The Obesity/Diabetes Epidemic:Adiposopathy & ‘Obesity’- The New

Disease!Weight Management in Obesity and DM:

Emphasis on New Medical Therapies

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

A Guide to Selecting TreatmentBMI (kg/m2)

Treatment 25–26.9 27–29.9 30–34.9 35–39.9 ≥40

Diet, exercise, and behavior therapy

With comor-bidities

With comor-bidities

+ + +

PharmacotherapyWith

comor-bidities

+ + +

Bariatric surgeryWith

comor-bidities

+

NIH/NHLBI, NAASO. The Practical Guide: Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. Bethesda, MD: NIH, 2000.

Lifestyle Modification

Low-Low-CalorieCalorie

DietDiet

IncreasedIncreasedPhysicalPhysicalActivityActivity

BehaviorBehaviorTherapyTherapy

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

Compliance, Use foods Used to Eating

Cumulative Effect of Small Daily Errors in Energy Balance on Body Fat Mass

Leads to ‘100 cal/ day = 1 lb/m’ ruleMy Advice: use foods patient used to

eating

Lb/yr

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.

Burning a lot less energy (per half hour) in 2004 vs 1984

Calories Burned 2004 Calories Burned 1984

Lift (2 mins) 3 Take Stairs 19

Order take away 1 Cook Meal 70

Load Dishwasher 23 Wash Up 80

Watch TV 35 Play Cards 52

Go to car wash 35 Wash Car 104

Play Video Game 53 Play Basketball 280

Ride Lawn Mower 88 Mow Lawn 193

So… Hard to lose weight with exercise