DOCSLIB.ORG

Obesity Medicine and Bariatric Surgery

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Obesity Medicine and Bariatric Surgery Obesity Medicine Your MOVE TIME Bariatric TEAM! • Obesity Medicine Physicians • Bariatric Surgeons • Behavioral Medicine/Psychologists • Dietitians • Physical Therapists • Nursing and Clerical staff Goals of the MOVE TIME Clinic • To help you lose weight, live a healthy lifestyle and improve your quality of life – Medical management to help those not interested in surgery or not surgical candidate – Medically optimize obesity-related comorbid conditions – Surgical management for those interested in weight-loss surgery Medical Evaluation: What do we do? • Evaluate causes of obesity • Evaluate/treat obesity-related conditions • Offer medical treatments for obesity – Weight loss medications • Pre-operative evaluation • Post-operative care Common Causes of Obesity • Inactivity- computer, gaming, TV time, commuting, desk work • Excess caloric intake- large portions, liquid calories (alcohol/sodas), unhealthy food choices Medical Causes of Obesity • Untreated Sleep Apnea (OSA) • Insomnia/Poor sleep • Hormone related- Hypothyroidism, Polycystic Ovarian Syndrome, Low Testosterone, Cushings • Depression, anxiety, PTSD, sexual trauma, stress • Medications- e.g. psychiatric medications, insulin for diabetes • Genetics/Epigenetics • Traumatic Brain Injuries Medical conditions related to Obesity • Diabetes • Heart Failure • High Blood Pressure • Kidney disease • High Cholesterol • Inflammation • Sleep Apnea • Blood Clots • Heart Burn/Reflux • Cancers • Joint • Infertility pain/Osteoarthritis • Urinary Incontinence • Fatty liver and cirrhosis • Hormone Abnormalities Treatment of Obesity Treatment of Obesity • Improve physical activity • Improve diet • Behavioral/Psychological Health • Optimize obesity-related conditions • Weight loss medications • Limit medications that cause weight gain • Weight-loss surgery (Bariatric Surgery) Treatment of Obesity Optimize obesity-related conditions • Glucose control for Diabetics (goal A1c <7) • Control blood pressure (<140/90) • Treat high cholesterol • Evaluate for heart disease • Manage chronic pain • Treat obstructive sleep apnea Treatment of Obesity Limit medications causing weight gain • Psychiatric Medications • Insulin/glipizide/glyburide • Gabapentin • Steroids (prednisone) • Antihistamines (benadryl) • Many other medications! Treatment of Obesity Using Weight-Loss Medications • Requires careful evaluation and coordination with your MOVETIME Obesity Medicine provider to determine if these medications are right for you • Can provide up to 5-10% weight loss when combined with healthy diet and exercise Treatment of Obesity Available Weight Loss Medications at the VA • Orlistat (Alli or Xenical) • Lorcaserin (Belviq) • Phentermine • Phentermine/Topiramate (Qsymia) • Liraglutide (Saxenda) • Buproprion/Naltrexone (Contrave) • Lisdexamfetamine (for binge eating) Bariatric (Weight Loss) Surgery How does Bariatric Surgery work? • Bariatric Surgery is a TOOL to promote weight loss • Restricts the amount of food you can eat • Causes metabolic and hormonal changes – Improves diabetes almost immediately – Decreases hunger and promotes fullness Pre-Surgical Evaluation • Age appropriate • MOVE Participation Cancer screening • Healthy Diet/Exercise – Colonoscopy • If Indicated: – Mammogram – Cardiac evaluation – Pap smear – Sleep apnea • Endoscopy (EGD) evaluation • Blood and Urine Tests – Pulmonary Function • Psychological Tests Evaluation Post-Surgical Follow Up • 1 week Telephone visit • 2 weeks Surgery clinic visit • 2 months MOVE TIME clinic visit • 6 months MOVE TIME clinic visit • 1 year visit and then yearly with MOVE TIME clinic MOVE TIME clinic follow-up is important! • Review laboratory testing for possible vitamin or mineral deficiencies • Adjust medications for chronic conditions – (ie. Diabetes, High Blood Pressure, etc.) • Recommend CPAP adjustment or sleep studies • Vitamin supplementation – Multivitamin With Iron 200% RDA – Calcium Citrate 1200-1500mg/day – Vitamin D 1000-3000 units/day – B12 monthly injections/daily pill if Gastric Bypass – May need additional supplements Medical Benefits of Surgery • Diabetes- improves immediately! • High blood pressure improves • Decreases diuretic needs • Decreases cholesterol • Improves sleep apnea • Improves joint pain and mobility • Improves fatty liver • Decreases cancer risk • Decreases the risk of dying from obesity Medical Benefits…Continued • Improves fertility and sexual function – Men: increases testosterone – Women: • Those of child bearing age should avoid pregnancy for 12-18 months after surgery • Following Gastric Bypass women may need contraception other than “the pill” • Following Gastric Bypass emergency contraception may not work • We will discuss these changes with you Medical Issues following Surgery If there are difficulties after surgery then we will help you manage them! • Vitamin Deficiencies • Acid Reflux • Low blood glucose • Alcohol problems • Low blood pressure • Mental Health Issues • Kidney stones, gallstones • Medication Absorption • Gout flares changes • Hair loss, excess skin • Constipation • Bone thinning • Dumping syndrome • Taste/Food tolerance changes Obesity Medicine at the Palo Alto VA • We want to help you and we look forward to seeing you in the MOVE TIME Clinic! • Ask your primary care provider to refer you to MOVE TIME if you are interested in beginning the evaluation for Bariatric Surgery!.
Load more

Recommended publications
  • Obesity: Surgical and Pharmaceutical Options & Navigating Diet Trends
    Obesity: Surgical and Pharmaceutical options & Navigating diet trends Guillermo Higa MD, FACS, FASMBS Bariatric Surgery Medical Director Chief of Division of Bariatric Surgery St. Mary’s Hospital Tucson-Arizona What is Obesity? The Obesity Medicine Association Definition of Obesity • “Obesity is defined as a chronic, relapsing, multi-factorial, neurobehavioral disease, wherein an increase in body fat promotes adipose tissue dysfunction and abnormal fat mass physical forces, resulting in adverse metabolic, biomechanical, and psychosocial health consequences.” Obesity Algorithm®. ©2017-2018 Obesity Medicine Association. Obesity is common, serious, and costly • The prevalence of obesity was 39.8% and affected about 93.3 million of US adults in 2015-2016. • Obesity-related conditions include heart disease, stroke, type 2 diabetes and certain types of cancer that are some of the leading causes of preventable, premature death. • The estimated annual medical cost of obesity in the United States was $147 billion in 2008 US dollars; the medical cost for people who have obesity was $1,429 higher than those of normal weight. https://www.cdc.gov/obesity/data/adult.html Obesity Kills • Leading cause of preventable death • Recently surpassed smoking as leading cause • Lifespan shortened 9 - 12 years • Over 400,000 deaths per year • 46 deaths each hour Prevalence of Self-Reported Obesity Among U.S. Adults by State and Territory, BRFSS, 2017 ¶ Prevalence estimates reflect BRFSS methodological changes started in 2011. These estimates should not be compared
    [Show full text]
  • Optimal Resources for Metabolic and Bariatric Surgery
    Optimal Resources for Metabolic and Bariatric Surgery 2019 Standards facs.org/mbsaqip AMERICAN COLLEGE OF SURGEONS AMERICAN COLLEGE OF SURGEONS AMERICAN COLLEGE OF SURGEONS AMERICAN COLLEGE OF SURGEONS AMERICAN COLLEGE OF SURGEONS AMERICAN COLLEGE OF SURGEONS AMERICAN COLLEGE OF SURGEONS A AMERICAN COLLEGE OF SURGEONS Optimal Resources for Metabolic and Bariatric Surgery 2019 Standards Copyright © 2019 American College of Surgeons, 633 N. Saint Clair St., Chicago, IL 60611-3295. All rights reserved. Table Foreword ii MBSAQIP Designations and Accreditation Pathways vi of Contents Designations vii Designation Requirements Overview viii Accreditation Pathways x Standard 1 Institutional Administrative Commitment 1 1.1 Administrative Commitment 3 Standard 2 Program Scope and Governance 5 2.1 Volume Criteria 7 2.2 Low Acuity Center Patient and Procedure 9 Selection 2.3 Ambulatory Surgery Center Patient and 10 Procedure Selection 2.4 Metabolic and Bariatric Surgery (MBS) Committee 11 2.5 Metabolic and Bariatric Surgery (MBS) Director 13 2.6 Metabolic and Bariatric Surgery (MBS) 15 Coordinator 2.7 Metabolic and Bariatric Surgery (MBS) Clinical 16 Reviewer 2.8 Obesity Medicine Director (OMD) 18 Standard 3 Facilities and Equipment Resources 21 3.1 Health Care Facility Accreditation 23 3.2 Facilities, Equipment, and Furniture 24 3.3 Designated Bariatric Unit 26 Standard 4 Standard 6 Personnel and Services Resources 29 Data Surveillance and Systems 59 4.1 Credentialing Guidelines for Metabolic and 31 6.1 Data Entry 61 Bariatric Surgeons 6.2 30-Day
    [Show full text]
  • Obesity and Its Relation to Mortality Costs Report
    Obesity and its Relation to Mortality and Morbidity Costs DECEMBER 2010 SPONSORED BY PREPARED BY Committee on Life Insurance Research Donald F. Behan, PhD, FSA, FCA, MAAA Society of Actuaries Samuel H. Cox, PhD, FSA, CERA University of Manitoba CONTRIBUTING CO-AUTHORS: Yijia Lin, Ph.D. Jeffrey Pai, Ph.D, ASA Hal W. Pedersen, Ph.D, ASA Ming Yi, ASA The opinions expressed and conclusions reached by the authors are their own and do not represent any official position or opinion of the Society of Actuaries or its members. The Society of Actuaries makes no representation or warranty to the accuracy of the information. © 2010 Society of Actuaries, All Rights Reserved Obesity and its Relation to Mortality and Morbidity Costs Abstract We reviewed almost 500 research articles on obesity and its relation to mortality and morbidity, focusing primarily on papers published from January 1980 to June 2009. There is substantial evidence that obesity is a worldwide epidemic and that it has a significant negative impact on health, mortality and related costs. Overweight and obesity are associated with increased prevalence of diabetes, cardiovascular disease, hypertension and some cancers. There also is evidence that increased weight is asso- ciated with kidney disease, stroke, osteoarthritis and sleep apnea. Moreover, empirical studies report that obesity significantly increases the risk of death. We used the results to estimate costs due to overweight and obesity in the United States and Canada. We estimate that total annual economic cost of overweight and obesity in the United States and Canada caused by medical costs, excess mortality and disability is approximately $300 billion in 2009.
    [Show full text]
  • Childhood Obesity During the 1960S Are Available for Certain Age Groups
    NATIONAL CENTER FOR HEALTH STATISTICS SEPTEMBER Health E-Stats 2018 Prevalence of Overweight, Obesity, and Severe Obesity Among Children and Adolescents Aged 2–19 Years: United States, 1963–1965 Through 2015–2016 by Cheryl D. Fryar, M.S.P.H., Margaret D. Carroll, M.S.P.H., and Cynthia L. Ogden, Ph.D., Division of Health and Nutrition Examination Surveys Results from the 2015–2016 National Health and Nutrition Examination Survey (NHANES), using measured heights and weights, indicate that an estimated 18.5% of U.S. children and adolescents aged 2–19 years have obesity, including 5.6% with severe obesity, and another 16.6% are overweight. Body mass index (BMI), expressed as weight in kilograms divided by height in meters squared (kg/m2), is commonly used to classify obesity among adults and is also recommended for use with children and adolescents. Cutoff criteria are based on the sex-specific BMI-for-age 2000 CDC Growth Charts for the United States (available from: https://www.cdc.gov/growthcharts/cdc_charts.htm). Based on current recommendations from expert committees, children and adolescents with BMI values at or above the 95th percentile of the growth charts are categorized as having obesity. This differs from previous years in which children and adolescents above this cutoff were categorized as overweight. This change in terminology reflects the category labels used by organizations such as the National Academy of Medicine and the American Academy of Pediatrics. For more information, see “Changes in Terminology for Childhood Overweight and Obesity,” available from: https://www.cdc.gov/nchs/data/nhsr/nhsr025.pdf.
    [Show full text]
  • Overweight and Obesity Among Adults
    4. RISK FACTORS FOR HEALTH Overweight and obesity among adults Being overweight, including pre-obesity and obesity, is a Initiative in the United States aims to improve access to major risk factor for various non-communicable diseases healthy foods in underserved areas. Despite these efforts, including diabetes, cardiovascular diseases and certain the overweight epidemic has not been reversed, cancers. High consumption of calories-dense food and highlighting the issue’s complexity (OECD, 2019[3]). increasingly sedentary lifestyles have contributed to growing global obesity rates. The rate of growth has been highest in early adulthood and has affected all population groups, in particular women and those with lower levels of Definition and comparability education (Afshin et al., 2017[1]). High body mass index (BMI) has been estimated to cause 4.7 million deaths worldwide Overweight is defined as abnormal or excessive (Global Burden of Disease Collaborative Network, 2018[2]) accumulation of fat, which presents a risk to health. Based on measured data, 58% of adults were overweight or The most frequently used measure is body mass index obese in 2017 on average across 23 OECD countries with (BMI), which is a single number that evaluates an comparable data (Figure 4.11). For Chile, Mexico and the individual’s weight in relation to height (weight/ 2 United States this figure exceeds 70%. Conversely, in Japan height , with weight in kilograms and height in and Korea, less than 35% of adults were overweight or obese. metres). Based on WHO classifications, adults over age The remaining 13 OECD countries include self-reported 18 with a BMI greater than or equal to 25 are defined as data, with rates ranging from 42% in Switzerland to 65% in pre-obese, and those with a BMI greater than or equal Iceland.
    [Show full text]
  • The Evidence Report
    Obesity Education Initiative C LINICAL GUIDELINES ON THE IDENTIFICATION, EVALUATION, AND TREATMENT OF OVERWEIGHT AND OBESITY IN ADULTS The Evidence Report NATIONAL INSTITUTES OF HEALTH NATIONAL HEART, LUNG, AND BLOOD INSTITUTE C LINICAL GUIDELINES ON THE IDENTIFICATION, EVALUATION, AND TREATMENT OF OVERWEIGHT AND OBESITY IN ADULTS The Evidence Report NIH PUBLICATION NO. 98-4083 SEPTEMBER 1998 NATIONAL INSTITUTES OF HEALTH National Heart, Lung, and Blood Institute in cooperation with The National Institute of Diabetes and Digestive and Kidney Diseases NHLBI Obesity Education Initiative Expert Panel on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults F. Xavier Pi-Sunyer, M.D., M.P.H. William H. Dietz, M.D., Ph.D. Chair of the Panel Director Chief, Endocrinology, Diabetes, and Nutrition Division of Nutrition and Physical Activity Director, Obesity Research Center National Center for Chronic Disease Prevention St. Luke's/Roosevelt Hospital Center and Health Promotion Professor of Medicine Centers for Disease Control and Prevention Columbia University College of Physicians and Atlanta, GA Surgeons New York, NY John P. Foreyt, Ph.D. Professor of Medicine and Director Diane M. Becker, Sc.D., M.P.H. Nutrition Research Clinic Director Baylor College of Medicine Center for Health Promotion Houston, TX Associate Professor Department of Medicine Robert J. Garrison, Ph.D. The Johns Hopkins University Associate Professor Baltimore, MD Department of Preventive Medicine University of Tennessee, Memphis Claude Bouchard, Ph.D. Memphis, TN Professor of Exercise Physiology Physical Activity Sciences Scott M. Grundy, M.D., Ph.D. Laboratory Director Laval University Center for Human Nutrition Sainte Foy, Quebec University of Texas CANADA Southwestern Medical Center at Dallas Dallas, TX Richard A.
    [Show full text]
  • Liposuction Surgery Procedure and Post Care
    The Paragon Plastic Surgery & Med Spa! Mark A. Bishara, M.D., P.A. ! LIPOSUCTION SURGERY! PROCEDURE AND POST CARE INSTRUCTIONS! I. ITEMS NEEDED:! • Prescription medicines! • Hibiclens antimicrobial soap! • Polysporin ointment! • Plastic sheeting (large trash can bags)! • Towels! • Absorbant pads (diapers work well)! • Saran wrap! • Sunscreen with a UVA/UVB SPF of 15 (we have excellent sunscreen available)! • Vitamin C 2000mg twice daily for 14 days.! • Zinc 50mg once daily for 14 days.! • Constipation Prevention (while taking narcotic pain medication): Colace 100 mg twice daily and Milk of Magnesia until normal bowel movements.! • Arnica Montana. Starting 5 days before your procedure and then continuing 10 days after your procedure, take 4 tablets of Arnica Montana, under your tongue 4 times a day. (DO NOT EXCEED 16 TABLETS A DAY). This will help with swelling and bruising.! OFFICE PHONE NUMBER: 817-473-2120 (8am — 6pm M-F)! EMERGENCIES OR AFTER HOURS: 817-473-2120 (24-hour answering service)! BEFORE PROCEDURE:! Starting 5 days before your procedure and then continuing 10 days after your procedure, take 4 tablets of Arnica Montana, under your tongue 4 times a day. (DO NOT EXCEED 16 TABLETS A DAY). This will help with swelling and bruising.! THE PROCEDURE:! A. Goals for surgery: Liposuction removes fat cells beneath the skin in order to shape areas of the body. The surgery can be performed in nearly any place on the body and has proven particularly effective in the abdomen, waist, hips and thighs. It can also be used on the arms, buttocks and knees. The procedure is suitable for both men and women who are in good health.! B.
    [Show full text]
  • Obesity Update 2017
    Obesity Update 2017 Policy insights Did you know? More than one in two adults and nearly one in six children are overweight or obese in OECD countries. Adult obesity rates are highest in the United States, Mexico, New Zealand and Hungary, while they are lowest in Japan and Korea. Obesity rates are projected to increase further by 2030, and Korea and Switzerland are the countries where obesity rates are projected to increase at a faster pace. Social inequalities in overweight and obesity are strong, especially among women. In about half of the eight countries for which data are available, less- educated women are two to three times more likely to be overweight than those with a higher level of education. In the last few years, some OECD countries have relied on fiscal policies to increase the price of potentially unhealthy products to encourage a healthier diet such as in Belgium, Chile, Finland, France, Hungary and Mexico. This Obesity Update focusses on communication policies designed to empower people to make healthier choices, which are increasingly used in OECD countries. New developments in communication policies include new easy-to- understand schemes of food labelling, mass media campaigns to increase public awareness, the use of social networks and new technologies for health promotion campaigns, and reinforced regulation of marketing of potentially unhealthy products, especially when directed to children. Comprehensive policy packages, including not only communication but also school-based interventions, interventions in primary care settings, and broader regulatory and fiscal policies, provide an affordable and cost-effective solution to tackle obesity. www.oecd.org/health/obesity-update.htm © OECD 2017 Obesity update - © OECD 2017 Obesity Update 2017: introduction Today, more than one in two adults and nearly one in six children are overweight or obese in the OECD area.
    [Show full text]
  • Childhood Obesity Fact Sheet
    CHILDHOOD OBESITY FACT SHEET DEFINING CHILDHOOD OBESITY Body mass index (BMI) is a measure used to determine childhood overweight and obesity. Overweight is defined as a BMI at or above the 85th percentile and below the 95th percentile for children and teens of the same age and sex. Obesity is defined as a BMI at or above the 95th percentile for children and teens of the same age and sex. CHILDHOOD OBESITY RATES One in five children in the United States has obesity. The prevalence of obesity among U.S. youth ages 2-19 was 18.5% in 2015-2016. Preschool-aged children (2-5 years) – 13.9% School-aged children (6-11 years) – 18.4% Adolescents (12-19 years) – 20.6% There was no significant difference in the prevalence of obesity between boys and girls overall or by age group. The prevalence of obesity decreased with increasing level of education of the head of household. Lowest income group – 18.9% Middle income group – 19.9% Highest income group – 10.9% Obesity prevalence was lower in the highest income group among non-Hispanic Asian and Hispanic boys, and non-Hispanic White, non-Hispanic Asian, and Hispanic girls. Obesity prevalence did not differ by income among non-Hispanic Black girls. Written by Gurpreet Boparai, MD, FOMA © Obesity Medicine Association. All rights reserved. Materials may not be reproduced, redistributed, or translated without written permission. CAUSES OF CHILDHOOD OBESITY NUTRITION PHYSICAL ACTIVITY MEDICAL ISSUES High-calorie foods, Increased sedentary Medications low-nutrient foods, activities and screen (e.g.,
    [Show full text]
  • Nutrition Recommendations for Obesity Management
    NUTRITION RECOMMENDATIONS FOR OBESITY MANAGEMENT The medical treatment of obesity hinges on four pillars – nutrition, physical activity, behavior, and medication. Nutritional recommendations have to be tailored to the individual patient and his or her likes and dislikes, medical co-morbidities, and current medications. The best diet is the one that is sustainable for the patient long-term. These recommendations are generalized guidelines to assist in creating an individualized nutrition prescription for your patient. STEP 1 CREATE A CALORIE DEFICIT When you eat fewer calories than you burn, you create a calorie deficit (also called an energy deficit). When you create a calorie deficit, your body gets energy from stored fat. Your body can use energy from stored fat to keep moving instead of using energy from food. When your body burns fat for energy, you lose weight. 3 STRATEGIES TO ESTIMATE ENERGY DEFICIT: Estimate individual energy requirements according to expert guidelines, such as the Harris Benedict Equation, the Mifflin‐St Jeor Equation, or the World Health Organization formula. Prescribe a diet with an energy deficit of 500 kcal/day, 750 kcal/day, or 30 percent. Specify an energy intake target that is less than that required for energy balance, usually 1,200 to 1,500 kcal/day for women and 1,500 to 1,800 kcal/day for men. (Kcal will need to be adjusted for the individual’s body weight and physical activity levels.) Use an open approach, where a formal energy‐deficit target is not prescribed, but lower calorie intake is achieved by restriction or elimination of particular food groups or provision of prescribed foods.
    [Show full text]
  • AACE/ACE Guidelines AMERICAN ASSOCIATION of CLINICAL
    AACE/ACE Guidelines AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY COMPREHENSIVE CLINICAL PRACTICE GUIDELINES FOR MEDICAL CARE OF PATIENTS WITH OBESITY W. Timothy Garvey, MD, FACE1; Jeffrey I. Mechanick, MD, FACP, FACE, FACN, ECNU2; Elise M. Brett, MD, FACE, CNSC, ECNU3; Alan J. Garber, MD, PhD, FACE4; Daniel L. Hurley, MD, FACE5; Ania M. Jastreboff, MD, PhD6; Karl Nadolsky, DO7; Rachel Pessah-Pollack, MD8; Raymond Plodkowski, MD9; and Reviewers of the AACE/ACE Obesity Clinical Practice Guidelines* American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice are systematically devel- oped statements to assist health care professionals in medical decision-making for specific clinical conditions. Most of the content herein is based on a systematic review of evidence published in peer-reviewed literature. In areas in which there was some uncertainty, professional judgment was applied. These guidelines are a working document reflecting the state of the field at the time of publication. Because rapid changes in this area are expected, periodic revisions are inevitable. We encourage medical professionals to use this infor- mation in conjunction with their best clinical judgment. The presented recommendations may not be appropriate in all situations. Any decision by practitioners to apply these guidelines must be made in light of local resources and individual patient circumstances. From 1Professor and Chair, Department of Nutrition Sciences, University of Alabama at Birmingham,
    [Show full text]
  • PAPER Obesity: the Disease of the Twenty-first Century
    International Journal of Obesity (2002) 26, Suppl 4, S2–S4 ß 2002 Nature Publishing Group All rights reserved 0307–0565/02 $25.00 www.nature.com/ijo PAPER Obesity: the disease of the twenty-first century SRo¨ssner1* 1Obesity Unit, Huddinge University Hospital, Stockholm, Sweden The prevalence of obesity is increasing globally, with nearly half a billion of the world’s population now considered to be overweight or obese. The obesity epidemic is related both to dietary factors and to an increasingly sedentary lifestyle. Obesity has significant co-morbidities and these are associated with substantial health care and social costs. Of particular concern is the fact that obesity is increasing among children and adolescents. National health policymakers must take action to deal with the obesity problem. Prevention should be the primary target, but it is also important to develop strategies to treat those already affected with obesity. International Journal of Obesity (2002) 26, Suppl 4, S2 – S4. doi:10.1038/sj.ijo.0802209 Keywords: obesity epidemic; sedentary lifestyle; dietary fat; co-morbidities Introduction predisposition, disruption in energy balance, and environ- The statistics on obesity are appalling, with nearly half a mental and social factors. The rapid increases in obesity, billion of the world’s population now considered to be however, cannot be related purely to genetic change as the overweight or obese. The problem does not only affect genetic pool changes slowly over thousands of years. In developed countries, as there is now a significant increase contrast, the environment has changed dramatically over in overweight and obesity throughout the developing world.
    [Show full text]