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WhatIstheDiseaseofObesity?
Obesity,theChronicDisease
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ChronicDiseaseManagementasAppliedtoObesity
Garvey TW, et al. Endocr Pract. 2016;22(suppl 3):1-205.
Interventionphase Definitionandgoals Method
PrimaryPrevention Preventdevelopmentofoverweight andobesity
• Educatethepublic• Modifyobesogenicbuilt
environment• Promotehealthyeatingand
regularphysicalactivity
SecondaryPrevention
Preventfutureweightgainanddevelopmentofweight-relatedcomplicationsinpatientswithoverweightorobesity
• ScreenusingBMI• DiagnoseusingBMIandevaluation
for complications• Treatwithlifestyle/behavioral
interventions± weightlossmedications
TertiaryPrevention Treatwithweight-losstherapytoeliminateorameliorateweight-relatedcomplicationsandpreventdiseaseprogression
• Treatwithlifestyle/behavioralinterventionsplusweightlossmedications
• Considerbariatricsurgery
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ObesityMeetsAMACriteriaforaDisease
3
Impairment ofNormalFunction
• Physicalimpairments• Alteredphysiologicfunction(inflammation, insulinresistance,dyslipidemia, etc)
• Alteredregulationofsatiety inthehypothalamus
Characteristic SignsorSymptoms
• Increasedbodyfatmass
• Jointpain• Impairedmobility• Lowself-esteem• Sleepapnea• Alteredmetabolism
HarmorMorbidity
• Cardiovasculardisease• Type2diabetes• Metabolic syndrome• Cancer• Death
AMA = American Medical Association.
Mechanick JI, et al. Endocr Pract. 2012;18:642-648.
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MedicalComplicationsofObesity
4
Obesity
NAFLD
CardiovascularDisease
Dismotility/disabilityGERD
Lung functiondefects
Osteoarthritis
Sleep apneaUrinary
incontinence
Prediabetic states
HypertensionDyslipidemia
PCOS
Diabetes
CardiometabolicBiomechanical Other
GERD = gastroesophageal reflux disease; NAFLD = nonalcoholic fatty liver disease; PCOS = polycystic ovary syndrome.
Pi-Sunyer X. Postgrad Med. 2009;121:21-33.
Androgen deficiency
CancerGallstone disease
Psychologicaldisorders
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Obesity-RelatedAbnormalities:MechanicalProblems
§ Breathingdisorders(sleepapnea,asthma)§Osteoarthritis§Urinarystressincontinence§GERD
GERD = gastroesophageal reflux disease.
Garvey TW, et al. Endocr Pract. 2016;22(suppl 3):1-205.
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Obesity-RelatedAbnormalities:MetabolicandOrganDysfunction
§ Appetitedysregulation§ Abnormalenergybalance
§ Endocrinedysfunction§ Elevatedleptinlevels§ Insulinresistance
§Dysregulatedadipokinesignaling
§ Abnormalendothelialfunction
§Hypertension§ Infertility§Nonalcoholicfattyliverdisease(NAFLD)
§Dyslipidemia§ Systemicinflammation§ Adiposetissueinflammation
GERD = gastroesophageal reflux disease.
Garvey TW, et al. Endocr Pract. 2016;22(suppl 3):1-205.
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ObesityHasMultiplePathophysiologicOrigins
7Bray GA, et al. Lancet. 2016;387:1947-1956.
Obesity
Epigenetic
Genetic
Physiologic
Behavioral
Sociocultural
Environmental
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AACEObesityAlgorithmObesity,theChronicDisease
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Summary
• Obesityisadisease• Genetic,environmental,andbehavioralfactorsallcontributetoitspathogenesis
• Thepathophysiologyinvolvesneuroendocrinefactorsinvolvedinregulatingbothappetiteandenergybalance
• Impairmentsinphysicalandphysiologicfunctioningcontributetohighratesofmorbidityandmortality