Obesity Management: Lifestyle Modification/Bariatric Surgery

Comparison of Diets: 12-Month Weight Loss a Atkins n=77 Weight Loss (kg) Zone n=79 b LEARN n=79 b Ornish n=76 b

Stephen N. Jones, MD, FRCP Chief, Division of Diabetes, Endocrinology and Metabolism Mark Collie Professor of Medicine and Molecular Physiology and Biophysics

Identifying the Glycemic Burden Fasting Preprandial Postprandial Hepatic glucose output Hepatic glucose output Glucose disposal Bolus insulin secretion Bolus insulin secretion 24-Hour Glucose

Why Care about Postprandial Hyperglycemia (PPHG)? Coagulation Oxidative Stress Oxidative Stress Increased Inflammatory Markers Increased Inflammatory Markers Oxidized LDL Oxidized LDL Microvascular disease Microvascular disease Hyper TG Hyper TG CVD PPHG

Maintaining Balance: Postprandial Physiology and the Pathogenesis of Disease John Davis, MD, FRCP Chief, Diabetes, Endocrinology and Metabolism Jack Collie Professor of Medicine, Molecular Physiology and Biophysics

Current View of the Action of Insulin Anti-inflammatory  NF-KB,  IkB,  MCP-1,  ICAM-1,  CRP Anti-inflammatory Antithrombotic  TF,  PAI-1 Antithrombotic Vasodilation and platelet inhibition  NO release,  cAMP,  eNOS Vasodilation and platelet inhibition  NO release,  cAMP,  eNOS Antioxidant  ROS Antioxidant Mechanism of the benefit of insulin in acute illness

Abdominal Adiposity There is No Time to Weight Michael Black, M.D. Mayo College of Medicine

FFA and Obesity  molkg LBM -1 min -1 * *  mol/L

Visfatin Leptin Adipsin (ASP) Resistin Angiotensinogen RBP- 4 IL-6 Adipocyte Adipose Tissue as Endocrine Cells AdiponectinAdiponectin Insulin sensitivity Improved metabolism