P261-264 Physical Activity

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IV.3. PHYSICAL ACTIVITY:
{Childhood obesity treatment book p261-264} Importance of Physical Activity:
Physical activity is the only modifiable component of the energy expenditure portion of the energy balance equation. Increasing physical activity improves weight loss and maintenance and decreases obesity health hazards. Strategies to increase physical activity should include both increasing in structured and non-structured physical activity and reducing the amount of time spent in sedentary activities (140, 141).
Accurate measurement of physical activity is very complex because of differences in designs and methods. Several but not all studies have demonstrated that increased physical activity is associated with decreased BMI in children
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Pharmacodynamics:
- Short half-life (∼1–2h).
- Three times per day with meals.
- Gastrointestinal absorption is negligible.
- It is excreted in the stool.
- Orlistat is considered safe because it is minimally absorbed.
Mechanism of action:
- It inhibits intestinal lipases and thereby blocks hydrolysis of triglycerides.
- Intestinal absorption of fatty acids and monoglycerides is reduced by 25–30%.
- It reduces body weight by a mean of 2.7 kg (∼2.9%) relative to placebo.
- There are variable reductions (0.7–3.4 cm) in waist circumference.
- The response to treatment and compliance with therapy are highly variable and the effect may persist for as long as 4 years in compliant patients.
- Drug treatment may limit weight regain.
- It is associated with reductions in total cholesterol (–12.7 mg%) and LDL cholesterol (–10.4 mg%) and only minimal reductions in HDL-cholesterol (–0.8 mg%); consequently, the cholesterol/HDL and LDL/HDL ratios decline.
- Drug-dependent reductions in diabetes prevalence could reflect reductions in body fat mass and/or increases in post-prandial levels of GLP-1, which promotes glucose-stimulated, insulin secretion and reduces food

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