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Query: UMLS:C0011849 (diabetes)
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Overweight and obesity may develop in individuals with genetically determined low resting energy expenditure. Drugs are among the recognised precipitating factors. The obesity promoting impact of beta-blockers is, however, less well known. Resting energy expenditure, and thermogenesis induced by stimuli such as meals, cold and heat exposure, stress and anxiety, have a facultative component mediated by the sympathoadrenal system through catecholamines working on beta-adrenoceptors. Treatment with beta-blockers reduces the facultative thermogenesis by 50-100 kcal/d, which corresponds to the weight gain of 2-5 kg/year reported in clinical trials. Treatment with beta-blockers also results in insulin resistance, which may aggravate existing diabetes and elicit diabetes in predisposed patients. Overweight and obesity are frequently complicated with hypertension and angina pectoris, which are often treated with beta-blockers. Obesity is associated with a defective sympathetic activity, and treatment with beta-blockers may further reduce facultative thermogenesis and promote weight gain. The consequence may be aggravation of hypertension, insulin resistance and other atherogenic factors. The causal therapy of android overweight and obesity complicated with diabetes or hypertension is a sufficient weight loss. If pharmacological treatment is inevitable, combined treatment with diuretics and ACE-inhibitors are most appropriate.
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PMID:[Obesity and diabetes as side-effects of beta-blockers]. 197 28

Overweight and obesity have been examined in 7735 middle-aged men in 24 British towns. Half the men exceeded the body mass index (BMI) range associated with minimum mortality (20-25 kg/m2). Social class differences in BMI were marked and obesity was more marked in manual workers. The association of reduced BMI with cigarette smoking and of increased BMI with stopping smoking was most clearly seen in manual workers. With increasing alcohol intake, BMI increased progressively, but the effect in the heaviest drinkers was probably diminished by concurrent heavy smoking. Mean BMI decreased with increasing levels of physical activity. There was considerable variation in the rate of obesity between the towns, from 11 to 28 per cent, determined to some extent by social class. Positive associations were observed between BMI and the presence of ischaemic heart disease, high blood pressure, gout, arthritis and gallbladder disease but not with diabetes mellitus. Peptic ulcer was inversely related to BMI and bronchitis showed a curvilinear relationship. For these men, overweight or obesity is virtually 'normal', and a considerable health education effort will be needed to produce a leaner, healthier society.
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PMID:Overweight and obesity in middle-aged British men. 338 26

Overweight and obesity are associated with several important diseases, including diabetes, cardio- and cerebrovascular diseases, digestive disorders and cancer. We decided, therefore, to present estimates of the prevalence of overweight and obesity in the general Italian population. The prevalence of overweight and obesity in Italy was evaluated using data from the 1990-91 Italian National Health Survey. 25,818 households were surveyed, representing the whole Italian population. A sample of 24,602 males and 26,090 females aged 15 or over was randomly selected, within strata of geographical area, size of municipality and size of household, in order to be fully representative. Quetelet's index was considered as a measure of body mass index, on the basis of self reported height and weight, and was a priori divided into four levels: underweight (< 20 kgm-2), normal weight (20 to 24.9 kgm-2), overweight (25 to 29.9 kgm-2), and obese (> or = 30 kgm-2). In the overall national sample, 11.0% of subjects were underweight (4.4% males, 12.2% females), 50.8% normal weight (49.4% males, 52.2% females), 31.6% overweight (39.2% males, 24.5% females), and 6.5% obese (7.0% males, 6.1% females). The prevalence of overweight and obesity was higher in middle age and in the South of the country, and was directly related to history of diabetes, hypertension, heart diseases, gallbladder disease and chronic respiratory disorders. These data quantify the importance of overweight and obesity as a public health issue in the general Italian population.
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PMID:Overweight and obesity in Italy, 1990-91. 786 61

Overweight and obesity are generally considered to have a negative impact on longevity because of their association with many diseases, including hypertension, diabetes, coronary artery disease, osteoarthritis, and certain types of cancer. Nevertheless, some authors, notably Ancel Keys, have concluded that being overweight improves one's chances for longevity. I studied 122 consecutive patients who had comprehensive geriatric assessment with regard to their body mass index, responses to Wolinsky's Nutritional Risk Index, and serum albumin levels. There was a high prevalence of overweight (60% of men and 45.6% of women). This fact, coupled with the observed low prevalence of underweight subjects, tends to support Keys' statement concerning the benefit of being overweight. However, the relative absence of significant obesity supports the impression that significantly obesity reduces prospects for longevity. Although serum albumin measurements were obtained for only 38 subjects, the fact that the value was low in only one instance--in the case of a person who was seriously ill--suggests that obtaining routine serum albumin measurements in ambulatory, community-dwelling elderly people is not cost-effective.
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PMID:Assessment of nutritional status and obesity in elderly patients as seen in general medical practice. 836 44

The aim of this study was to estimate the coexistence of risk factors for coronary heart disease (CHD) in hyperlipidemic patients. Studies were performed in 1002 (601 women, 401 men) subjects who referred to our outpatient clinic among 12 months. Hypercholesterolemia was the predominant lipid disorder found in 66% of patients, mixed hyperlipidemia in 31.8%, and hypertriglyceridemia only in 2.2%. Overweight and obesity remain a major health burden among our patients: BMI > or = 25 was observed in 66%. Hypertension was recognized in 37.5% of subjects, and diabetes mellitus in 11.2%, 17% were long-term smokers. Familial aggregation of hyperlipidemia was observed in 15.7% of subjects, and more than 44% had a positive family history of cardiovascular disease. Low HDL cholesterol levels (< 35 mg/dl) were seen frequently in men (24.7%) and rare in women (7%). Lp(a) excess (> or = 30 mg/dl) was observed in 12% of patients. Myocardial infarction (MI) had already 11.7% subjects (7% women, 18.7% men). In these patients CHD risk factors were observed more frequently. The higher apo B and Lp(a) levels and lower HDL cholesterol levels were recognized in the patients who suffered from MI. More than 83% of our hyperlipidemic patients had coexistence CHD risk factors. The multiple coexisting risk factors cause the high risk for CHD and they require intensive correction.
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PMID:[Risk factors for coronary heart disease in 1002 patients with hyperlipidemia]. 941 22

Physicians are reluctant to treat obesity despite the rapid increase in its prevalence in the UK and its associated health problems such as diabetes, coronary heart disease and hypertension. Overweight and obesity are chronic conditions that require long-term treatment. Any therapeutic programme should combine dietary restriction with physical activity and alterations to lifestyle. The use of pharmacological treatment as an adjunct to conventional treatment modalities is justified in certain circumstances. The criteria applied for the prescription of an anti-obesity drug should be comparable to that applied to the treatment of other relapsing disorders. The objective of the Royal College of Physicians' new report, Clinical management of overweight and obese patients with particular reference to the use of drugs, is the provision of such necessary guidance. Based on evidence from clinical trials, the recommendations of the report utilise a 12-week goal (outside a drug trial) of 5% body weight loss from the start of drug treatment. Failure to achieve this goal is an indication for stopping drug therapy. Safety and efficacy demand appropriate use of anti-obesity drugs in a supervised setting with clinicians weighing up likely medical benefit against possible risks.
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PMID:Prescribing for obesity. Comment on the Royal College of Physicians' Working Party report on clinical management of overweight and obese patients with particular reference to drugs. 1019 66

Overweight and obesity represent a rapidly growing threat to the health of populations in an increasing number of countries. Indeed they are now so common that they are replacing more traditional problems such as undernutrition and infectious diseases as the most significant causes of ill-health. Obesity comorbidities include coronary heart disease, hypertension and stroke, certain types of cancer, non-insulin-dependent diabetes mellitus, gallbladder disease, dyslipidaemia, osteoarthritis and gout, and pulmonary diseases, including sleep apnoea. In addition, the obese suffer from social bias, prejudice and discrimination, on the part not only of the general public but also of health professionals, and this may make them reluctant to seek medical assistance. WHO therefore convened a Consultation on obesity to review current epidemiological information, contributing factors and associated consequences, and this report presents its conclusions and recommendations. In particular, the Consultation considered the system for classifying overweight and obesity based on the body mass index, and concluded that a coherent system is now available and should be adopted internationally. The Consultation also concluded that the fundamental causes of the obesity epidemic are sedentary lifestyles and high-fat energy-dense diets, both resulting from the profound changes taking place in society and the behavioural patterns of communities as a consequence of increased urbanization and industrialization and the disappearance of traditional lifestyles. A reduction in fat intake to around 20-25% of energy is necessary to minimize energy imbalance and weight gain in sedentary individuals. While there is strong evidence that certain genes have an influence on body mass and body fat, most do not qualify as necessary genes, i.e. genes that cause obesity whenever two copies of the defective allele are present; it is likely to be many years before the results of genetic research can be applied to the problem. Methods for the treatment of obesity are described, including dietary management, physical activity and exercise, and antiobesity drugs, with gastrointestinal surgery being reserved for extreme cases.
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PMID:Obesity: preventing and managing the global epidemic. Report of a WHO consultation. 1123 59

Overweight and obesity are associated with the development of type 2 diabetes. Thus, it is important for clinicians to accurately measure and monitor the body composition of at-risk individuals and patients with diabetes. This article reviews valid and reliable field methods and prediction equations for assessing the body composition of obese individuals, as well as persons with type 2 diabetes. We also reviewed research that assessed the validity of practical methods in estimating the body composition of individuals with either type 1 or type 2 diabetes.
Diabetes Technol Ther 1999
PMID:Assessing body composition of adults with diabetes. 1147 75

Overweight and obesity in children is epidemic in North America and internationally. Approximately 22 million children under 5 years of age are overweight across the world. In the United States, the number of overweight children and adolescents has doubled in the last two to three decades, and similar doubling rates are being observed worldwide, including in developing countries and regions where an increase in Westernization of behavioral and dietary lifestyles is evident. Comorbidities associated with obesity and overweight are similar in children as in the adult population. Elevated blood pressure, dyslipidemia, and a higher prevalence of factors associated with insulin resistance and type 2 diabetes appear as frequent comorbidities in the overweight and obese pediatric population. In some populations, type 2 diabetes is now the dominant form of diabetes in children and adolescents. Disturbingly, obesity in childhood, particularly in adolescence, is a key predictor for obesity in adulthood. Moreover, morbidity and mortality in the adult population is increased in individuals who were overweight in adolescence, even if they lose the extra weight during adulthood. Although the cause of obesity in children is similar to that of adults (i.e., more energy in vs. energy utilized), emerging data suggest associations between the influence of maternal and fetal factors during intrauterine growth and growth during the first year of life, on risk of later development of adult obesity and its comorbidities. In addition, recent data suggest that varying biological responses in different racial/ethnic groups differently contribute to overweight, obesity, and their comorbidities. Although differences in gene-nutrient interactions may contribute, the role of varying cultural and socioeconomic variables still needs to be determined to understand these disparities. Novel approaches in the prevention and treatment of childhood overweight and obesity are urgently required. With the strong evidence that a lifecycle perspective is important in obesity development and its consequences, consideration must be focused on prevention of obesity in women of child-bearing age, excessive weight gain during pregnancy, and the role of breast-feeding in reducing later obesity in children and adults. Consideration must be given to family behavior patterns, diet after weaning, and the use of new methods of information dissemination to help reduce the impact of childhood obesity worldwide.
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PMID:Childhood obesity: the health issue. 1170 48

Overweight and obesity have become a frequent phenomenon among pregnant women during last thirty years. They result in increased morbidity rates of different chronic, health- or even life-threatening diseases. Among different perinatal complications associated with obesity the most important are: hypertension, diabetes, varices, cholecystolithiasis, prolonged pregnancy, intrauterine growth retardation. Increased rates of operative deliveries, intrapartal and postpartal infections, thrombotic complications, anaemia, urinary infections and lactation disorders can be observed.
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PMID:[Overweight and obesity as the risk factor in perinatology]. 1188 35


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