Browsing by Subject "lihavuus"

Obesity is a growing health challenge in Finland. Despite the fact, that obesity is recognized as a chronic disease, it remains underdiagnosed and undertreated. In the past few years, two new anti-obesity drugs have entered the market to support the lifestyle changes Anti-obesity medication would be a natural option to support lifestyle changes, but physicians have not widely adopted the medication in their treatment patterns. The aim of this study was to understand, what are the abilities of primary care physician (PCP) to treat obesity, considering their knowledge, resources and, local care pathways. In addition, the study sought to determine the most important factors, that are involved in the initiation of anti-obesity medication. The study was conducted as a semi-structured thematic interview. A total of nine PCPs from all over Finland were interviewed for the study. Of these, three worked on the private sector and six on the public sector. The interviews were conducted during October-November 2020. The framework of the interviews was built based on the previous studies and information within a pharmaceutical company specializing in the treatment of obesity. The content was analysed with inductive content analysis. PCPs interested in the treatment of obesity raised the topic of weight quite easily in various situations and some of them mentioned that they even find it easy to bring up the subject. However, the subject is mainly brought up when the patient already has some weight-related comorbidities. Preventively, weight is less often talked about, especially because of a lack of human and time resources. Currently the most comprehensive care pathways and interdisciplinary teams are in occupational healthcare. In occupational healthcare, resources are perceived as adequate and the interdisciplinary teams works well. In most healthcare centers, a separate care pathway for the treatment of obesity had not been built. In general, knowledge of the obesity treatment was considered adequate, but education on the biological basis of obesity is needed. Most of the PCPs knew about the new anti-obesity drugs and had positive attitude towards them, but they did not prescribe the drugs themselves. The most significant barrier to prescribe the anti-obesity drugs, was the price of the products and the lack of reimbursement. In addition, experience with anti-obesity drugs is limited and the need for education is high. Currently, occupational health physicians have better abilities to treat obesity in terms of care pathways, interdisciplinary teams and, resources than PCPs in public healthcare. The conditions are also better for the implementation of pharmacotherapy as resources and care pathways enables proper lifestyle guidance alongside pharmacotherapy. Prior to reimbursement, pharmacotherapy may not be a realistic option in the public sector, and the conditions for proper lifestyle guidance alongside pharmacotherapy are not sufficient in all locations.

Obesity is considered one of the major public health challenges. One way to control obesity is to regulate appetite. Because brain is the primary regulative unit responsible for food intake, the research in this field has now been allocated especially to the central nervous system. The aim of this thesis was to clarify the role of cholinergic projections from pedunculopontine tegmentum (PPT) to lateral hypothalamus (LH) in food intake. In this study, DREADD-technology (designed receptors exclusively activated by designer drugs) based on chemogenetics was utilized with a gene manipulated mouse strain. For the experimental part of this work the mice were divided in three separate groups: one transducted with an activating DREADD-receptor (hM3Dq), one transducted with an inhibiting DREADD-receptor (hM4Di) and one transducted only with a fluorescent protein called m-Cherry. The last group was also defined as a control group of this study. In addition, the gene which coded m-Cherry fluorescent protein was transducted together with hM3Dq- and hM4Di-receptor genes for the first two groups to be able to examine the receptor expression later. At the baseline level, no differences were observed in food intake between the three study groups. The food intake did not differ between the groups while clozapine-N-oxide (CNO), a selective DREADD-receptor ligand, was administered straight into the LH area (0,03 µg/injection) with or without fasting of the animals. While administrating CNO to the mice intraperitoneally (1 mg/kg), the hM3Dq-group mice were observed to consume more food compared to the hM4Di-group or the control group. This difference was detected while food consumption was examined cumulatively during total four measuring hours. When the animals were fasted before the intraperitoneal administration test, however no differences were found between the study groups regarding food intake. As a conclusion of this study, cholinergic projections from pedunculopontine tegmentum (PPT) to lateral hypothalamus (LH) were not regulating food intake in mice. However, the cholinergic cells in PPT and some of their axons might be involved in the regulation of food intake while the food consumption is studied continuously and long-term. More studies are required to better define the role of the cholinergic projections from pedunculopontine tegmentum (PPT) to lateral hypothalamus (LH) in food intake.