Obesity: a global health problem

Since time immemorial, obesity has engulfed the mankind. It’s a pandemic. The prevalence is increasing by leaps and bound. Evidences date back to 30,000 BC. Earlier it was linked to wealth and status and it took a long time for it to be considered as a disease. This change in mind-set of the people occurred in mid-19th century. Different formulas for calculating the BMI (Body Mass Index) were invented which was different for the world and the South-East Asians. Slowly it became a topic for research among the scientific society and first priority was given to finding out the cause of obesity. It could not be pointed down to one as many factors were found to contribute to the menace of obesity. Age, gender, genetics, environment, food habits, various co-morbid conditions and the list of contributing factors is endless. Studies done at the molecular level have shown that various cytokines like TNF, Interleukins, Monocyte Chemoattractant Protein, adipokines, etc., have been implicated in the pathogenesis of obesity. The first line in the management of obesity is to take preventive measure. Those who have started to develop the disease should undergo a few non-pharmacological treatment options like lifestyle modification, change in food habits and behavioural therapy. Initially drugs like fenfluramine and sibrutramine were developed. With newer researches coming up more safer and consistent molecules like Tesofensin have been found and undergoing trial. If not benefited by medical treatment the last option what remains for the patient is bariatric surgery but they are too costly for general population to afford. Finally, it is best seen that it is wise enough to follow the saying “Prevention is better than cure” for a disease with such a vast etiology.

Dispensações de psicotrópicos anorexígenos no município de Juiz de Fora, Minas Gerais, Brasil / Prescriptions for anorectic psychotropic drugs in the municipality of Juiz de Fora, Minas Gerais, Brazil

A obesidade é um grave problema de saúde pública, com prevalência crescente em níveis epidêmicos. Tratamento farmacológico é uma das abordagens terapêuticas, mas deve ser precedido de mudança de hábitos alimentares e prática regular de atividades físicas. Há preocupação com o uso não racional de medicamentos anorexígenos, independente da condição de doença. O estudo avaliou as dispensações destes psicotrópicos realizadas em 2009, Juiz de Fora, MG. Realizou-se a pesquisa em boletins de consumo, enviados mensalmente à VISA municipal, e em registros obtidos no SNGPC. De 7.759 notificações pesquisadas, 93,3% foram dispensadas por farmácias magistrais e 6,7% por drogarias. Daquele total, 55,4% foram de anfepramona, 33,1% de femproporex e 11,5% de mazindol. Com base em relatório da Anvisa, as três substâncias apresentaram consumo maior no município (DDD/mil hab/ano) do que no país como um todo, para o mesmo período. O profissional com maior número de receitas aviadas teve 3.535 dispensações. Todas foram dispensadas em farmácias, sendo 99,5% em um único estabelecimento. O cenário mostra a dispensação de anorexígenos como problema relevante de saúde coletiva e indica a necessidade de reavaliação dos critérios de monitoramento de sua prescrição, dispensação e consumo.

Obesity is a serious public health issue of epidemic proportions. Although drug therapy is one of the therapeutic approaches, it should be preceded by a change in eating habits along with regular exercise. This study assessed prescription of such drugs in 2009, in Juiz de Fora, Minas Gerais, Brazil. Data were collected from consumption bulletins sent monthly to the municipal sanitary surveillance agency (VISA), and from the Brazilian National Management System of Controlled Products. Of the 7,759 notifications assessed, 93.3% were dispensed by prescription pharmacies and 6.7% by drugstores. Of that total, 55.4% were for amphepramone, 33.1% for femproporex, and 11.5% for mazindol. The three drugs had a larger consumption rate in the municipality (daily defined dose/1,000 inhabitants/day) than in the country as a whole, during the period under study. The professional with the highest prescription rate was responsible for 3,535 prescriptions. All of these were dispensed by prescription pharmacies, a single outlet being responsible for 99.5% of these prescriptions. This scenario shows that anorectic psychotropic drug prescription is a relevant public health issue and the criteria for monitoring the prescription and consumption of these drugs should be re-evaluated.

Impact of health legislation on the sale of anorectics in a city in the Amazon region / Impacto da legislação sanitária na comercialização de anorexígenos em uma cidade da Amazônia

OBJECTIVES: The International Narcotics Control Board released its 2005 annual report, highlighting the Brazil population as one of the largest consumers of anorectics. In Brazil, the National Health Surveillance Agency issued the resolution RDC 58/2007 in order to control the prescription and sale of such drugs. In Belém, the biggest city in the Brazilian Amazon region, this resolution came into force in 2008, leading to inspections of drugstores and magistral pharmacies. The aim of this work was to evaluate the consumption of psychotropic anorectic drugs and the impact of RDC 58/2007 on the prescription and dispensing of anorectics in drugstores and magistral pharmacies in Belém. METHODOLOGY: A retrospective quantitative and descriptive study was conducted of records from the Municipal Department of Health Surveillance of Belém, for 2005 to 2008. The differences in findings were regarded significant when p < 0.05. RESULTS: A total of 1,641 balance sheets of drugstores and magistral pharmacies were analyzed. Amfepramone was the most dispensed medication, followed by fenproporex and mazindol. The highest consumption of anorectics occurred in magistral pharmacies. In 2008, there was a significant reduction in dispensing of anorectics, in drugstores as well as in magistral pharmacies. CONCLUSIONS: This study showed that there was a decrease in the dispensing of anorectics after RDC 58/2007 came into force, and that the magistral pharmacies dispensed more of these drugs. This resolution is a remarkable tool in health control, where it is of great benefit to public health and contributes substantially to the rational use of medicines in Brazil.

OBJETIVOS: O International Narcotics Control Board publicou em 2005 sua pesquisa anual que demonstrou que a população brasileira são um dos maiores consumidores de anorexígenos. No Brasil, a Agência Nacional de Vigilância Sanitária publicou a resolução RDC 58/2007 com o objetivo de controlar a prescrição e comercialização deste tipo de medicamento. Em Belém, a maior cidade da Amazônia brasileira, esta resolução entrou em vigor em 2008, levando à inspeções em drogarias e farmácias. Este trabalho propõe avaliar o consumo de psicotrópicos anorexígenos e o impacto da RDC 58/2007 na prescrição e dispensação de anorexígenos nas drogarias e farmácias magistrais de Belém. METODOLOGIA: foi realizado um estudo retrospectivo, quantitativo e descritivo, com dados coletados do Departamento de Vigilância Sanitária de Belém, de 2005 a 2008. Os dados foram considerados quando p < 0,05. RESULTADOS: Um total de 1.641 balanços foram analisados oriundos de drogarias e farmácias magistrais. Anfepramona foi o medicamento mais dispensado, seguido do femproporex e manzidol. O maior consumo de anorexígenos ocorreu nas farmácias magistrais. Em 2008, houve uma redução significativa na dispensação de anorexígenos, tanto em drogarias quanto em farmácias magistrais. CONCLUSÕES: Este estudo demonstrou que houve uma diminuição na dispensação de anorexígenos após a entrada em vigor da RDC 58/2007, e as farmácias magistrais foram responsáveis por um elevado número na dispensação destes medicamentos. Esta resolução é um marco divisor no controle sanitário, para enorme benefício da saúde pública, contribuindo substancialmente para o uso racional de medicamentos no Brasil.