Obesity and Obesity Clinic Endocrinology Metabolism Dol Mi

Obesity and Obesity Clinic Endocrinology & Metabolism Dol Mi Kim

Determination of besity Body Mass Index = Height(kg)/Weight(m 2) 18. 5 UW NW 23 OW 25 30 GIOB GIIOB 35 HGOB Obesity-related comorbidities World Health Organization, 1998

Bailliere’s Clin Endocrinol Metab 1999; 13(I): 71 -92

Determination of Regional Fat Waist Circumference M > 90 cm ( >35인치) F > 80 cm ( >31인치) 85 cm? Abdominal obesity middle-aged men postmenopausal women Abdominal obesity ‡ Visceral obesity Metabolic risk

Obesity is a problem of health!

The comorbidities related to obesity include; type 2 diabetes (T 2 D), hypertension, coronary heart and cerebrovascular disease, respiratory disease(mainly obstructive sleep apnea), osteoarthritis (OA), several types of cancer, Asthma?

Relationship between BMI and RR of T 2 D, HTN, CAD

Prediabetes; Impaired Fasting Glucose

Respiratory Disease Excess fat deposition in the neck, chest wall and abdomen adverse mechanical effects on lung function with reduced chest wall and diaphragm movement reduced lung volumes and mismatching of lung ventilation and perfusion (VQ mismatching)

Obstructive Sleep Apnea • during sleep, collapse with consequent hypoxia until the apnea resolves with the airway becoming patent again • smaller upper airways (greater soft tissue deposition around the pharynx) + impaired respiratory mechanics apneic episodes • particularly during rapid eye movement (REM) sleep daytime drowsiness

Gallbladder Stones • particularly in morbidly obese women - a sevenfold increased risk • due both to altered bile composition and to impaired GB emptying • Rapid weight loss (>3 kg per week) may increase the risk of symptomatic gallstones due to the effects such diets have to reduce GB emptying

Factors Related to Increased Gallstone Formation in the Obese • Diet and diet composition Increased dietary cholesterol and fat Decreased dietary fiber • Weight loss and weight cycling (the rate of weight loss or regain) • Inactivity • Fat distribution • Gastric surgery International Textbook of Obesity 2001

Osteoarthritis of weight-bearing joints • knees, rather than the hips • Greater BMI at ages 20 -29 years predicts the risk of subsequent knee osteoarthritis better than current weight

Cancer • Breast (esp. Post-menopausal) and endometrial cancers in women • colorectal and prostate cancers in men • excess body weight and physical inactivity account for approximately 1/4 to 1/3 of breast, colon, endometrium, kidney, and esophagus cancers • increased availability of estrogens derived from synthesis from androgens in adipose tissue may increase tumor growth • the enhanced risk of endometrial cancer with raised estrogens unopposed by progesterone

Reproductive Function • Menstrual irregularities and infertility • insulin resistance (esp. PCOS) • Moderate weight loss and reduction of abdominal fat improve menstrual irregularities, ovulatory function and fertility • Weight loss should be promoted as an initial treatment option for obese women with infertility • Obesity is a major risk factor for the development of GDM and PIH

Anti-obesity Stategies • • • Calorie-reduction Regular exercise Life-style modification Mineral supplementation Weight-reducing drugs Bariatric surgery

Action Mechanism of Sibutramine

Effects of Sibutramine

Side Effects of Sibutramine • • Dry mouth Constipation headache Mild elevation of blood pressure Nonresponders /Resistance to Tx • Excessive drinkingbinge eating • inactivity • Great expectations • Sensitive to side effects • High cost • Poor compliance • Secondary obesity

Bariatric Surgery -Roux-en Y Gastric Bypass Procedure Indication; Morbidly obese (BMI>40) Complicated(BMI>35) Refractory to medical Tx Abdominally obese Results; 85% achieve weight loss of almost 2/3 of excess weight within 1 year with correction of comorbidities