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The prevalence of type 2 diabetes continues to show a clear upward trend in Germany. In earlier days it was considered the "harmless diabetes of old age," but has become increasingly recognized as a disease carrying a high risk of vascular sequelae as well as shortening the diabetic's remaining life expectancy if adequate therapy is not initiated. In addition to correcting hyperglycemia, treatment consists in effective management of concomitant risk factors such as hypertension, dyslipidemia, and adiposity resulting from faulty nutrition and lack of exercise. In the large majority of overweight type 2 diabetics, metformin is the oral antidiabetic agent of first choice provided the patient does not exhibit renal insufficiency, which represents the most important contraindication. This recommendation for monotherapy of overweight type 2 diabetics is supported by an endpoint study. In contrast, no equivalent evidence is available on any of the possible options for oral combination therapy.
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PMID:[Oral diabetes treatment. Which substance is indicated at which time?]. 1553 16

Obesity has become an increasingly important public health problem. Recent evidence suggests that obesity has become a close second to tobacco use as a preventable cause of death in the United States. During the past decade an increase in the prevalence of type 2 diabetes in adolescents has been observed. The association of type 2 diabetes and obesity is well established and most adolescents with type 2 diabetes have body mass index (BMI) in a range that would already be considered obese in an adult. Childhood overweight is also associated with the atherosclerotic process. In the Bogalusa autopsy study, Berenson et al. found that the extent of fatty streaks and fibrous plaques in the aorta and coronary arteries was associated with BMI. There are three modalities currently available for the treatment of overweight in children and adolescents, including behavioral approaches, pharmacologic approaches, and surgical approaches. Surgical intervention may be considered if the BMI > or = 40 kg/m2 and a severe medical comorbidity including type 2 diabetes, obstructive sleep apnea or pseudotumor cerebri, or if the BMI is > or = 50 kg/m2 and comorbid conditions such as hypertension, dyslipidemia, or the metabolic syndrome are present. Behavioral intervention is usually made by a psychologist, behavioral therapist, dietician, or exercise physiologist. There is evidence that the effect of behavioral therapy for weight loss in childhood will be longer lasting than that seen in adults.
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PMID:Regulation of body mass and management of childhood overweight. 1570 Feb 53

Obesity is the most common nutritional disorder in the Western world. Actually, 250 million adults are obese, and 500 million adults and 22 million children under 5 years of age are overweight. Obesity is a complex trait, depending upon interactions between multiple genes and the environment, but its recent rise and "epidemic proportions" are, above all, the consequences of dramatic changes in lifestyle, socioeconomic progress, and political and cultural trends. Eating behavior has strong extraphysiological determinants, being influenced by neuroendocrine, nutritional, environmental, and cognitive stimuli, able to modify the body weight set-point. Health care professionals should be concerned about obesity, because of the well-established relations between excess body weight and pathologies such as type II diabetes, hypertension, atherosclerosis, osteoarthritis, dyslipidemia, and cancer, which afflict more and more people in the Western world--sort of "well-being syndromes." An overview of modern Western diets--the American, Mediterranean, Atkins, and Zone diets--reveals the contradictions existing about the correct and healthy approach to human nutrition and suggests a "return to Nature." From the actual artificial nutrition systems, based on cereals, milk, and their products, irrespective of our genome and metabolic attitudes, a simple diet based on natural food can be an ally in health maintenance and restoration.
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PMID:A natural diet versus modern Western diets? A new approach to prevent "well-being syndromes". 1571 28

The metabolic syndrome (MetS), characterized by a clustering of risk factors associated with insulin resistance and abdominal obesity, is associated with an increased risk of coronary heart disease and cardiovascular disease mortality. Persons with MetS have a wide spectrum of coronary heart disease risk and appropriate evaluation of risk using global risk algorithms. Measurement of other risk markers and subclinical disease is potentially needed to best set treatment goals and accompanying treatment regimens. The presence of MetS risk factors should be considered in global risk assessment. Clinical management emphasizes addressing underlying risk factors predisposing to MetS-specifically overweight/obesity and physical inactivity. Further recommendations are given for clinical risk factors, including atherogenic dyslipidemia, elevated blood pressure, insulin resistance/hyperglycemia, prothrombotic state, and proinflammatory state. Clinicians are recommended to assess MetS in their routine practice and to intensify efforts to adequately treat accompanying lifestyle and clinical risk factors.
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PMID:Intensified screening and treatment of the metabolic syndrome for cardiovascular risk reduction. 1572 94

The prevalence of overweight and obesity is increasing worldwide. During the last two decades, the prevalence of adults in the higher body mass index (BMI) categories in the US has increased the most, as much as 300% for those with a BMI above 40kg/m2. In children and adolescents, a doubling of the prevalence of severe overweight poses a serious health risk to future generations of young adults who may develop chronic diseases normally associated with aging. The simple definition of obesity, an imbalance between energy intake and energy expenditure, ignores the complexity of, and largely unknown interactions between, genes, food intake and physical activity, which together determine bodyweight and fat distribution. Although the etiology and manifestations of overweight and obesity are complex, the assessment of overweight and obesity requires only an accurate measurement of bodyweight, height and abdominal circumference, as well as a history and physical examination attuned to the morbidities that commonly accompany overweight and obesity such as diabetes mellitus, hypertension, dyslipidemia and sleep apnea. The treatment of patients with overweight and obesity continues to be based on changes to diet and physical activity. Simple behavior modification techniques are within the reach of busy clinicians. The additional use of available bodyweight reduction medications can reliably lead to a 5 to 10% reduction from initial bodyweight, a loss that has been shown to provide significant health benefit. The use of meal replacements has also been shown to be effective and is probably an under-appreciated treatment resource. Surgery is the most successful treatment for those with severe obesity and should be discussed as an option for those in the appropriate bodyweight categories. Because societal trends favor the greater intake of calorie-dense foods and less physical activity to accomplish the activities of daily life, the future of obesity treatment will require the development of bodyweight reduction medications that work by a variety of mechanisms to decrease food intake or increase energy expenditure. Such medications should not be viewed as a 'crutch' but rather as a 'helping hand' that enable people to better adhere to a healthier lifestyle.
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PMID:Strategies for the management of patients with obesity. 1576 18

The prevalence of overweight among children and adolescents has dramatically increased. There may be vulnerable periods for weight gain during childhood and adolescence that also offer opportunities for prevention of overweight. Overweight in children and adolescents can result in a variety of adverse health outcomes, including type 2 diabetes, obstructive sleep apnea, hypertension, dyslipidemia, and the metabolic syndrome. The best approach to this problem is prevention of abnormal weight gain. Several strategies for prevention are presented. In addition, treatment approaches are presented, including behavioral, pharmacological, and surgical treatment. Childhood and adolescent overweight is one of the most important current public health concerns.
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PMID:Overweight in children and adolescents: pathophysiology, consequences, prevention, and treatment. 1583 36

The metabolic syndrome represents the association in a single individual of a cluster of metabolic and hemodynamic factors, leading to an increased risk of type 2 diabetes and/or cardiovascular diseases. Several definitions exist (WHO, EGIR, NCEP-ATP III, AACE), but all of them include a cluster of criteria (hyper glycemia or type 2 diabetes, arterial hypertension, dyslipidemia, abdominal obesity) which increased these risks in parallel to their aggregation. The prevalence of the metabolic syndrome in industrialized countries represents 10 to 30% of the adult population, depending on the definition used and of the range of age, with a regular progression, particularly in women. Thus, it is needed to identify subjects with metabolic syndrome in the general population, and not only in overweight/obese subjects. This review, briefly presents the main definitions, as well as current data on pathophysiology, prevalence and consequences of the metabolic syndrome. Steps to diagnose it and guidance for the therapeutic management of metabolic syndrome in primary care practice are described.
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PMID:[How to manage the metabolic syndrome?]. 1595 95

The prevalence of obesity in industrialized countries has reached epidemic proportions, with about one in three people being obese and another one in three people being overweight and at risk of developing obesity. In recent years, obesity has gained the traditional tetrad of cardiovascular risk factors of smoking: hypertension, dyslipidemia, and dysglycemia. Attention has also focused on the importance of abdominal (or central) obesity as a determinant of cardiovascular risk, independent of the body mass index. In addition to effects on coronary artery disease, obesity has an effect on cardiovascular disease, including stroke, ventricular function, peripheral arterial disease, and venous thromboembolism. The objectives of this review are to summarize the effects of obesity on cardiovascular disease, and the possible mechanisms for these associations, and to investigate the effects of weight-loss interventions on the burden of cardiovascular disease. Large ongoing clinical outcome trials, such as the SOS study, the Look-AHEAD trial, or the SCOUT study, should provide important information on the effects of surgical and nonsurgical obesity treatment on cardiovascular morbidity and mortality.
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PMID:Obesity and cardiovascular disease: pathogenic mechanisms and potential benefits of weight reduction. 1596 77

Despite the importance of randomized, dose-response studies for proper evaluation of effective clinical interventions, there have been no dose-response studies on the effects of exercise amount on abdominal obesity, a major risk factor for metabolic syndrome, diabetes, and cardiovascular disease. One hundred seventy-five sedentary, overweight men and women with mild to moderate dyslipidemia were randomly assigned to participate for 6 mo in a control group or for approximately 8 mo in one of three exercise groups: 1) low amount, moderate intensity, equivalent to walking 12 miles/wk (19.2 km) at 40-55% of peak oxygen consumption; 2) low amount, vigorous intensity, equivalent to jogging 12 miles/wk at 65-80% of peak oxygen consumption; or 3) high amount, vigorous intensity, equivalent to jogging 20 miles/wk (32.0 km). Computed tomography scans were analyzed for abdominal fat. Controls gained visceral fat (8.6 +/- 17.2%; P = 0.001). The equivalent of 11 miles of exercise per week, at either intensity, prevented significant accumulation of visceral fat. The highest amount of exercise resulted in decreased visceral (-6.9 +/- 20.8%; P = 0.038) and subcutaneous (-7.0 +/- 10.8%; P < 0.001) abdominal fat. Significant gains in visceral fat over only 6 mo emphasize the high cost of continued inactivity. A modest exercise program, consistent with recommendations from the Centers for Disease Control/American College of Sports Medicine (CDC/ACSM), prevented significant increases in visceral fat. Importantly, a modest increase over the CDC/ACSM exercise recommendations resulted in significant decreases in visceral, subcutaneous, and total abdominal fat without changes in caloric intake.
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PMID:Inactivity, exercise, and visceral fat. STRRIDE: a randomized, controlled study of exercise intensity and amount. 1600 76

The aim of the review is to determine complex relations between obesity and disability. Obesity is defined as an abnormal, pathologic increase in body fat. This disease results from environmental factors, like: low level of physical activity, excessive intake of high energy food and genetic predisposition to storage of fat. The health consequences of obesity are chronic diseases: diabetes mellitus type 2, dyslipidemia, coronary heart disease, gallbladder disease, osteoarthritis, sleep apnea, certain types of cancers and also psychosocial problems, which together have an adverse effect on quality of life. The consequences of this comorbidities and conditions are also higher rates of disability in this group of people. Limitations in everyday functioning of the overweight and obese people are the consequence of comorbidities, for example: diseases of the circulatory system and late diabetic complications. The leading cause of disability (especially in functional area) is impairement of the musculoskeletal system, caused by excessive weight, for ex. chronic back pain. In this case the mechanism of "vicious cycle" is observed where sedentary lifestyle contributes to obesity and obesity exacerbates disability. The role of physical inactivity in the development of weight gain emphasises the fact that among people with disabling conditions rates of obesity are significantly higher.
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PMID:[Obesity as a cause and result of disability]. 1601 21


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