tirzepatide, a new era of dual-targeted treatment for diabetes and obesity: a mini-review." Molecules 27.13(2022): 4315.
• Min, Thinzar, and Stephen C. Bain. "The role of tirzepatide, dual GIP andGLP-1 receptor agonist, in the management of type 2 diabetes: the SURPASS clinical trials." Diabetes Therapy 12 (2021):143-157.
• https://uspl.lilly.com/mounjaro/mounjaro.html#ug0(accessed at 4:00PM on 25/7/2023).
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