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Obesity/Diabetes Epidemic: Adiposopathy & 'Obesity' - New Disease! Weight Management & New Medical Therapies

Explore the relationship between obesity, diabetes, and adiposopathy in this informative article. Learn about potential targets for obesity therapy and the impact of weight change on health outcomes after bariatric surgery.

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Obesity/Diabetes Epidemic: Adiposopathy & 'Obesity' - New Disease! Weight Management & New Medical Therapies

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  1. The Obesity/Diabetes Epidemic:Adiposopathy & ‘Obesity’- The New Disease!Weight Management in Obesity and DM: Emphasis on  New Medical Therapies Part 5 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. Brain External factors Emotions Food characteristics Lifestyle behaviors Environmental cues Central signals Stimulate NPY AGRP galanin Orexin-A dynorphin Inhibit a-MSH CRH/UCN GLP-I CART NE 5-HT Peripheral signals Peripheral organs Gastrointestinal tract Glucose CCK, GLP-1, Apo A-IV Vagal afferents Insulin – Food intake + Adipose tissue Ghrelin – Leptin + Cortisol Adrenal glands Regulation of Food Intake: Potential Targets for ObesityTherapy

  3. Weight Change and Health Outcomes at 3 Years After Bariatric Surgery Among Individuals With Severe Obesity Percent Weight Change TrajectoriesGrowth mixture models were used to estimate weight change trajectories for each participant and to classify participants with similar modeled trajectories into groups. Lines indicate modeled group trajectories; data markers, observed median values; bars, observed interquartile ranges. JAMA. 2013;310(22):2416-2425. doi:10.1001/jama.2013.280928

  4. Ps: 1 year sleeve (endoscopic)= 47% DM remission Escalona, Ann Surgery 2012 .

  5. Swedish study-DM remission- EASD 2013 2 yr -70% 10 yr- 36% 15 yr- 30% 20 yr- 18% Don’t promise cure!!- but even delay over time must translate to decrease DM complications

  6. Roux-en-Y restores incretin effect Sleeve- decrease postulated duodenal ‘messenger’

  7. Diabetes Mellitus

  8. Obesity, Insulin Resistance, Metabolic Syndrome and the Natural History of Type 2 Diabetes Age 0-15 15-40+ 15-50+ 25-70+ Envir.+ Other Disease Genes Macrovascular Complications Obesity (visceral) Poor Diet Inactivity IR phenotypeAtherosclerosisobesityhypertensionHDL,TG, HYPERINSULINEMIA Endothelial dysfunctionPCO,ED Disability Insulin Resistance MICVAAmp pp>7.8 DEATH IGT – OMINOUS OCTET Type II DM 8 mechanisms of hyperglycemia  Beta Cell Secretion EyeNerveKidney BlindnessAmputationCRF Disability Risk of Dev. Complications ETOHBPSmoking Microvascular Complications

  9. Considering the Epidemic of Metabolic Syndrome, Prediabetes,Prevention Data, Undiagnosed Diabetes- SCREENING IS CRITICAL! Risk factors and screening for diabetes: • Family history: whether parents or siblings have had diabetes • Obesity: especially with an increase in abdominal girth • High-risk ethnic group: African Americans, Hispanics,Native Americans, Asians, and Pacific Islanders • Age: we’re looking at all ages, if patient seems at risk • Impaired fasting glucose or impaired glucose tolerance • Hypertension: blood pressure ≥ 140/90 mm Hg in adults • High density lipoproteins < 35 mg/dL or triglyceride levels ≥ 250 mg/dL • Gestational diabetes or given birth to an infant weighing > 9 pounds

  10. Incidence 4-10%/year

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