Obesity as a chronic disease. Troy Glembot MD MBA CPE FACS FASMBS Medical Director VH Metabolic and Bariatric Program

Transcription

1 Obesity as a chronic disease Troy Glembot MD MBA CPE FACS FASMBS Medical Director VH Metabolic and Bariatric Program

2 Objectives Understand why obesity is a chronic disease Discuss how obesity develops Review how surgical treatment options work Compare long term outcomes between surgical and non-surgical treatment of obesity

3 Disclosures Troy Glembot is a paid speaker and a Grant recipient from Nestle Healthcare Nutrition

4 Obesity and chronic disease Chronic disease lasts a long time Chronic disease is difficult to treat Chronic disease keeps coming back Chronic disease is never really cured, but can be controlled

5 Obesity and chronic disease Chronic disease lasts a long time Chronic disease is difficult to treat Chronic disease keeps coming back Chronic disease is never really cured, but can be controlled US National Center for Health Statistics: CD is one that lasts longer than 3 months, cannot be prevented by vaccinations or cured by medications and never disappear

6 Obesity and chronic disease

7 Obesity and chronic disease

8 Obesity and chronic disease

9 Energy balance

10 Energy balance Energy intake per year Error of 0.4% Calories to gain 1 pound per year calories per day

11 Energy balance Bariatric Times September 2012 Supplement C

12 Energy balance Energy balance

13 Energy balance The data presented in the above graph is from a study conducted on laboratory rats

14 Energy balance Bernstein, IL. Proc Soc Exp Biol Med; 1975 Nov; 150(2): The data presented in the above graph is from a study conducted on laboratory rats

15 Energy balance

16 Energy balance Altered food supply Decreased physical activity Stress and distress Drugs

17 Energy balance Bacteroidetes Firmicutes

18 Nature 2006 (444) 1009 Energy balance

19 Energy balance ter-obesity/index.html Accessed 16 Aug ion/sunday/debunking-the-huntergatherer-workout.html?_r=1& Accessed 16 Aug 2014

20 Figure 3. Percent body fat plotted against physical activity level, PAL. Pontzer H, Raichlen DA, Wood BM, Mabulla AZP, et al. (2012) Hunter-Gatherer Energetics and Human Obesity. PLoS ONE 7(7): e doi: /journal.pone Accessed 16 Aug 2014

21 Energy balance

22 Bariatric Surgery changes physiology

23 Bariatric Surgery changes physiology Evidence for physiologic mechanisms Dramatic effects on hunger and satiety Few patients become underweight Transient weight gain during pregnancy Little or no weight loss in thin patients Changes in GI endocrine markers Increased energy expenditure (GBP) Ability to reverse effect with drugs/genes

24 Bariatric Surgery changes physiology

25 Bariatric Surgery changes physiology

26 Bariatric Surgery changes physiology

27 Bariatric Surgery changes physiology

28 Bariatric Surgery changes physiology

29 Bariatric Surgery changes physiology

30 Bariatric Surgery changes physiology Kaplan, LM et al. Bariatric Times. 2012;9(7):12 14.

31 Bariatric surgery outcomes

32 Bariatric surgery outcomes

33 Bariatric surgery outcomes Obes Surg. 2007;17(6):

34 Bariatric surgery outcomes

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37 Bariatric surgery outcomes

38 Bariatric surgery outcomes

39 Bariatric surgery outcomes

40 Bariatric surgery outcomes

41 Bariatric surgery outcomes

42 Bariatric surgery outcomes

43 Bariatric surgery outcomes

44 Bariatric surgery outcomes

45 Bariatric surgery outcomes

46 Bariatric surgery outcomes

47 Bariatric surgery outcomes

48 Bariatric surgery outcomes

49 Conclusions Obesity is a chronic progressive disease with a complex physiologic etiology There is much more to bariatric surgery than just restrictive and malabsorptive procedures Bariatric surgery leads to reduced mortality, reduced disease burden and improved quality of life