obesity management: lifestyle modification/bariatric surgery
TRANSCRIPT
Obesity Management:Obesity Management:Lifestyle Lifestyle
Modification/Bariatric Modification/Bariatric SurgerySurgery
Comparison of Diets:Comparison of Diets:12-Month Weight Loss12-Month Weight Lossaa
-4.7
-1.6
-2.2
-3.8
-5
-4
-3
-2
-1
0
Atkinsn=77
Wei
gh
t L
oss
(kg
)
Zonen=79
b LEARNn=79
b Ornishn=76
b
Stephen N. Jones, MD, FRCPStephen N. Jones, MD, FRCP
Chief, Division of Diabetes,Chief, Division of Diabetes,Endocrinology and MetabolismEndocrinology and Metabolism
Mark Collie Professor of Medicine and Molecular Mark Collie Professor of Medicine and Molecular Physiology and BiophysicsPhysiology and Biophysics
Identifying the Glycemic BurdenIdentifying the Glycemic Burden
FastingFasting PreprandialPreprandial PostprandialPostprandial
Hepatic glucoseoutput
Hepatic glucoseoutput
Glucose disposalGlucose disposal Bolus insulinsecretion
Bolus insulinsecretion
24-Hour Glucose24-Hour Glucose
Why Care about Postprandial Hyperglycemia (PPHG)?
Why Care about Postprandial Hyperglycemia (PPHG)?
CoagulationCoagulation
OxidativeStress
OxidativeStress
IncreasedInflammatory
Markers
IncreasedInflammatory
Markers
OxidizedLDL
OxidizedLDL
Microvasculardisease
Microvasculardisease
Hyper TG
Hyper TG
CVDCVD
PPHGPPHG
Maintaining Balance:Maintaining Balance:Postprandial Physiology and Postprandial Physiology and the Pathogenesis of Diseasethe Pathogenesis of Disease
Maintaining Balance:Maintaining Balance:Postprandial Physiology and Postprandial Physiology and the Pathogenesis of Diseasethe Pathogenesis of Disease
John Davis, MD, FRCPJohn Davis, MD, FRCPChief, Diabetes, Endocrinology and Chief, Diabetes, Endocrinology and
MetabolismMetabolism
Jack CollieJack CollieProfessor of Medicine, Molecular Professor of Medicine, Molecular
Physiology and BiophysicsPhysiology and Biophysics
Current View of the Action of InsulinCurrent View of the Action of Insulin
Anti-inflammatoryAnti-inflammatoryNF-KB, NF-KB, IkB, IkB, MCP-MCP-
1,1,ICAM-1, ICAM-1, CRPCRP
AntithromboticAntithromboticTF, TF, PAI-1PAI-1
Vasodilation andVasodilation andplatelet inhibitionplatelet inhibition
NO release, NO release, cAMP,cAMP,eNOSeNOS
AntioxidantAntioxidantROSROS
Mechanism of the benefit of Mechanism of the benefit of insulin in acute illnessinsulin in acute illness
Abdominal Adiposity Abdominal Adiposity There is No Time to WeightThere is No Time to Weight
Michael Black, M.D.Michael Black, M.D.Mayo College of MedicineMayo College of Medicine
FFA and ObesityFFA and Obesity
mo
l•kg
LB
M-1•m
in-1
**
**
mo
l/L
FFA Concentration
118
449
235
412
297
579
0
200
400
600
800
Basal Insulin
Non-Obese
LB Ob
UB Ob
FFA Release Rates
3.5
7.16.1
7.88.5
12.4
0
5
10
15
Basal Insulin
VisfatinVisfatin
LeptinLeptin
Adipsin (ASP)Adipsin (ASP)
ResistinResistin
AngiotensinogenAngiotensinogen
RBP- 4RBP- 4
IL-6IL-6
AdipocyteAdipocyte
Adipose Tissue as Endocrine CellsAdipose Tissue as Endocrine Cells
AdiponectinAdiponectinAdiponectinAdiponectin
Insulin sensitivityInsulin sensitivityImproved metabolismImproved metabolism