Medical Consequences Of Obesity Research Articles

Liraglutideas Adjunct Therapy in the Management of Obesity

The obesity epidemic has reached a new level with some impressive numbers recently published in the United States of America. Even more alarming is the rapid increase in childhood obesity, which has been universally documented over the past few decades. The reasons underlying the problem of obesity can be simplified into three categories: i) routine consumption of bigger portion size meals; ii) confusing messages from food industry to consumers; and iii) physical inactivity is the “new normal”. Considering that the medical consequences of obesity are serious and directly affect morbidity and mortality, it has become necessary to act concomitantly to prevent and treat the increase in body weight and fat excess accumulation. The prevention of obesity is a formidable task that can only be accomplished with a concerted effort put together by several governmental agencies, especially those interested in agriculture, health and education, the food industry and health care providers, including physicians and nutrition specialists. Treatment of obesity with behavioral management, nutritional manipulations (“diets”) and, even bariatric surgery has had some success, but these strategies are accompanied by limited benefits and only to a select group of individuals. More importantly, the overall impact of these on the growing obesity pandemic is disappointing, at best. Some dietary recommendations with caloric restriction and adjustments in nutrient intake combined to pharmacotherapy have expanded our ability to manage obese patients.The recent approval by the U.S. Food and Drug Administration (FDA) agency of the Glucagon-Like-Peptide-1 (GLP-1) receptor analog liraglutide, at the dose of 3.0 mg once daily, has provided us with an additional tool to combat the disease and minimize its complications. In this particular study, a significant reduction in the conversion ratesfrom pre-diabetes to diabetes was also shown and represents an important findingof the trial. Despite the fact that nausea, vomiting and diarrhea were frequently reported during the 1-year period of observation, tolerance was acceptable and most subjects completed the study.These data clearly indicate that combination drug therapy with dietary adjustments can be successful in promoting weight reduction and further support routine utilization of adjuvant pharmacotherapy in the management of obesity.

Primary care provider management of patients with obesity at an integrated health network: A survey of practices, views, and knowledge

BackgroundObesity is a serious health problem that affects a wide range of patients and disease processes. ObjectiveThe purpose of this study is to evaluate perceptions, knowledge, and practice habits of primary care providers (PCPs) regarding the care of patients with obesity, including barriers to effective care and their experience with bariatric surgery in our integrated health network. SettingIntegrated health network. MethodsA 16-question survey was distributed electronically to 160 PCPs at our integrated health network. Results were analyzed to identify attitudes, knowledge, practice habits, and bariatric surgery referral patterns while treating patients with obesity. ResultsAmong 160 PCPs, 45 (28.1%) responded. Specialty, sex, patient population, insurance accepted, and practice years of PCPs were reported. Most PCPs reported “always” calculating patient body mass index (88.9%) with only 13.3% “always” discussing the body mass index results. Respondents most frequently prescribed diet and exercise to patients with obesity and rarely prescribed medications, with bariatric surgery referrals falling between the two. PCPs viewed management of obesity as the responsibility of the patient (97.6%) and the PCP (100%). Ninety-three percent felt obesity is a common diagnosis in their practice, but no one correctly identified the prevalence of obesity in our region. Respondents demonstrated adequate knowledge regarding medical consequences of obesity. A majority was able to identify the correct eligibility criteria for bariatric surgery, as well specific medical problems that can improve or be eliminated postoperatively. While 61.9% of respondents were aware of free weight loss and bariatric informational sessions offered, 28.6% reported that they were unfamiliar with existing bariatric surgeons. One respondent was not aware of any bariatric surgery performed. Some PCPs reported prior negative experiences with post-bariatric surgery patients, and thus were hesitant to refer additional patients. ConclusionsPCPs report discussing an obesity diagnosis with patients but are not always using body mass index in that discussion. They most often prescribe lifestyle modification as treatment for patients, which they believe to be most effective to treat obesity. However, they report only one third of their patients are motivated to lose weight. Additionally, they demonstrate appropriate knowledge of indications and benefits of bariatric surgery. A majority of the PCPs is aware of weight loss informational sessions and bariatric services provided within our integrated health network, but almost one third were unable to identify a surgeon, a possible target for improved relationships. Barriers to care include patient motivation and insurance coverage.

Liraglutideas Adjunct Therapy in the Management of Obesity

ABSTRACTThe obesity epidemic has reached a new level with some impressive numbers recently published in the United States of America. Even more alarming is the rapid increase in childhood obesity, which has been universally documented over the past few decades. The reasons underlying the problem of obesity can be simplified into three categories: i) routine consumption of bigger portion size meals; ii) confusing messages from food industry to consumers; and iii) physical inactivity is the “new normal”. Considering that the medical consequences of obesity are serious and directly affect morbidity and mortality, it has become necessary to act concomitantly to prevent and treat the increase in body weight and fat excess accumulation. The prevention of obesity is a formidable task that can only be accomplished with a concerted effort put together by several governmental agencies, especially those interested in agriculture, health and education, the food industry and health care providers, including physicians and nutrition specialists. Treatment of obesity with behavioral management, nutritional manipulations (“diets”) and, even bariatric surgery has had some success, but these strategies are accompanied by limited benefits and only to a select group of individuals. More importantly, the overall impact of these on the growing obesity pandemic is disappointing, at best. Some dietary recommendations with caloric restriction and adjustments in nutrient intake combined to pharmacotherapy have expanded our ability to manage obese patients.The recent approval by the U.S. Food and Drug Administration (FDA) agency of the Glucagon-Like-Peptide-1 (GLP-1) receptor analog liraglutide, at the dose of 3.0 mg once daily, has provided us with an additional tool to combat the disease and minimize its complications. In this particular study, a significant reduction in the conversion ratesfrom pre-diabetes to diabetes was also shown and represents an important findingof the trial. Despite the fact that nausea, vomiting and diarrhea were frequently reported during the 1-year period of observation, tolerance was acceptable and most subjects completed the study.These data clearly indicate that combination drug therapy with dietary adjustments can be successful in promoting weight reduction and further support routine utilization of adjuvant pharmacotherapy in the management of obesity.

L’obésité du sujet âgé

Our population is ageing, and obesity is increasing in the elderly. BMI value associated with the lowest relative mortality is slightly higher in older than in younger (between 25 and 32kg/m2). Nevertheless, the combined effect of aging and obesity increases the risk of comorbidities, including type 2 diabetes mellitus, cardiovascular risk, respiratory insufficiency, obstructive sleep apneas, cancer, urinary incontinence and dementia. The medical consequences of obesity are alleviated by modest, achievable weight loss (5–10kg) with an evidence-based maintenance strategy. A combination of exercise and modest calorie restriction appears to be the optimal method of reducing fat mass and preserving muscle mass. The clinical outcomes have been evaluated in diabetes mellitus and in cardiovascular diseases, showing favorable effects on the morbidity and probably on the mortality. Very-low-energy diets have to be avoided for elderly patients. The risk of muscle loss increases with the level of diet restriction. In older people, the risks of laparoscopic bariatric surgery are not higher than in younger but the benefits have not been evaluated. The sarcopenic obesity (excess in body fat and loss of muscle mass and function) burdens the functional consequences of obesity in older people. Since sarcopenia is frequent in the elderly, a screening should be done in obese patients for whom a restrictive diet is not recommended. In renal or cardiac insufficiency, only physical activity can be recommended. In elderly people, weight management interventions using moderate calorie restriction and physical activity exercise are recommended. Daily protein intake must be maintained. Health benefits and risks from long-term weight management in obese elderly have to be studied in randomized controlled studies.

The Gravity of Weight: A Clinical Guide to Weight Loss and Maintenance; Nutrition in InstitutionsThe Gravity of Weight: A Clinical Guide to Weight Loss and Maintenance KarasuSylvia R.M.D., and KarasuT. ByramM.D.; Washington, D.C., American Psychiatric Publishing, 2010, 518 pages, $66Nutrition in Institutions CrossMaria and MacDonaldBarbara; Oxford, United Kingdom, Wiley-Blackwell, 2009, 440 pages, $109.99

The Gravity of Weight: A Clinical Guide to Weight Loss and Maintenance; Nutrition in InstitutionsThe Gravity of Weight: A Clinical Guide to Weight Loss and Maintenance KarasuSylvia R.M.D., and KarasuT. ByramM.D.; Washington, D.C., American Psychiatric Publishing, 2010, 518 pages, $66Nutrition in Institutions CrossMaria and MacDonaldBarbara; Oxford, United Kingdom, Wiley-Blackwell, 2009, 440 pages, $109.99

Obesity and weight management in the elderly

Our population is ageing, and obesity is increasing in the elderly bringing massive and rapidly changing burdens of ill health related to increased body weights and fat as well as the main drivers of poor diet and inactivity. Overweight and obesity, and a static body mass index (BMI) commonly conceal sarcopenia (gain in body fat but loss of muscle mass and functional capacity) in older people, aggravated by inactivity. A systematic computerized literature search using an iterative manipulation process of the keywords: obesity, elderly, weight loss. The following databases were accessed on 20 October 2010: Medline, Cochrane Collaboration, Ovid and Scholar Google. A large number of clinical consequences of overweight and obesity are particularly problematic for elderly individuals, including type 2 diabetes mellitus, arthritis, urinary incontinence and depression. The observation that the BMI value associated with the lowest relative mortality is slightly higher in older than in younger adults has often been misinterpreted that obesity is not as harmful in the elderly. BMI may be a less appropriate index in the elderly. All the medical consequences of obesity are multi-factorial but all are alleviated by modest, achievable weight loss (5-10 kg) with an evidence-based maintenance strategy. Since sarcopenic obesity is common in the elderly, a combination of exercise and modest calorie restriction appears to be the optimal method of reducing fat mass and preserving muscle mass. Reduction in polypharmacy is a valuable target for weight management. Age is not an obstacle to weight management interventions using moderate calorie restriction and exercise, and the currently licensed drug orlistat appears to have no age-related hazards. Overall balance of clinical outcomes has not been evaluated. In older people the risks from bariatric surgery outweigh benefits. Obesity, and specifically sarcopenic obesity, should also be prevented not only from younger age, but also during major life transitions including retirement, to improve better health outcomes and quality of life in later years, with a focus on those in 'obese families', where the main increases in obesity are located. Randomized controlled trials to determine health benefits and risks from long-term weight management in obese elderly are necessary.

Obesity, its associated disorders and the role of inflammatory adipokines in companion animals

Obesity is characterised by an expansion of white adipose tissue mass that can lead to adverse health effects, such as decreased longevity, diabetes mellitus, orthopaedic and respiratory disease and neoplasia. Once thought a passive fuel depot, adipose tissue is now recognised as an active endocrine organ that communicates with the brain and peripheral tissues by secreting a wide range of hormones and protein factors, collectively termed adipokines. Examples include leptin, adiponectin, cytokines (tumour necrosis factor-alpha, interleukin-6), chemokines, acute phase proteins, haemostatic and haemodynamic factors and neurotrophins. Adipokines can influence various body systems, and perturbation of normal endocrine function is thought central to the development of many associated conditions. This review focuses on the medical consequences of obesity in companion animals, assesses the endocrine function of adipose tissue in disease pathogenesis, and highlights the potential role of adipokines as biomarkers of obesity-associated disease.

What are the health risks? The medical consequences of obesity and its health risks.

It is important to establish what the medical view of obesity should be. An important step is the development of a standardised definition of obesity. The World Health Organisation (WHO) has proposed body mass index (BMI) as a simple measure of obesity. Whereas BMI has great clinical utility, it should be remembered that calculation of a raised BMI does not automatically indicate a high degree of adiposity. This is because BMI does not distinguish between weight due to excess fat, and weight due to a large mass of muscle or bone. Gender and age also have to be considered when evaluating BMI measurements. Obesity is related to many disorders, most of which are metabolic in origin. For example, hypertension and the adverse lipid profile associated with obesity increases the risk of coronary heart disease (CHD). There is also a profound association between obesity, particularly intra-abdominal adiposity, and the development of non-insulin dependent diabetes mellitus (NIDDM). Obesity has reached epidemic proportions. This is paralleled by an increasing incidence of NIDDM. There is no doubt that weight gain and obesity are major clinical problems, which need to be prevented and managed more effectively. This is essential, given the role of obesity in many of the chronic health problems affecting westernised societies.

Developing national obesity prevention policies: an international perspective

It is only recently that governments have come to recognise that national prevention strategies are needed so it is unreasonable to demand evidence of successful and unsuccessful national programmes. For decades the assumption has been that individual concern and effort should be sufficient to prevent something as simple as weight gain but in practice this advice for decades has been accompanied by an unrelenting rise in obesity rates. Recent rigorous analyses show that individualised advice to reduce intake and take more exercise is an exceptionally poor way of ensuring that a population does not gain weight. The unrelenting epidemic reflects the presence of a “toxic environment” where the need for physical activity has almost been eliminated by cars, mechanical aids at work and in the home, TV and computers etc. It is now very difficult to consider leisure time activity as a population strategy for improving weight gain and preventing the exceptionally expensive medical consequences of obesity. New policies are needed from policy makers independent of industrial interests, many of which have contributed to the current epidemic. Food labelling with traffic light systems is now shown to be highly effective and helps consumers to eat more healthily but the principal ways of changing food patterns depend on governmental and industrial action. We also have to overcome the distortions of the market place induced by the Common Agriculture Policy which has favoured meat, fat, butter and sugar price reduction to the detriment of fruit and vegetables. Approaches to altering the price, availability and the marketing of foods is urgently needed with tough measures to prevent children being commercialised and confused by the marketing of very inappropriate food and drinks.

Obesity—time to wake up

The obesity epidemic in the United Kingdom is out of control, and none of the measures being undertaken show signs of halting the problem, let alone reversing the trend. The...

Das Metabolische Syndrom: Eine neue Kinderkrankheit?

Overweight and obesity in children and adolescents have become a major public health problem in recent years throughout the world. The medical consequences of obesity may manifest as an increase in the prevalence of the metabolic syndrome in children and adolescents putting them at increased risk for future cardiovascular diseases. Obesity can cause insulin resistance and might disturb glucose homeostasis eventually leading to type 2 diabetes in susceptible patients. Insulin resistance is also involved in the pathogenesis of dyslipidemia in obese children characteristically presenting as hypertriglyceridemia and low HDL cholesterol. Even elevated blood pressure might be present in obese kids. Here we present a 12-year-old boy diagnosed with the metabolic syndrome. The diagnostic criteria of the metabolic syndrome in children and adolescents are discussed. Thoughts about pathophysiology and therapeutic options are offered.

Severe Obesity: A Growing Health Concern A.S.P.E.N. Should Not Ignore

The definition of malnutrition in the published standards of the American Society of Parenteral and Enteral Nutrition (A.S.P.E.N.) is any derangement in the normal nutrition status and includes overnutrition, commonly referred to as obesity. The incidence of obesity is increasing and reaching epidemic proportions in the United States and even worldwide. This has significant financial impact as our society spends billions of dollars on fad diets, commercial weight-loss programs, nutrition and dietary supplements, prescription and over-the-counter medications, and health clubs. Another approximately dollars 100 billion are spent to treat the medical consequences of obesity. Currently, for those patients with intractable morbid obesity, defined as having a body mass index >40 kg/m2, surgery offers the only option for achieving meaningful and sustainable weight loss. The resultant weight loss dramatically improves health and decreases the cost of health care for these patients. Years of refinement in technology and the introduction of safer and less invasive procedures have dramatically reduced the short-term morbidities and long-term metabolic consequences of these procedures. This address will review the field of weight loss (bariatric) surgery and will offer a compelling request for A.S.P.E.N. to include obesity in its fabric.

Obesity in Children and Adolescents

1. Marcie B. Schneider, MD* 2. Susan R. Brill, MD† 1. *Director, Adolescent Program, Greenwich Hospital, Greenwich, Conn., and Assistant Clinical Professor of Pediatrics, Yale University School of Medicine, New Haven, Conn 2. †Director, Girl Street: A Young Women’s Health Program, Children’s Medical Center, Adolescent/Young Adult Center for Health, Overlook Hospital, Summit, NJ, and Assistant Professor of Clinical Pediatrics, University of Medicine & Dentistry of New Jersey, Newark, NJ After completing this article, readers should be able to: 1. Describe the appropriate use of the body mass index. 2. Delineate the relationship between sedentary activities such as television/video viewing and overweight. 3. Explain when clinicians should screen for impaired glucose tolerance in overweight children and adolescents. 4. Explain the expected results of thyroid studies in tall-for-age obese children. 5. List the psychiatric disorders for which obese children and adolescents should be screened. 6. Describe the management approach to obesity in overweight children and adolescents. Obesity has grown to epidemic proportions in children and adults. The medical consequences of obesity, including heart disease, hypertension, and diabetes, also have increased. Hospital costs from obesity-related diseases in youth have increased from $35 million (0.43% of total hospital costs) during 1979 to 1981 to $127 million (1.79% of total costs) during 1997 to 1999. Thus, it has become increasingly important to identify the risk factors predisposing to obesity and to identify youth who are overweight and at risk for becoming overweight. To prevent both the medical and psychological complications of obesity, treatment should be started as early as possible Although there are several methods of describing overweight, body mass index (BMI), defined as weight in kilograms divided by height in meters squared (kg/m2), has become the acceptable format for children, adolescents, and adults. The correlation of BMI with measures of adiposity is excellent in adults, but slightly less reliable for children, whose BMI changes with age during childhood and adolescence. Adiposity is influenced by several factors, including age, sex, pubertal stages, waist-to-hip ratio, and race. Boys have less body fat than do girls at the same BMI. Maturational level is more important than age, with those who are further along in puberty having more body fat. Those who have a higher waist-to-hip ratio at the same BMI have …

Medical consequences of obesity

The obese are subject to health problems directly relating to the carriage of excess adipose tissue. These problems range from arthritis, aches and pains, sleep disturbance, dyspnea on mild exertion, and excessive sweating to social stigmatization and discrimination, all of which may contribute to low quality of life and depression ( Table 1). The most serious medical consequences of obesity are a result of endocrine and metabolic changes, most notably type 2 diabetes mellitus, cardiovascular disease, and increased risk of cancer. Not all obesity comorbidities are fully reversed by weight loss. The degree and duration of weight loss required may not be achievable by an individual patient. Furthermore, “weight cycling” may be more detrimental to both physical and mental health than failure to achieve weight loss targets with medical and lifestyle advice.

Medical consequences of obesity.

Obesity is an epidemic disease that threatens to inundate health care resources by increasing the incidence of diabetes, heart disease, hypertension, and cancer. These effects of obesity result from two factors: the increased mass of adipose tissue and the increased secretion of pathogenetic products from enlarged fat cells. This concept of the pathogenesis of obesity as a disease allows an easy division of disadvantages of obesity into those produced by the mass of fat and those produced by the metabolic effects of fat cells. In the former category are the social disabilities resulting from the stigma associated with obesity, sleep apnea that results in part from increased parapharyngeal fat deposits, and osteoarthritis resulting from the wear and tear on joints from carrying an increased mass of fat. The second category includes the metabolic factors associated with distant effects of products released from enlarged fat cells. The insulin-resistant state that is so common in obesity probably reflects the effects of increased release of fatty acids from fat cells that are then stored in the liver or muscle. When the secretory capacity of the pancreas is overwhelmed by battling insulin resistance, diabetes develops. The strong association of increased fat, especially visceral fat, with diabetes makes this consequence particularly ominous for health care costs. The release of cytokines, particularly IL-6, from the fat cell may stimulate the proinflammatory state that characterizes obesity. The increased secretion of prothrombin activator inhibitor-1 from fat cells may play a role in the procoagulant state of obesity and, along with changes in endothelial function, may be responsible for the increased risk of cardiovascular disease and hypertension. For cancer, the production of estrogens by the enlarged stromal mass plays a role in the risk for breast cancer. Increased cytokine release may play a role in other forms of proliferative growth. The combined effect of these pathogenetic consequences of increased fat stores is an increased risk of shortened life expectancy.

Medical Consequences of Obesity

Obesity is chronic disease with important health and psycho-social consequences. The medical complications affect almost every body system (Figure 1). Evidence for these risks comes from both cross-sectional surveys and large, prospective studies following cohorts of men and women over decades. Body mass index (BMI) is most commonly used to determine obesity in such epidemiological studies, though waist circumference (or waist:hip ratio) is increasingly important.