1. The Obesity/Diabetes Epidemic: Perspectives, Consequences, Prevention, Treatment 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

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

3. Gene Variants and Binge Eating as Predictors of Co-morbidities and Outcome of Treatment in Severe Obesity Melanocortin-4 receptor gene (MC4R) variants are associated with obesity and binge-eating disorder (BED). 300 patients (233 women, 67 men) with a mean BMI of 43.5 and a mean age of 42 Laparoscopic Adjustable Gastric Banding 36-month follow-up All MC4R patients had BED, compared to 18 percent in noncarriers. MC4R patients showed less weight loss and five times more gastric complications. Potoczna, et al. J Gastro Surg 2004:8(9).

4. Relationship Between Adoptee Weight and Weight of Biological Parents +, but with Adoptive Parents- none Stunkard AJ, Sorensen TI, Hanis C,et al. N Engl J Med 1986;314:193. Weight Classification of Adoptees BMI of Parents (kg/m 2 ) Thin Median Overweight Obese Biological Parents Adoptive Parents 27 21 26 25 24 23 22 Fathers Mothers

6. 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

7. Increasing Caloric Intake Over time in USA Energy Intake (kcal) NHANES 1 (1971-74) NHANES 2 (1976-80) NHANES 3 (1988-94) NHANES 4 (1999-2002) All 1968 ± 201942 ± 162172 ± 182205 ± 16 Men 2420 ± 302409 ± 262627 ± 272616 ± 22 Women 1537 ± 171503 ± 131741 ± 141820 ± 20 Kant AK. Am J Clin Nutr. 2006:84:1215-23.

8. Health Benefits of Modest Weight Loss (5-10%)  Decreased cardiovascular risk  Decreased blood glucose and insulin levels  Decreased blood pressure  Decreased LDL and triglycerides, increased HDL  Decrease in severity of sleep apnea  Reduced symptoms of degenerative joint disease  Improvement in gynecologic conditions  Multiple cardiovascular risk factors and other complications can be improved. Source: The Practical Guide to the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults..

10. 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.

11. Burning a lot less energy (per half hour) in 2004 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

12. MenWomen % Obese Colorado6733638416.0 U.S.5940527622.8 Tennessee4547473025.0 Average Steps/Day

13. Childhood Obesity http://www.committed-to-kids.com

14. 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

15. Medical Complications of Obesity Phlebitis venous stasis