VCU Stravitz-Sanyal Institute for Liver Disease and Metabolic Health’s Post

Great to see this new framework for the diagnosis, staging and management of obesity in adults from EASO. 'In many settings, the diagnosis of obesity is still based solely on body mass index (BMI) cut-off values, and does not reflect the role of adipose tissue distribution and function in the severity of the disease.' I agree it is time to move away from BMI and towards a more complete clinical evaluation of the patient. 'Based on current clinical evidence, the diagnosis of obesity should not be based solely on the presence of an abnormal and/or excessive fat accumulation (anthropometric component). The diagnosis of obesity should instead include a careful analysis of the present and potential effects that dysfunctional and/or excessive fat accumulation may have on health.' Another key part to highlight 'Behavioral modifications, including nutritional therapy, physical activity, stress reduction and sleep improvement, were agreed as main cornerstones of obesity management, with the possible addition of psychological therapy, obesity medications and metabolic or bariatric (surgical and endoscopic) procedures.' Treatment needs to be individualised and delivered in collaboration with the patient.

I wanted to share some thoughts on the American Heart Association's statement on Implementation of Obesity Science Into Clinical Practice: A Scientific Statement From the American Heart Association (and give a special shout out to one of the co-authors, my amazing residency colleague and friend, Chiadi E. Ndumele, MD, PhD, FAHA). The gaps that they reviewed methodically are at the very core of our mission at FORM. Among many important points that they make, they highlight how adopting new technologies and telemedicine are among promising methods to unlock successful, evidence-based obesity care. They also underscore the lack of familiarity of so many health care professionals with guideline-based treatment, quoting a study demonstrating that only 15% of clinicians surveyed were familiar with guideline-directed indications for prescribing obesity pharmacotherapies. We leverage the experience and expertise of FORM's American Board of Obesity Medicine physicians and connect patients with evidence-based expert obesity care wherever they may be. The AHA has been a powerful organization in US healthcare, focused on scientific evidence to drive clinical best practices. We thank them for their impactful support of the message that obesity is a chronic disease, and that treatment is not about weight, but about prevention of cardiometabolic and other diseases. The case for increasing access to evidence-based obesity care could not be stated more simply -- "the rewards of lower mortality, long-term health care cost savings, and improved quality of life warrant the investment."

Concerning Prevalence of Subclinical Cardiovascular-Kidney-Metabolic (CKM) Syndrome What is CKM Syndrome? CKM syndrome is a newly defined health disorder that recognizes the interconnectedness of cardiovascular disease, kidney disease, diabetes, and obesity. These conditions often occur together and share common risk factors, leading to worse health outcomes. The American Heart Association has established a framework for CKM syndrome, dividing it into five stages based on the severity and presence of risk factors: - Stage 0: No CKM syndrome risk factors - Stage 1: Excess and/or dysfunctional adiposity (unhealthy weight distribution) - Stage 2: Metabolic risk factors and kidney disease - Stage 3: Subclinical CVD (early signs of cardiovascular disease without symptoms) - Stage 4: Clinical CVD (diagnosed heart disease) Study Findings and Implications The study, spearheaded by Dr. Abdul Mannan Khan Minhas, analyzed data from the National Health and Nutrition Examination Survey (NHANES) and found a high prevalence of subclinical CKM syndrome (stages 1-3) across different age groups: - 80.94% of people aged 20 to 44 years - 85.95% of people aged 45 to 64 years - 72.03% of people aged 65 years or older These findings emphasize the need for early identification and management of CKM syndrome to prevent progression to more severe stages and adverse cardiovascular events. Public health efforts should focus on: - Raising awareness about CKM syndrome and its risk factors - Promoting healthy lifestyle choices to prevent or manage obesity, diabetes, and other metabolic conditions - Implementing targeted screening programs to identify individuals with early-stage CKM syndrome - Developing comprehensive management strategies that address the interconnected nature of CKM syndrome. Link to the article: https://lnkd.in/dGUgMASn #CKMsyndrome #publichealth #cardiovascularhealth #kidneyhealth #metabolichealth #prevention

Improving implementation of best practices in obesity management: Physician experiences in obesity care. In this study, we sought to analyse experiences in weight management among physicians working in the area of obesity and contrast these experiences with best practices. By understanding experiences of physicians working in obesity management, we can better support implementation of best practices in their day-to-day practice. An online survey of Canadian primary care physicians, internists and endocrinologists recruited from a nationwide market research database was conducted. The survey captured demographic characteristics and perceptions about weight loss and its management. One hundred and ninety-two physicians (140 primary care, 22 internists and 30 endocrinologists) were recruited and completed the survey. Challenges identified by the physicians in helping patients lose weight included patients' poor compliance and lack of time and resources to address the issue. Most physicians reported considering obesity to be a chronic disease, but most did not incorporate a multi-dimensional, chronic disease model of obesity treatment (i.e., combination of lifestyle interventions with psychological, medical and/or surgical interventions). Endocrinologists reported management practices consistent with a chronic disease model more frequently than primary care physicians. These data highlight the need for improvement in obesity management, particularly in primary care. Despite proliferation of guidelines on best practices, implementation of these practices into daily practice remains low. Lee-Baggley D, Fils-Aimé N, Audet I, Barakat M. Improving implementation of best practices in obesity management: Physician experiences in obesity care. Clin Obes. 2023. Accessed January 17, 2024. https://lnkd.in/dS7qAbBp

A year in review: The field of obesity medicine in 20

Obesity pakistan’s national disease. 62% women and 31% are over weight. Obesity is associated with a wide range of complications affecting various organ systems. Here are some of the key complications: Cardiovascular System 1. Hypertension (High Blood Pressure) 2. Coronary Artery Disease 3. Heart Failure 4. Stroke 5. Atrial Fibrillation Endocrine and Metabolic 1. Type 2 Diabetes Mellitus 2. Dyslipidemia (Abnormal Cholesterol Levels) 3. Metabolic Syndrome 4. Polycystic Ovary Syndrome (PCOS) 5. Non-Alcoholic Fatty Liver Disease (NAFLD) Respiratory System 1. Obstructive Sleep Apnea 2. Obesity Hypoventilation Syndrome 3. Asthma Gastrointestinal System 1. Gastroesophageal Reflux Disease (GERD) 2. Gallbladder Disease 3. Colorectal Cancer Musculoskeletal System 1. Osteoarthritis 2. Gout 3. Chronic Back Pain Reproductive System 1. Infertility 2. Complications During Pregnancy 3. Erectile Dysfunction Psychological and Social 1. Depression 2. Anxiety 3. Social Stigmatization 4. Reduced Quality of Life Cancer Increased risk of various cancers, including: 1. Breast Cancer 2. Endometrial Cancer 3. Colorectal Cancer 4. Prostate Cancer 5. Kidney Cancer Actually 13 cancers are associated with obesity, out which 11 are preventable with weight loss Others 1. Chronic Inflammation 2. Impaired Immune Function 3. Chronic Kidney Disease Calculating the index of obesity. The Body Mass Index (BMI) Alternatively, if weight is in pounds (lb) and height is in inches (in), the formula is: Example Calculation Using Metric Units: • Weight: 70 kg • Height: 1.75 m Using Imperial Units: • Weight: 154 lbs • Height: 69 inches These complications highlight the importance of addressing obesity through lifestyle interventions, medical management, and, in some cases, surgical options. Why is he smiling? Pride in pounds! May be

🧑⚕️💉 ɴᴇᴡ ᴏʙᴇꜱɪᴛʏ ᴛʀᴇᴀᴛᴍᴇɴᴛꜱ ᴄᴏᴜʟᴅ ꜱᴘᴇᴇᴅ ᴜᴘ ᴍᴇᴛᴀʙᴏʟɪꜱᴍ, ꜰɪɴᴅꜱ ᴄʟɪɴɪᴄᴀʟ ᴛʀɪᴀʟ A new study at St. Vincent's University Hospital (SVUH) suggests that weight-loss medications such as Ozempic, Wegovy, or Monjaro may not just suppress appetite but also speed up metabolism. A randomised controlled trial led by Professor Donal O’Shea, SVUH and UCD School Of Medicine found a strong relationship between the amount of weight lost and increases in metabolic activity caused by daily use of medications based on the hormone Glucagon-like peptide-1 (GLP-1). The findings published in the Journal of the Obesity Society challenge the belief that recent weight loss medications work just by simply causing those who use them to eat less. “It always seemed oversimplistic to me that these new treatments were just making people eat less,” said Professor O’Shea. “So, this study finding is an exciting step forward in our understanding of how these new medicines for obesity work.” Adding: “This study challenges the main narrative about these newer treatments which is that they simply make you eat less, and that any action on energy burn is minimal. “The findings also provide science to support the fact that the treatment of obesity is not simply to eat less and move more – that’s the prevention piece – treatment is more complex than that.” In the randomised controlled trial, which involved 30 patients, those who had low metabolic activity before starting treatment benefited the most from medications such as Ozempic, Wegovy and Monjaro. The patients had specialised imaging of the fat within their abdomen using a PET-CT scanner, with scans carried out before and after six months of treatment. The results showed a strong correlation between increased metabolic activity and the degree of weight loss. Furthermore, those with low metabolic activity before starting treatment benefited the most from it. “The strength of the association is surprising given the relatively small numbers studied and suggests this increase in metabolic activity is a significant contributor to how these drugs work,” said Professor O’Shea. “Safe medical treatment for obesity is still in its infancy and we need to understand fully how the treatment works. Understanding how these agents increase energy burn should be an important part of future research. “I hope the companies involved in the development of these treatments will examine this area in more detail because these are very expensive studies to carry out and we are very grateful to the Health Research Board and University College Dublin for supporting it.” The study ‘GLP‐1 therapy increases visceral adipose tissue metabolic activity: lessons from a randomised controlled trial in obstructive sleep apnea’ was co-authored by Professor Silke Ryan, SVUH, funded by the Health Research Board (HRB) and supported by University College Dublin.

Harnessing the Power of Tirzepatide: A Breakthrough in Combating Obesity In the battle against obesity, the arsenal of available treatments has expanded, offering new hope for those struggling to shed excess weight. Among these groundbreaking options is tirzepatide, a medication that has garnered attention for its promising results in clinical trials. Tirzepatide is a novel dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptor agonist developed by Eli Lilly and Company. It works by targeting multiple pathways involved in glucose and weight regulation, making it a potent tool in the fight against obesity and related metabolic conditions. Clinical trials have demonstrated the remarkable efficacy of tirzepatide in promoting weight loss and improving metabolic parameters. In a Phase 3 trial involving individuals with type 2 diabetes, tirzepatide led to significant reductions in body weight and improved glycemic control compared to placebo and other antidiabetic medications. Another Phase 3 trial focusing on individuals with obesity without type 2 diabetes showed similarly promising results, with participants experiencing substantial weight loss and improvements in cardiovascular risk factors. One of the key advantages of tirzepatide is its superior efficacy compared to existing medications. Studies have shown that tirzepatide induces greater weight loss and glycemic control compared to GLP-1 receptor agonists alone, making it a compelling option for individuals with obesity and/or type 2 diabetes. Additionally, tirzepatide's convenient dosing regimen, typically administered once weekly, enhances adherence and simplifies treatment for patients. Tirzepatide represents a significant advancement in the field of obesity management, offering new hope for individuals struggling with weight loss. Its multifaceted approach targeting both weight and metabolic parameters makes it a promising option for addressing the complex nature of obesity and its associated comorbidities. As researchers continue to explore tirzepatide's potential in diverse patient populations, the future of obesity management looks increasingly bright. The emergence of tirzepatide as a powerful weapon in the fight against obesity marks a significant milestone in the field of metabolic medicine. With its impressive efficacy and convenient dosing regimen, tirzepatide has the potential to transform the lives of millions affected by obesity and related conditions. As we harness the power of innovative treatments like tirzepatide, we move closer to overcoming the global epidemic of obesity and improving the health and well-being of individuals worldwide. #Tirzepatide #ObesityTreatment #WeightLoss #MetabolicHealth #MedicalInnovation #HealthcareAdvances #ClinicalTrials #HealthResearch

Irritable bowel syndrome (IBS) affects an estimated 5-10% of the global population and 10-15% of American adults. This condition, more commonly diagnosed in women, stems from a complex interaction between the brain, gut, and nervous system, leading to symptoms like abdominal pain, bloating, diarrhea, and constipation. IBS's impact varies widely, from mild inconvenience to severe debilitation, significantly affecting emotional, social, and professional life. Despite the high prevalence of IBS, which accounts for 20-40% of gastroenterologist visits, many do not seek medical care, with only 2.4 to 3.5 million annual visits in the U.S. While treatments are available, their effectiveness varies, highlighting the need for personalized approaches. Recent studies underscore the potential of dietary modifications over medications. Research published in The Lancet Gastroenterology & Hepatology from Sahlgrenska University Hospital, Sweden, compared dietary treatments to medication. The findings suggest that a low FODMAP diet, which limits certain carbohydrates that trigger digestive symptoms, might be particularly effective. After a 4-week treatment period, 76% of participants on a low FODMAP diet reported significant symptom relief, compared to 71% on a low-carb, high-protein diet and 58% on medication. The study emphasized the importance of diet in managing IBS and suggested continuing research into personalized treatment strategies. As the quest for effective IBS management continues, the focus remains on understanding individual dietary triggers and developing tailored interventions to improve the quality of life for those affected. https://lnkd.in/e8Q7EbhX

We had a very engaging and informative talk by Alia Marie Abreo, Director of Potential Health Development. She talked about women’s metabolic health and various female health conditions that affect women from puberty to menopause. One review she referenced was published in the International Journal of Cardiovascular Science by Oliveira GMM and her team at Universidade Federal do Rio de Janeiro. This review reports on metabolic syndrome in Brazilian women and factors influencing the condition. Link to the review article: https://lnkd.in/gDAynU8d Menopausal women often experience a decline in estrogen levels, leading to conditions such as insulin resistance, obesity, sleep disturbances, and inflammation, collectively known as metabolic syndrome. This syndrome increases the risk of type 2 diabetes and cardiovascular diseases. Socioeconomic and lifestyle factors contribute to the development of metabolic syndrome. To tackle this issue, strategies include educating the population on the importance of healthy lifestyle changes from early childhood. Currently, metabolic syndrome is managed by giving pharmacological medication. Addressing metabolic syndrome requires a comprehensive approach involving lifestyle modifications, education, and medical interventions. Altogether, considering age and gender-specific risk factors is crucial for menopausal women.