1. The Obesity/Diabetes Epidemic: Adiposopathy & Obesity- The New Disease! Dx & (Rx) of Insulin Resistance & early DM (Part 2) 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

2. 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

3. Perspectives on Obesity Moral problem? NOT- Must not blame an individual for issues they cannot have complete control over- ie: Their genes! IT’s A DISEASE AFTER ALL Psychological problem? Aesthetic problem? culture based- self perception/esteem Medical problem!- Recognized a Disease Public health problem! = Increased Societal Cost

4. Cultural Defintions Change Over Time

5. Perspectives on Obesity Moral problem? NOT- Must not blame an individual for issues they cannot have complete control over- ie: Their genes! IT’s A DISEASE AFTER ALL Psychological problem? Aesthetic problem? culture based- self perception/esteem Medical problem!- Recognized a Disease Public health problem! = Increased Societal Cost

6. Avg. Sedentary person (1800 kcal/d) Avg. Physically active person (2200 kcal/d) 60% Components of Total Daily Energy Expenditure 32% 75% 8% 17% 8% Thermic effect of feeding Resting energy expenditure Energy expenditure of physical activity

7. Obesity Is Caused by Long-Term Positive Energy Balance Fat stores Energy intake Energy expenditure

8. Cumulative Effect of Small Daily Errors in Energy Balance on Body Fat Mass Leads to ‘100 cal/ day = 1 lb/m’ rule And patients are NOT ‘pigging out’ Lb/yr

9. Regulation of Body Weight Genes confer the potential for obesity. Environment determines whether and to what extent the potential is realized.

10. Thrifty Genes Contribute to Morbid Obesity Genetic factors account for 80 percent of a person ’ s tendency to develop obesity. These “ thrifty genes ” are designed to protect us from starvation by allowing us to store large amounts of energy in the form of fat when food is abundant. This is the first time in human history that food has been so abundant. The age-old advantage of thrifty genes has been influenced by our unique environment to cause disease. Kaplan L. Body Weight Regulation and Obesity. Journal of Gastrointestinal Surgery 2003;7(4):443-451.

11. Environment Genes Polygenic Monogenic dominant MC4-R Monogenicrecessive Leptin Leptin-R POMC PC-1 Genetic Approach of Obesity GAD2

12. Regulation of Body Weight Genes confer the potential for obesity. Environment determines whether and to what extent the potential is realized.- Diet/ Exercise

14. The “Toxic Environment” High-Calorie Food is… –Highly palatable –Inexpensive –Heavily advertised –Near-ubiquitous Brownell KD & Horgen KB. Food Fight. New York: McGraw-Hill; 2003. supersized