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Query: UMLS:C0028754 (obesity)
 124,988 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Metabolic abnormalities and obesity have long been associated with the development of cardiovascular disease in the general population. These same features are also associated with polycystic ovary syndrome (PCOS). An increased prevalence of hypertension, dyslipidaemia, obesity and hyperinsulinaemia, as well as changes in coagulation and blood vessel function, provide an explanation as to why women with PCOS are at an increased risk of developing cardiovascular disease over the long term.
Best Pract Res Clin Obstet Gynaecol 2004 Oct
PMID:Long-term metabolic, cardiovascular and neoplastic risks with polycystic ovary syndrome. 1538 Jan 48

Recent international agreement on the definitions of polycystic ovary syndrome (PCOS) has helped to clarify the clinical approach to diagnosis of PCOS. However, in the precise assessment of an individual patient it is still necessary for a detailed history of menstrual disorder (especially oligo- and amenorrhoea and anovulatory dysfunctional uterine bleeding), infertility or miscarriage, hyperandrogenism (mainly acne, hirsutism and scalp hair loss, distinguished from virilization) and obesity supplemented by the demonstration of polycystic ovaries on transvaginal ultrasound scanning. Assessment of endocrine changes in serum levels of luteinizing hormone, follicle stimulating hormone, oestradiol and prolactin, plus appropriate measures of circulating androgens (especially total and free testosterone, sex hormone binding globulin, 17 hydroxy-progesterone, dehydro-epiandrosterone sulphate and sometimes a 24-hour urinary free control) might help in further defining the abnormalities. Assessment of ovulatory status, obesity (body mass index and waist-hip ratio) and insulin resistance (oral glucose tolerance test with serum insulin levels) are also important in most cases. PCOS is a highly variable condition and investigation and management needs to be individualized. Long-term follow-up is also to a great extent dictated by the constellation of symptoms and clinical features of individual patients, but potential long-term hazards should be defined and patients warned of these.
Best Pract Res Clin Obstet Gynaecol 2004 Oct
PMID:Current recommendations for the diagnostic evaluation and follow-up of patients presenting with symptomatic polycystic ovary syndrome. 1538 Jan 49

The increased incidence of obesity makes it imperative to understand the regulation of food intake and body weight. We review the signals that interact with the brain to control energy homeostasis, i.e. energy intake and expenditure. Three broad categories can be distinguished. Signals generated in the gastrointestinal tract during meals ('satiety' signals, e.g. cholecystokinin) elicit satiation and contribute to stopping the meal. The potency of these acutely acting signals must be increased if they are to be used therapeutically. Hormonal signals whose secretion is proportional to body fat (adiposity signals, leptin and insulin) robustly reduce food intake and body weight by directly stimulating receptors locally in the brain. Therapeutic applications will have to find ways to circumvent the systemic actions of these hormones, targeting only the brain. Satiety and adiposity signals interact with neuronal circuits in the brain that utilize myriad neurotransmitters to cause net catabolic or anabolic responses. Considerable effort is being directed towards finding ways to intervene in specific circuits to help accomplish weight loss.
Best Pract Res Clin Endocrinol Metab 2004 Dec
PMID:Clinical endocrinology and metabolism. Regulation of energy homeostasis by peripheral signals. 1553 72

The 42 amino acid polypeptide glucose-dependent insulinotropic polypeptide/gastric inhibitory polypeptide (GIP) is released from intestinal K-cells in response to nutrient ingestion. Based on animal studies, the peptide was initially assumed to act as an endogenous inhibitor of gastric acid secretion. Later it was found that GIP is capable of augmenting glucose-stimulated insulin secretion, and subsequent studies provided evidence that, in humans, the peptide predominantly acts as an incretin hormone. A role for GIP in the regulation of lipid homeostasis and in the development of obesity has been inferred from different animal studies. While GIP strongly stimulates insulin release in healthy humans, the peptide has almost completely lost its insulinotropic effect in patients with type 2 diabetes. This is different from the actions of glucagon-like peptide 1, which stimulates insulin secretion even in the later stages of type 2 diabetes. This suggests that a diminished insulinotropic effect of GIP may contribute to the pathogenesis of type 2 diabetes. This review will summarize the actions of GIP in human physiology and discuss its role in the pathogenesis of type 2 diabetes, as well as the therapeutic options derived from these findings.
Best Pract Res Clin Endocrinol Metab 2004 Dec
PMID:Clinical endocrinology and metabolism. Glucose-dependent insulinotropic polypeptide/gastric inhibitory polypeptide. 1553 77

Low carbohydrate diets are gaining popularity, however there is no clear consensus regarding their safety and efficacy for weight loss. Proponents of these diet plans advocate dramatic reductions in carbohydrate intake to combat insulin resistance and hyperinsulinaemia, which they claim are responsible for obesity. There are no long-term studies that directly compare the weight loss potential of low versus higher carbohydrate diets. Evidence from randomized controlled trials suggests that low carbohydrate diets may enable short-term weight loss by facilitating reduced energy intakes, however poor dietary compliance may prevent long-term success. Unbalanced nutrient profiles may increase the risk of adverse health consequences in adherents. Low carbohydrate diets should not be recommended at this time due to a lack of adequate long-term follow up data. Successful weight loss occurs through the creation of a sustained energy deficit, and should be achieved through a combination of exercise and a nutritionally balanced and varied diet.
Best Pract Res Clin Gastroenterol 2004 Dec
PMID:Is there an optimal macronutrient mix for weight loss and weight maintenance? 1556 37

Eating disorders (anorexia nervosa, bulimia nervosa, and binge eating disorder) are regarded as psychiatric syndromes that have some relationship to obesity. This review describes current clinical and scientific knowledge concerning the clinical descriptions of these disorders, etiology of each disorder, diagnostic signs, and treatment approaches that have been found to be efficacious. Anorexia nervosa is a very serious eating disorder that is associated with severe medical complications. Anorexia nervosa is very difficult to successfully treat, even when intensive inpatient methods are used. Bulimia nervosa and binge eating disorder are typically less severe eating disorders and are more easily treated using outpatient therapy. Pharmacotherapy has not been found to be an effective treatment for anorexia nervosa, but it has been used successfully with bulimia nervosa and binge eating disorder. Psychotherapy approaches have been successfully employed for all three eating disorders. The review concludes with an integrative perspective that illustrates the similarities and differences of the eating disorders and obesity.
Best Pract Res Clin Gastroenterol 2004 Dec
PMID:Psychological aspects of eating disorders. 1556 39

Non-alcoholic fatty liver disease (NAFLD) is a frequent syndrome encompassing fatty liver alone and steatohepatitis (NASH). Often asymptomatic, the suspicion arises because of abnormal aminotransferases or a bright liver on abdominal ultrasound. It should be suspected during evaluation of associated conditions as obesity, diabetes or dyslipidaemia. The diagnostic evaluation must exclude other potential causes of liver disease and may include a liver biopsy, the only method able to confirm features of necroinflammation and fibrosis that define NASH and its prognostic implications. Indeed, the presence of necroinflammation has been associated with a significant risk of progression to cirrhosis and eventually hepatocellular carcinoma. Age >45 years, obesity and diabetes have also been associated with an increased risk of liver fibrosis and progression to cirrhosis. Given the high prevalence of NAFLD, general measures of life-style changes, focusing on exercise, diet, and total alcohol abstinence, should be implemented before a liver biopsy is considered.
Best Pract Res Clin Gastroenterol 2004 Dec
PMID:Non-alcoholic fatty liver disease/non-alcoholic steatohepatitis (NAFLD/NASH): diagnosis and clinical course. 1556 40

Obesity has, among physicians, since long been considered to cause gastro-oesophageal reflux. The evidence in support of this belief has been scarce, however. During the last few years some population-based studies have addressed this clinically important issue. These studies demonstrated a clear and dose-dependent association between increasing degrees of overweight and gastro-oesophageal reflux. The mechanisms by which obesity causes reflux are unknown, although there is some limited data suggesting that hiatal hernia may be the causal link between obesity and reflux. Moreover, some evidence has been presented showing that obesity is clearly a stronger risk factor among women than among men, and that the relation between overweight and reflux is substantially augmented by postmenopausal hormone therapy. The data so far available point in the direction of oestrogens, the activity of which is strengthened by increasing body mass, being responsible for this effect. If the results are repeated in future studies, postmenopausal therapy might be avoided among obese females suffering from severe reflux. Weight-reduction seems to reduce the risk of symptomatic gastro-oesophageal reflux disease, indicating that such strategy might be a useful tool in the treatment of reflux.
Best Pract Res Clin Gastroenterol 2004 Dec
PMID:The relation between body mass and gastro-oesophageal reflux. 1556 42

At the beginning of the 21st Century, obesity has become the leading metabolic disease in the World. So much so, that the World Health Organisation refers to obesity as the global epidemic. In fact, obesity is a common disease affecting not only affluent societies but also developing countries. Currently 300 million people can be considered as obese and, due to the rising trend in obesity prevalence, this figure could double by year 2025 if no action is taken against this threat. In terms of health impairment, the importance of obesity lies in the fact that, besides being a disease in itself, it is a risk for many other diseases, mainly from the metabolic and cardiovascular area. Among these, type 2 diabetes, dyslipemia, hyperuricemia, arterial hypertension and cardiovascular disease are the most frequent. Also, respiratory diseases such as obesity hypoventilation syndrome and obstructive sleep apnoea syndrome are strongly associated with obesity.
Best Pract Res Clin Gastroenterol 2004 Dec
PMID:Obesity: epidemiology and clinical aspects. 1556 43

Conservative treatment has been shown in long-term studies to be ineffective in morbid obesity. Surgical treatments break down into restrictive, malabsorptive, combined restrictive and malabsorptive or motility-reducing procedures. Laparascopic implantation of an adjustable gastric band is an efficient restrictive measure for treating the majority of patients with this condition. The adjustable gastric band enables weight loss and food intake to be adapted to the individual patient's need. Eighty percent to 90% of these patients can expect to lose 55-70% of their excess weight. Vertical banded gastroplasty is losing ground among the restrictive options. Preliminary experiences are encouraging but the long term results are disappointing when assessed by the standard criteria. Gastric bypass is gaining ground in Europe and a standard procedure in USA. This operation is estimated to give 70-80% excess weight loss and provide better quality of life than restrictive procedures. The biliopancreatic diversion with duodenal switch combines a sleeve gastrectomy with a duodenoileal switch to achieve maximum weight loss. Consistent excess weight loss between 70 and 80% is achieved with acceptable decreased long-term nutritional complications. The laparoscopic approach to this procedure has successfully created a surgical technique with optimum benefit and minimal morbidity, especially in the super obese patient. Intra-gastric stimulation is the least invasive surgical procedure at present. However, the excess weight loss is lowest with this method at only 32% in the first 2 years after the operation. Provided safety recommendations are observed, laparoscopic operations for obesity are fairly low-risk. The mortality rate in centres with experienced staff is less than 0.3%. Surgical treatment for obesity has proved that it is the best and most effective means of preventing the life-threatening complications and serious degenerative problems associated with morbid obesity. There is no one operation that is effective for all patients.
Best Pract Res Clin Gastroenterol 2004 Dec
PMID:Obesity: surgical options. 1556 44


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