Obesity

Obesity Dr Thomas Fox SpR Endocrinology Royal Cornwall Hospital

Introduction ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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Definition of obesity Body Mass Index (kg/m 2 ) Category <18.5 Underweight 18.5-25 Healthy weight 25-30 Overweight 30-35 Grade 1 obese 35-40 Grade 2 obese >40 Grade 3 obese

BMI ,[object Object],[object Object],[object Object],[object Object]

Waist circumference ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

A global epidemic ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Health Survey England 2005 (HSE) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Gender, age and obesity in UK ,[object Object],[object Object],[object Object]

Ethnicity and Obesity rates BMI>30kg/m 2 (UK) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Social class and obesity ,[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Causes of obesity - food ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Percentage change in amount of food and energy contained between 1985-95 in Australia

Between 1985-95 in Australian children (Magarey et al 2005) ,[object Object],[object Object],[object Object],[object Object]

Australian National Nutritional Survey of Children 1995 - snapshot ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Causes of obesity – physical activity (HSE 2005) ,[object Object],[object Object]

Influence of genetic and environmental factors on prevalence of type 2 diabetes (Schulz LO et al 2006) Arizona Pima Indians N=888 Mexican Pima Indians n-=223 Mexicans N=193 BMI (kg/m 2 ) 34.6 25.1 25.8 Calorie intake (kcal/day) 1751 2458 2593 Lipid intake (%) 36.3 26.3 25.6 Physical activity (hr/week) 7 27 27 Prevalence TIIDM (%) 38.1 7.1 2.6

“ It’s my metabolism Doctor” ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Leptin ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Pharmacological causes of obesity ,[object Object],[object Object],[object Object],[object Object],[object Object]

Endocrine causes of obesity ,[object Object],[object Object],[object Object],[object Object],[object Object]

Cushing’s syndrome ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Cushings and obesity ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Exogenous glucocorticoids ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Prader-Willi syndrome ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Laurence-Moon syndrome ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Health effect of obesity ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Management of obesity ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Aims of weight loss ,[object Object],[object Object],[object Object],[object Object],[object Object]

Diet ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Low calorie diets ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Very low calorie diets ,[object Object],[object Object],[object Object],[object Object],[object Object]

Low carbohydrate diets ,[object Object],[object Object],[object Object],[object Object],[object Object]

Samaha et al, NEJM 2003 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Meta-analysis: the effect of dietary counselling for weight loss. Dansinger ML et al 2007 ,[object Object],[object Object],[object Object]

Exercise ,[object Object],[object Object],[object Object],[object Object]

Exercise ,[object Object],[object Object]

Pharmacotherapy ,[object Object],[object Object],[object Object],[object Object]

Sibutramine ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Orlistat ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Bariatric surgery ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Roux-en-Y ,[object Object],[object Object],[object Object]

Adjustable vertical banding gastroplasty ,[object Object],[object Object]

Swedish Obese Subjects ,[object Object],[object Object],[object Object],[object Object],[object Object]

SOS 10 years ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Banding vs RYGB ,[object Object],[object Object],[object Object]

Obesity and diabetes ,[object Object],[object Object],[object Object]

Prevalence of diabetes 2008 ,[object Object],[object Object],[object Object],[object Object]

Glycaemic control and exercise ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Weight gain in treatment of diabetes ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Insulin ,[object Object],[object Object],[object Object],[object Object],[object Object]

Sulphonylureas ,[object Object],[object Object]

Pioglitazone ,[object Object],[object Object]

Newer therapies ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

GLP-1 ,[object Object],[object Object],[object Object],[object Object],[object Object]

DPP-4 inhibitors ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

GLP-1 agonists ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Incretin levels and effect are markedly increased 1 month following Roux-en-Y gastric bypass surgery in obese patients with type II diabetes ( Laferere et al 2007) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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Obesity summary ,[object Object],[object Object],[object Object],[object Object]

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