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The Obesity/Diabetes Epidemic: Adiposopathy & 'Obesity' - The New Disease!

This article focuses on weight management in obesity and diabetes, with an emphasis on new medical therapies. It discusses the benefits of modest weight loss and the improvement in various cardiovascular risk factors. The text also includes information on the relationship between weight loss and insulin sensitivity, plasma lipids, blood pressure, sleep apnea, and endothelial function. Furthermore, it highlights the impact of weight reduction on cytokines and CHD risk factors, as well as the potential increase in life expectancy for obese patients with type 2 diabetes.

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The Obesity/Diabetes Epidemic: Adiposopathy & 'Obesity' - The New Disease!

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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 2 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. 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..

  3. 150 * 100 * Insulin (pmol/L) 50 * 0 Before 15 2.5–6.9 0–2.4 7.0–14.0 Weight Loss at 1 Year (%) Insulin Sensitivity Improves With Weight Loss in Patients With Type 2 Diabetes *P<0.01 vs before. Wing et al. Arch Intern Med 1987;147:1749.

  4. HDL-C (weight stable) HDL-C (actively losing) Total Cholesterol LDL-C TG 0.02 0.5 0.0 0.00 * * -0.5 * D mmol/L per kg of Weight Loss * -0.02 -1.0 D mg/dL per kg of Weight Loss -1.5 -0.04 -2.0 * -0.06 -2.5 Plasma Lipids Improve With Weight Loss Meta-analysis of 70 Clinical Trials *P0.05. LDL-C=low density lipoprotein cholesterol; HDL-C=high-density lipoprotein cholesterol; TG=triglycerides. Dattilo et al. Am J Clin Nutr 1992;56:320.

  5. 6 4 2 0 -2 -4 -6 -8 Diastolic Systolic Change in Blood Pressure (mm Hg) 5 1 2 3 4 Quintile of Weight Change 10 5 0 Change in Weight (kg) -5 -10 Relationship Between Change in Weight and Blood Pressure: Trials of Hypertension Prevention II Stevens et al. Ann Intern Med 2001;134:1.

  6. Effect of Weight Change on Apnea-Hypopnea Index (AHI) 6 4 2 Mean Change in AHI (Events/h) 0 -2 -4 +10 to +20 (n=79) -20 to <-10 (n=22) -10 to <-5 (n=39) -5 to <+5 (n=371) +5 to <+10 (n=179) Change in Body Weight (%) Peppard et al. JAMA 2000;284:3015.

  7. Relation Between %Weight Loss and Endothelial Function 7% 20 10 Change in FMD of Brachial Artery (%) 0 -10 -10 -6 2 -14 -12 -8 -4 -2 0 R2 = 0.468 p = 0.001 Reduction in Body Weight (%) Hamdy et al Diabetes Care 2003;26:2119-25

  8. Benefits of weight reduction on cytokines in type 2 DM and in pre-diabetes p<0.05 NS NS p<0.001p<0.01 NS % Change From Baseline IL-6 TNF-ahCRP PAI-1 Leptin Adiponectin Hamdy O et al. Diabetes Care. 2003;26:2119-2125 Monzillo LUObes Res. 2003;11(9):1048-54

  9. Loss 2.25 kg Gain 2.25 kg 60 40 20 0 -20 -40 -60 Relationship Between Weight Change and CHD Risk Factor Sum: Framingham Offspring Study Weight Change During 16-y Follow-up * +37% * +20% Change in Risk Factor Sum (%) –40% –48% * * Women Men *P<0.002 vs baseline. Wilson et al. Arch Intern Med 1999;159:1104.

  10. 18 16 14 Life Expectancy (y) 12 10 8 0 0 2 4 6 8 10 12 14 16 Weight Loss in First 12 Months (kg) Weight Loss Can Increase Life Expectancy in Obese Patients With Type 2 Diabetes Lean et al. Diabet Med 1990;7:228.

  11. 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- • Basics, Generalities • Obesity • Lifestyle- Diet , Activity, Behavior • Medications • Weight Control, WEIGHT REDUCTION in DIABETES

  12. Weight Loss Goals in Lifestyle Modification • “The initial goal of weight loss therapy for overweight patients is a reduction in body weight of about 10 percent….Moderate weight loss of this magnitude can significantly decrease the severity of obesity-associated risk factors.” • Most patients desire much greater weight losses. • Higher goals may be related to more weight loss. NIH/NHLBI, NAASO. The Practical Guide: Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. Bethesda, MD: NIH, 2000.

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