Empower Preventive Medicine. Timothy J. McCormick, DO, MPH 4221 Baymeadows Suite 6 Jacksonville, FL

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1 Empower Preventive Medicine Timothy J. McCormick, DO, MPH 4221 Baymeadows Suite 6 Jacksonville, FL Drtim@emprevmed.com

2 Obesity Medicine Old paradigm: Obesity was a matter of willpower, laziness, and excess energy (calories) over expenditure was stored as fat New paradigm: Obesity is a chronic medical conditions It is a interactions between metabolic factors, nutrition, behavior, and psychological factors

3 Obesity Medicine Hormonal factors play a huge role Can be manipulated through diet Food can be thought of as a drug: it has actions, side effects, and effects multiple body hormones and responses

4 Obesity Medicine Great results Reducing or eliminating medications Correcting associated medical conditions People feel better and feel better about themselves Energy levels improved They are happy

5 Obesity Classes Underweight <18.5 Normal Overweight Class I Obesity Class II Obesity Extreme >40 Class III

6 Obesity Prevalence 1960 to 1980 flat at 10% 1990 s - 18% % Multiple factors: Agricultural emphasis on corn; high fructose corn syrup Plate sizes bigger / portion sizes up Low fat diets increased carbohydrates

7 Fat Distribution Body Shape Central Obesity Android Apple shape High risk more visceral fat Lower Obesity Gynoid Pear shape

8 Medical Complication of Obesity GI: NAFLD, Reflux, gall bladder disease Hypertension Diabetes / insulin resistance Dyslipidemia Pulmonary: Sleep apnea, restrictive pulm function Gyn: polycystic ovarian syndrome, abnormal menses, infertility Ortho: osteoarthritis, gout CV: CAD, peripheral vascular disease

9 Obesity and Co-morbid Conditions Reduced life expectancy Poorer quality of life Depression and mood problems Poor energy and activity tolerance

10 Inflammation and Central Obesity Central obesity higher risk due to pro inflammatory cytokines Adipocyte & Macrophage release Monocyte Chemotactic Protein-1 IL-8 Interleukin-8 Trigger monocyte adhesion TNF- - influence insulin signally and inhibits insulin action

11 Metabolic Syndrome Insulin resistance 1 3 American Hypertension Central obesity (android) Abnormal glucose metabolism Dyslipidemia

12 Insulin Mother hormone in an bariatric practice Insulin response to diet stores carbohydrates as fats, inhibits fat breakdown Chronic insulin production leads to insulin resistance Leads to increase fat deposits (inhibits fat utilization)

13 Weight Related Hormones Orexigens (stimulate hunger) Neuropeptide Y (NPY) Agouti Related peptide (AgRP) Ghrelin (stomach) Melanin Concentrating hormone (MCH) Orexin / Hypocretin Anorexigens (hunger inhibitors) Insulin Multiple brain hormones Gut hormones CCK, Peptide YY, GLP-1 Adipose Leptin Adiponectin

14 Leptin Important satiety hormone Leptin drops body interprets as loss of energy hunger leptin hunger & weight loss Leptin in obese; paradoxcally may be leptin resistance

15 Adiponectin Adiponectin beneficial hormone from fat better CV protective More fat less Adiponectin Less fat more Adiponectin Antiatherogenic Anti-Inflammatory Insulin sensitizing Wt loss Adiponectin

16 Medical Approach Medical condition contributory to obesity or co morbidities than need to be monitored during treatment ( ie blood pressures, diabetes) Behavioral issues- impulsive, compulsive etc Metabolic / hormonal aspects Body compositions monitored treatment to reduce fat and preserve lean body mass

17 Obesity Treatment Chronic Health problem Readiness Active participution H&P unique elements- eating patterns, medications, medical conditions, eating disorders Lab to identify metabolic problems & tailor Rx

18 Medical Treatment Nutrition plans Food appropriate for individual /lifestyle Plan they can understand and follow Change eating patterns Behavioral issues addressed Medications Prescribed FDA approved Off labels use consistent with bariatric standard of care Monitor progress Initiate exercise Educate, educate, educate Psychological barriers refer for appropriate care

19 HCG HCG Used with 500 calories diets (lean loss) FDA made over the counter HCG illegal; Rx HCG FDA stated no substantial evidence it increases weight loss beyond caloric restriction ASBP position statement against use

20 Conclusions Weight loss as little as 10% substantially reduces multiple health risks. Protein is essential to preserve muscle mass and reduce fat mass. Food is utilized like a drug considering its actions, side effects, and hormone influences. Medical bariatric treatment can eliminate usage of hypertension and diabetic medications and improve lipid profiles.