The Obesity/Diabetes Epidemic: Adiposopathy & ‘Obesity’- The New Disease! Weight Management in Obesity and DM: Emphasis on New Medical Therapies 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 3

A Guide to Selecting Treatment BMI (kg/m 2 ) Treatment25–26.927–29.930–34.935–39.9≥40 Diet, exercise, and behavior therapy With comor- bidities +++ Pharmacotherapy With comor- bidities +++ Bariatric surgery With comor- bidities + NIH/NHLBI, NAASO. The Practical Guide: Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. Bethesda, MD: NIH, 2000.

Lifestyle Modification Low- Calorie Diet Increased Physical Activity BehaviorTherapy

The “Toxic Environment” High-Calorie Food is… –Highly palatable –Inexpensive –Heavily advertised –Near-ubiquitous Brownell KD & Horgen KB. Food Fight. New York: McGraw-Hill; supersized

Compliance, Use foods Used to Eating

Cumulative Effect of Small Daily Errors in Energy Balance on Body Fat Mass Leads to ‘100 cal/ day = 1 lb/m’ rule My Advice: use foods patient used to eating Lb/yr

The “Toxic Environment” Physical Activity is… –To be avoided –Nearly unnecessary –Limited by infrastructure Brownell KD & Horgen KB. Food Fight. New York: McGraw-Hill; 2003.

Burning a lot less energy (per half hour) in 2004 vs 1984 Calories Burned 2004Calories Burned 1984 Lift (2 mins) 3Take Stairs 19 Order take away 1Cook Meal 70 Load Dishwasher 23Wash Up 80 Watch TV 35Play Cards 52 Go to car wash 35Wash Car 104 Play Video Game 53Play Basketball 280 Ride Lawn Mower 88Mow Lawn 193

MenWomen % Obese Colorado U.S Tennessee Average Steps/Day

So… Hard to lose weight with exercise