Michael G. Knight, MD, MSHP, Dipl. ABOM Assistant Professor of Medicine The George Washington University

Transcription

1 Michael G. Knight, MD, MSHP, Dipl. ABOM Assistant Professor of Medicine The George Washington University

2 Disclosures I have no actual or potential conflict of interest in relation to this presentation

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4 Obesity Defined Obesity is a chronic, relapsing, multi-factorial, neurobehavioral disease: Wherein an increase in body fat promotes adipose tissue dysfunction and abnormal fat mass physical forces That results in adverse metabolic, biomechanical, and psychosocial health consequences Source: Obesity Medicine Association 2016

5 Obesity Recognized as a Chronic Disease obesity is a serious chronic disease with extensive and welldefined pathologies, including illness and death Recognizing obesity as a disease will help change the way the medical community tackles this complex issue that affects approximately one in three Americans (2013) Obesity is a chronic disease, prevalent in both developed and developing countries, and affecting children as well as adults

6 Disease Characteristics of Obesity Obesity is associated with impaired body function Obesity results from physiological dysfunction Obesity causes, exacerbates, or accelerates more than 180 significant comorbid diseases Obesity is associated with a substantial burden of morbidity and premature death Lee Kaplan, MD, PhD 2016

7 Obesity Prevalence: Adult Men 2016

8 Obesity Prevalence: Adult Women 2016

9 Obesity Prevalence: USA 2016

10 Obesity Prevalence: Caucasian 2016

11 Obesity Prevalence: Non-Hisp Black 2016

12 Medical Complications of Obesity

13 Pathophysiology of Obesity

14 Pathophysiology of Obesity Weight Maintenance? Food Intake Energy Expenditure

15 Pathophysiology of Obesity Weight Loss? Food Intake Energy Expenditure

16 Pathophysiology of Obesity Weight Maintenance Food Intake Energy Expenditur e Appetite Regulation Set Point Thermogenesis

17 The Neuroendocrine System Regulates Appetite

18 GI Hormones and Neuroendocrine Regulation Kairupan, T.S., Amitani, H., Cheng, KC. et al. J Gastroenterol (2016) 51: 93. htt

19 GI Hormones During Nutritional Weight Loss

20 GI Hormones Defend the Set Point

21 Lee Kaplan, MD, PhD, MGH-Harvard 2016 Obesity Treatment

22 Obesity Treatment Continuum Diet & Exercise Medications + Diet & Exercise Gastric Sleeve After Arrone L. FDA EMDAC 2010

23 Obesity Care Gap Less than 2% of eligible patients with obesity receive pharmacologic or surgical treatment In one study of 1.8 million eligible patients, less than 0.7% received pharmacotherapy Black patients were significantly less likely to be prescribed pharmacotherapy than Caucasian or Hispanic patients Seymour, Justine et al. A Qualitative Exploration of Weight Bias and Quality of Health Care Among Health Care Professionals Using Hypothetical Patient Scenarios. Inquiry: A Journal of Medical Care Organization, Provision and Financing 55 (2018)

24 Obesity Care Gap In one survey study, physicians rated weight loss medications and surgery as less effective, relative to lifestyle modification alone. Physicians must understand both the behavioral and the biological factors of obesity Patients with obesity have a less than 5% chance of returning to and maintaining a normal weight

25 Obesity Care Gap Physicians who better understand the biological challenge of achieving and maintaining weight loss: Are more likely to effectively counsel patients on appropriate weight loss goals Are more open to using biologic tools (medications and surgery) to help patients lose weight Clearly recognize the role they have in encouraging weight loss as a means to improve health

26 Conclusion Obesity is a complex chronic disease that requires our best medical efforts!

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