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12 Cards in this Set
- Front
- Back
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Background Knowledge, Obesity
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Accumulation of excess fat relative to body size
Estimated by Body Mass Index -Wt (kilos)/ht2 (meters) -BMI >25 overweight, >30 obese -Waist Circumference also utilized, cut points less standardized Multifactorial etiology -Environmental, behavioral, hormonal, genetic -Obesity can not occur in the absence of an imbalance between energy consumption and expenditure! |
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Health Consequences of Obesity
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Type 2 diabetes
Cardiovascular Disease -hypertension, coronary heart disease, stroke Certain types of cancer -GI and Breast, among the common cancers Sleep apnea Osteoarthritis Gallbladder disease Fatty liver disease Pregnancy complications |
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How to Lose Weight
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Diet alone, diet plus exercise, and meal replacement strategies seem equivalent, and better than exercise alone or just minimal adivice
Drug therapy may be incrementally better, HOWEVER -Many meds withdrawn over safety concerns, especially cardiovascular outcomes -SCOUT RCT --Prior CVD and/or type 2 diabetes, age 55+, N=9804, double blind, 3.4 years duration --Better weight loss, however risk of CV outcome 11.4% in sibutramine vs. 10.0% in placebo (HR 1.16, 95%CI 1.03-1.31, p=0.02) FDA recently signaling that will require more outcomes data prior to approving new obesity drugs- Contrave, Qnexa most recently |
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Bariatric Surgery
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Surgical approaches to Weight Loss (Bariatric Surgery)
-Drastic, but dramatic weight loss, improvement in co-morbidities Bariatric surgery for the treatment of morbid obesity: a meta-analysis of weight loss outcomes for laparoscopic adjustable gastric banding and laparoscopic gastric bypass Obes Surg. 2009 Oct;19(10):1447-55 Most studies include carefully selected patients, and there is limited randomized trial data There is some immediate operative risk (including death), however suggestion that long-term reduction in CV, and mortality, makes this an acceptable risk/benefit calculation |
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Where to deliver lifestyle interventions and how to pay for it
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Commercial programs such as Weight Watchers do work for those adherent
Until very recently, obesity treatment not reimbursed by Medicare or private insurers Interest in using phones, internet, other modalities to assist with weight loss |
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Criteria for Diabetes Diagnosis*
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Random glucose > 200mg/dl with symptoms
Fasting glucose >126 mg/dl Post oral glucose challenge >200 mg/dl HBA1c level A1C ≥6.5%. The test should be performed in a laboratory using a method that is NGSP certified and standardized to the DCCT assay * Updated January 2010 |
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General Diabetes Trends
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Type 2 diabetes increasing prevalence in US and most other countries that are also increasing in obesity rate
T2DM prevalence in increases with age, and is more common in non-White race/ethnic groups in US Alarming suggestions that pediatric type 2 diabetes is increasing There is fairly good evidence that increased prevalence is due to increased INCIDENCE of DM, not just better treatment (leading to longer duration of disease) or increased screening |
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Consequences of Diabetes Mellitus
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Diabetes associated with 2X all-cause mortality rate twice
CVD is the leading cause of morbidity and mortality in diabetic adults Persons with DM have increased risk for: -Renal insufficiency/Failure -Lower leg arterial disease, infection, -Eye disease/ blindness -Neuropathy (esp hands/legs) -Amputation |
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ACCORD study
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Showed no real benefit to tight glucose control on CVD
Advocate controlling non-glycemic risk factors as primary strategy for treating CVD in people with diabetes |
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Non-Pharmacologic Therapy to prevent Type 2 Diabetes 2009
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Diabetes Prevention Program (RCT)
-Impaired glucose tolerance, adults (high risk) -Modest weight loss (5-10%) -Increased Physical Activity (+150min/wk) 59% Reduction in incidence of diabetes (compared to placebo arm) -Better than a drug (metformin), which reduced DM by 30% |
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Potential Public Health Approaches to DM control
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Diabetes Registries
-NYC- reporting of HbA1c -HMO based Assessing/rewarding DM control -HEDIS, Medicare quality measures Requiring insurers to pay for Diabetes Education, or public classes -Nutrition, other counseling |
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Diabetes Main Messages
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Persons with diabetes have rates of CVD two times higher those of people without diabetes.
Diabetes incidence, and thus prevalence, is increasing in US and other countries Type 2 diabetes can be prevented (in high risk adults)- shown in a trial, by weight loss and exercise |
