The Obesity/Diabetes Epidemic: Adiposopathy & Obesity- The New Disease! Dx & (Rx) of Insulin Resistance & early DM Stan Schwartz MD, FACP, FACE Private Practice, Ardmore Obesity Program Cardiometabolic Diabetes Center and Affiliate, Main Line Health System Emeritus, Clinical Associate Professor University of Pennsylvania Part 6

Outline Epidemiology and Economics of obesity/diabetes Perspectives on Obesity Consequences of Obesity, Prediabetes, Obesity Obesity/ Diabetes Risk Factors, Obesity/ Diabetes Onset can be Prevented or Delayed – Early Risk Identification and Intervention. Medical Benefits to Weight Loss Treatment-CDC’s diabetes prevention program and other Evidence-Based Interventions- –Basics, –Next Lecture in Series

Relationship Between Weight Change and CHD Risk Factor Sum: Framingham Offspring Study *P<0.002 vs baseline. Wilson et al. Arch Intern Med 1999;159:1104. Weight Change During 16-y Follow-up Men Women Change in Risk Factor Sum (%) * * * * Loss  2.25 kg Gain  2.25 kg +37% –40% –48% +20%

Insulin Sensitivity Improves With Weight Loss in Patients With Type 2 Diabetes *P<0.01 vs before. Wing et al. Arch Intern Med 1987;147:1749. Insulin (pmol/L) Weight Loss at 1 Year (%) * * * Before 0– –6.9  –14.0

Plasma Lipids Improve With Weight Loss Meta-analysis of 70 Clinical Trials Dattilo et al. Am J Clin Nutr 1992;56: Total Cholesterol LDL-CTG HDL-C (weight stable) HDL-C (actively losing)  mmol/L per kg of Weight Loss  mg/dL per kg of Weight Loss * * * * * *P  LDL-C=low density lipoprotein cholesterol; HDL-C=high-density lipoprotein cholesterol; TG=triglycerides.

Relationship Between Change in Weight and Blood Pressure: Trials of Hypertension Prevention II Stevens et al. Ann Intern Med 2001;134:1. Change in Weight (kg) Change in Blood Pressure (mm Hg) Quintile of Weight Change Diastolic Systolic

Effect of Weight Change on Apnea-Hypopnea Index (AHI) Peppard et al. JAMA 2000;284:3015. Change in Body Weight (%) -20 to <-10 (n=22) -10 to <-5 (n=39) -5 to <+5 (n=371) +5 to <+10 (n=179) +10 to +20 (n=79) Mean Change in AHI (Events/h)

Reduction in Body Weight (%) Reduction in Body Weight (%) Change in FMD of Brachial Artery (%) R 2 = p = % Relation Between %Weight Loss and Endothelial Function Hamdy et al Diabetes Care 2003;26:

p<0.05 NS NS p<0.001 p<0.01 NS IL-6 TNF-  hCRP PAI-1 Leptin % Change From Baseline Monzillo LU Obes Res. 2003;11(9): Hamdy O et al. Diabetes Care. 2003;26: Adiponectin Benefits of weight reduction on cytokines in type 2 DM and in pre-diabetes

Weight Loss Can Increase Life Expectancy in Obese Patients With Type 2 Diabetes Weight Loss in First 12 Months (kg) Life Expectancy (y) Lean et al. Diabet Med 1990;7:228.