Bariatric Times

Insights into Patient Pop with Obesity 2016

A peer-reviewed, evidence-based journal that promotes clinical development and metabolic insights in total bariatric patient care for the healthcare professional

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C22 Bariatric Times • December 2016 • Supplement C P rimary care physicians (PCPs) and their patients should understand that obesity is a medical condition and that even modest weight loss can result in important benefits to the patient. A weight loss of around three percent can improve insulin sensitivity (glycemic control) and hypertriglyceridemia. 12 This is not to say that benefits stop with modest weight loss. As patients lose five percent of their weight, high-density lipoproteins (HDL) cholesterol decreases, systolic and diastolic blood pressure decrease. 12 Hepatic steatosis (fatty liver disease) measured by magnetic resonance spectroscopy (MRS) improves. 48 There will also at this point be certain measures of feeling and function that improve, namely an improvement in symptoms of urinary stress incontinence, 49 improvements in sexual function, 50,51 and enhanced quality of life. 52 Quality of life factors and improved function can be of paramount importance to patients and may be motivating factors to continue weight loss programs. As weight loss continues, at 10-percent loss, the nonalcoholic steatohepatitis (NASH) Activity Score (measured on biopsy) improves 53 as does the apnea-hypopnea index. 54 At the point the patient has lost 15 percent of weight, there is a reduction in cardiovascular events, lower mortality rates, and remission of type 2 diabetes mellitus (T2DM) may occur. While more substantial weight loss, such as 10 percent or more, is typically associated with bariatric surgery, weight loss of three or five percent confers real and important health benefits to patients. As such, patients should be encouraged that even seemingly modest weight loss will bring them health benefits. A large amount of visceral adipose tissue (VAT) or visceral fat increases blood insulin, blood glucose, thrombosis risk markers, inflammatory markers, impairs insulin sensitivity, worsens the lipid profile, and is associated with endothelial dysfunction. VAT is often assessed with the surrogate marker of waist circumference. So- called "abdominal obesity" is more associated with these negative factors as the adipose tissue is metabolically active. After weight loss, as VAT is lost, these same functions improve as the patient's waist line decreases. 55 It should be noted that a weight loss of 10 percent correlates with a 30- percent loss of VAT. Thus, BMI is an important marker and metric for obesity, but waist circumference (as measure of VAT) is an important metric for many of the health risks of obesity. Insights into the Patient Population with Obesity: Assessment and Treatment setting realistic expectations Christopher D. Still, DO, FACN, FACP Medical Director, Center for Nutrition and Weight Management; Director, Geisinger Obesity Institute; Medical Director, Employee Wellness, Geisinger Health System, Danville, Pennsylvania u

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