WhatIstheDiseaseofObesity?

Obesity,theChronicDisease

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

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.

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

5

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.

6

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.

ObesityHasMultiplePathophysiologicOrigins

7Bray GA, et al. Lancet. 2016;387:1947-1956.

Obesity

Epigenetic

Genetic

Physiologic

Behavioral

Sociocultural

Environmental

AACEObesityAlgorithmObesity,theChronicDisease

37

Summary

• Obesityisadisease• Genetic,environmental,andbehavioralfactorsallcontributetoitspathogenesis

• Thepathophysiologyinvolvesneuroendocrinefactorsinvolvedinregulatingbothappetiteandenergybalance

• Impairmentsinphysicalandphysiologicfunctioningcontributetohighratesofmorbidityandmortality