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The Obesity/Diabetes Epidemic: Perspectives, Consequences, Prevention, Treatment Part 3

This article discusses the genetic and environmental factors contributing to obesity and diabetes, as well as the medical complications and health benefits of weight loss. It also explores evidence-based interventions for prevention and treatment.

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The Obesity/Diabetes Epidemic: Perspectives, Consequences, Prevention, Treatment Part 3

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  1. The Obesity/Diabetes Epidemic:Perspectives, Consequences,Prevention, Treatment Part 3 Stan Schwartz MD, FACP, FACE Private Practice, Ardmore Obesity Program Cardiometabolic Diabetes Center and Affiliate, Main Line Health System Emeritus, Clinical Associate Professor University of Pennsylvania

  2. Genetic Approach of Obesity Environment Genes Monogenic recessive Leptin Leptin-R POMC PC-1 Monogenic dominant MC4-R Polygenic GAD2

  3. Gene Variants and Binge Eating as Predictors of Co-morbidities and Outcome of Treatment in Severe Obesity • Melanocortin-4 receptor gene (MC4R) variants are associated with obesity and binge-eating disorder (BED). • 300 patients (233 women, 67 men) with a mean BMI of 43.5 and a mean age of 42 • Laparoscopic Adjustable Gastric Banding • 36-month follow-up • All MC4R patients had BED, compared to 18 percent in noncarriers. • MC4R patients showed less weight loss and five times more gastric complications. Potoczna, et al. J Gastro Surg 2004:8(9).

  4. 27 Adoptive Parents Biological Parents 26 25 BMI of Parents (kg/m2) 24 23 Fathers 22 Mothers 21 Thin Median Overweight Obese Thin Median Overweight Obese Weight Classification of Adoptees Relationship Between Adoptee Weight and Weight of Biological Parents +, but with Adoptive Parents- none Stunkard AJ, Sorensen TI, Hanis C,et al. N Engl J Med 1986;314:193.

  5. The “Toxic Environment” supersized • High-Calorie Food is… • Highly palatable • Inexpensive • Heavily advertised • Near-ubiquitous Brownell KD & Horgen KB. Food Fight. New York: McGraw-Hill; 2003.

  6. Increasing Caloric Intake Over time in USA Kant AK. Am J Clin Nutr. 2006:84:1215-23.

  7. Health Benefits of Modest Weight Loss (5-10%) • Decreased cardiovascular risk • Decreased blood glucose and insulin levels • Decreased blood pressure • Decreased LDL and triglycerides, increased HDL • Decrease in severity of sleep apnea • Reduced symptoms of degenerative joint disease • Improvement in gynecologic conditions • Multiple cardiovascular risk factors and other complications can be improved. Source: The Practical Guide to the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults..

  8. The “Toxic Environment” • Physical Activity is… • To be avoided • Nearly unnecessary • Limited by infrastructure Brownell KD & Horgen KB. Food Fight. New York: McGraw-Hill; 2003.

  9. Burning a lot less energy (per half hour) in 2004

  10. Average Steps/Day

  11. Childhood Obesity http://www.committed-to-kids.com

  12. Outline • Epidemiology and Economics of obesity/diabetes • Perspectives on Obesity • Consequences of Obesity, Prediabetes, Obesity • Obesity/ Diabetes Risk Factors • Obesity/ Diabetes Onset can be Prevented or Delayed – Early Risk Identification and Intervention. • Medical Benefits to Weight Loss • Treatment-CDC’s diabetes prevention program and other Evidence-Based Interventions- • Basics, • Next Lecture in Series

  13. Idiopathic intracranial hypertension Pulmonary disease abnormal function obstructive sleep apnea hypoventilation syndrome Stroke Cataracts Nonalcoholic fatty liver disease steatosis steatohepatitis cirrhosis Coronary heart disease Diabetes Dyslipidemia Hypertension Gall bladder disease Severe pancreatitis Gynecologic abnormalities abnormal menses infertility polycystic ovarian syndrome Cancer breast, uterus, cervix colon, esophagus, pancreas kidney, prostate Osteoarthritis Skin Gout Medical Complications of Obesity Phlebitis venous stasis

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