Obesity In America - Obesity, Weight Loss and Patient Health

Obesity impacts other aspects of a patient's health. Examining the pathophysiology of obesity include: fat cell as an endocrine cell, impact of body fat distribution, impact on other health conditions, exercise and obesity

How Does Obesity Impact Other Aspects of a Patient's Health

Endocrine researchers are devoting much time and energy to observing how obesity impacts other aspects of a patient’s health. It is vital for endocrinologists to have the full picture of how obesity has a hand in either causing or contributing to serious obesity-related health conditions (diabetes, metabolic syndrome, hypertension, PCOS). Obesity is truly multifactorial and to be fully effective in treating and managing obesity, endocrinologists need to understand its implications. Key research developments examining the pathophysiology of obesity include:

Key research developments examining the pathophysiology of obesity include:

Identifying the Fat Cell as an Endocrine Cell/Organ
There are two prime examples of the impact fat cells have on obesity and a patient’s health:

Obesity inherently reflects an increased amount of fat cells and increased body mass (body mass index or BMI). Increased body mass causes conditions such as osteoarthritis and sleep apnea.
The discovery of leptin allowed for the acknowledgement by researchers that fat is an endocrine cell¹⁰⁵. (Please see sidebar for more information.) In addition to leptin, there are increased amounts of other peptides in the body that are affected by an increase in fat cells. At times, these proteins may alter – either slow or accelerate – the normal metabolic functioning of the body. Such metabolic changes tend to lead to complications, including the development of hyperinsulinemia, atherosclerosis or hypertension, and physical stress put on bones and joints.

Clarifying the Impact of Body Fat Distribution on Obesity
People with an uneven distribution of fat in their upper body (upper body obesity), and especially inside the abdomen, are prone to developing insulin resistance, Type 2 diabetes, abnormal blood lipid patterns associated with premature cardiovascular disease, as well as hypertension. Endocrine research has shown that elevated levels of free fatty acids (acids released primarily by fat cells and used for energy within the body) into the bloodstream can cause insulin resistance, abnormal production of triglycerides by the liver and blood vessel responses that can lead to hypertension. People with upper body obesity have elevated levels of free fatty acids and are therefore at higher risk for a number of other health problems seen in obesity. In addition, intra-abdominal fat has been shown to send excess free fatty acids to the liver, thereby causing the liver to produce too much glucose and triglycerides.

Understanding Obesity’s Impact on Other Health Conditions
Through important scientific and clinical research, endocrinologists are helping to build a framework from which clinicians are better able to address the root causes of obesity and to effectively assist with the management of obesity-related conditions. To date, some of the most compelling endocrine-related research has come from examining the link between obesity and diabetes.

What is the Diabetes Prevention Program (DPP)?
The Diabetes Prevention Program (DPP) was a major clinical trial, conducted primarily by endocrinologists, that looked at whether diet and exercise or the diabetes drug metformin (Glucophage) could prevent or delay the onset of Type 2 diabetes in people with impaired glucose tolerance (IGT).

Why is it considered groundbreaking endocrine research?
Groundbreaking research from the DPP found that over the three years of the study, diet and exercise sharply reduced the chances that a person with IGT would develop diabetes. Metformin also reduced risk, although less dramatically. The DPP resolved these questions so quickly that, on the advice of an external monitoring board, the program was halted a year early. The researchers published their findings in the New England Journal of Medicine in February 2002.

The DPP's results demonstrated that millions of high-risk people can use diet, exercise, weight loss, and behavior modification to avoid developing Type 2 diabetes. The DPP also suggests that metformin is effective in delaying the onset of diabetes. Future research and analysis will continue to examine and determine the true relationship between exercise and diet and the reduction of diabetes.

Through important medical research on obesity and obesity-related complications – much of it being conducted by endocrinologists – we are beginning to understand that obesity has many underlying medical causes, which may not be controlled by diet and exercise. We must move beyond stigma and dedicate ourselves to combating obesity on all fronts – behavioral, nutritional and metabolic – a concept endocrine researchers are currently addressing.

Examining the Link Between Exercise and Obesity
Endocrine researchers are actively exploring the link between exercise and activity and their impact on weight gain/weight loss. The National Weight Control Registry (NWCR), an ongoing, longitudinal prospective study led by endocrinologists Dr. James Hill of the University of Colorado and Dr. Rena Wing of Brown University and University of Pittsburgh, is examining individuals 18 years and older, who have successfully maintained a 30 pound weight loss for a minimum of one year. Currently, the weight loss study registry is comprised of nearly 3,000 individuals. The weight loss study is investigating and disproving one of the most popular myths about weight loss – that everyone who experiences weight loss will eventually gain it back. In recent years, the NWCR has reported that maintaining weight loss is easier than the initial loss of weight. In the trial, maintenance of weight loss is typically associated with continued consumption of a healthy low-calorie diet. Although there appears to be no evidence of increased metabolic efficiency in those who successfully lost weight, NWCR has identified a correlation between duration of weight loss maintenance and the effort required to maintain such weight loss (as the duration increases, effort required tends to decrease).