Obesity and Diabetes (eBook)

Anthony H. Barnett, Sudhesh Kumar (Herausgeber)

eBook Download: PDF

2005
John Wiley & Sons (Verlag)
978-0-470-01109-6 (ISBN)

Infos

Obesity has become the most common chronic disease of the present day, with significant increases in prevalence in populations across the world and all age groups. This has resulted in a dramatic increase in obesity-related metabolic and cardiovascular complications, making it an important public health issue.

Type 2 diabetes associated with obesity or 'diabesity' is today the most common form of type 2 diabetes. It is also associated with a number of other cardiovascular risk factors, which constitute the metabolic syndrome. Effective management of 'diabesity' is crucial to the reduction of morbidity and premature mortality due to cardiovascular disease.

This book comprises chapters written by leading international experts on various aspects of obesity-related diabetes. As a practical reference guide, it is suitable for all professionals with an interest in this field. Emerging problems such as childhood 'diabesity' and the impact of obesity on polycystic ovary syndrome will be of interest not only to paediatricians and endocrinologists, but also to general practitioners and other healthcare professionals.

The contemporary approach to the clinical assessment of obesity and its management in both primary and secondary care settings is also described.

Professor AH Barnett, MD, FRCP, Department of Medicine, Birmingham Heartlands Hospital, Birmingham, AL.

Dr S Kumar, MD, FRCP, Professor of Medicine (Diabetes & Metabolism), Warwick Medical School, University of Warwick, Canada.

Inhalt

Obesity and Diabetes 3
Contents 7
Foreword 13
List of Contributors 15
1 Changing Epidemiology of Obesity – Implications for Diabetes 19
Introduction 19
Assessment of obesity in epidemiological studies 19
Prevalence of obesity 20
The epidemiological link between obesity and diabetes 21
Factors modifying the relationship between obesity and diabetes 23
Conclusions 27
References 27
2 The Genetics of Human Obesity 31
Introduction 31
Why has the genetics of obesity been difficult to study? 31
How much of obesity is genetic? 33
Is there a major gene for obesity? 35
How to identify obesity genes 36
Summary and conclusions 47
References 48
3 Lifestyle Determinants of Obesity 51
The importance of energy balance 51
Physical activity 52
Energy intake 53
Environmental impacts on lifestyle 59
An integrated analysis 60
Conclusions 61
References 62
4 Pathogenesis of Obesity-Related Type 2 Diabetes 67
Introduction 67
Defining fat accumulation in terms of health risk 68
Implications of obesity-associated diabetes 69
Development of obesity-related type 2 diabetes 69
Fat distribution 72
Evaluating obesity-related hypotheses for progression of type 2 diabetes 73
Ectopic fat storage: fat content in obesity 74
Lipid metabolism in adipose tissue 76
Effects of NEFA on hepatic insulin action 79
Adipose-tissue derived factors 80
Summary 87
References 88
5 Obesity and Prevention of Type 2 Diabetes 97
Obesity and the risk of type 2 diabetes 97
Lifestyle intervention studies 101
Other intervention studies 106
Conclusions 109
References 112
6 Diet and Food-based Therapies for Obesity in Diabetic Patients 117
Introduction 117
Type 2 diabetes 117
Patterns of weight loss in diabetes 118
Target setting 119
Dietary and lifestyle alterations 119
Dietary nutrient composition in type 2 diabetes 120
The approach to dietary prescription 122
Failure of therapy 123
Fat or carbohydrate 123
Meal replacement therapy 126
Very low calorie diets (VLCD) 126
Conclusions 127
References 127
7 Behavioural Modification in the Treatment of Obesity 129
Introduction 129
Genetics 130
The ‘toxic environment’ 130
Components of obesity treatment 131
Features of behavioural lifestyle change 132
Behavioural modification strategies in obesity treatment 134
Efficacy of combination treatments 139
Conclusions and future work 143
References 143
8 Physical Activity, Obesity and Type 2 Diabetes 149
Introduction 149
Physical activity and exercise, what is the difference? 150
Current physical activity behaviour and guidelines 151
The importance of physical activity to health 153
Energy balance 156
Energy expenditure 157
Exercise tolerance and cardiorespiratory fitness in overweight and obese adults and children 163
Guidelines for exercise and activity prescription (including practical issues of clinical management for diabetics and the obese) 165
Research evidence on the role of physical activity in the prevention and treatment of obesity and type 2 diabetes 167
Physical activity and the behavioural treatment of obesity 173
Linking research and practice 174
Case study 174
Summary 177
References 179
9 Diabetes, Obesity and Cardiovascular Disease – Therapeutic Implications 185
Introduction 185
Obesity and mortality 186
Obesity and cardiovascular disease 186
Obesity and hypertension 187
Obesity and dyslipidaemia 188
Obesity, type 2 diabetes and insulin resistance 190
Obesity and type 2 diabetes 192
Insulin resistance and cardiovascular disease 193
Type 2 diabetes and dyslipidaemia 196
Type 2 diabetes and hypertension 197
Type 2 diabetes and CHD 197
Benefits of weight loss 200
Exercise 200
Pharmacotherapy 201
Management of hypertension 201
Management of dyslipidaemia 204
Antiplatelet therapy 207
Conclusion 208
References 208
10 Drug Therapy for the Obese Diabetic Patient 219
Introduction 219
Drugs for hyperglycaemia 219
The role of anti-obesity drugs in diabetic management 224
Antihypertensive treatment 227
Lipid-lowering treatment 228
Use of other drugs that may cause weight gain 228
References 229
11 The Role of Bariatric Surgery in the Management of Type 2 Diabetes 233
Introduction 233
Obesity and type 2 diabetes: 233
Surgical techniques 234
Resolution of diabetes after bariatric surgery 239
How does surgery ‘cure’ diabetes? 240
Conclusions 244
References 246
12 Childhood Obesity and Type 2 Diabetes 251
Introduction 251
Childhood is a time of change 251
The problem of size 252
The size of the problem 254
What causes obesity in childhood? 254
Does obesity in childhood matter? 257
Persistence in to adult life 266
Management of childhood obesity 266
Management of Complications 270
Conclusions 271
References 271
13 Obesity and Polycystic Ovary Syndrome 279
Definition of the syndrome 279
Pathogenetic mechanisms underlying the relationship between obesity and PCOS (Table 13.1) 280
Clinical features of obese PCOS women 288
Treatment of obese women with PCOS (Table 13.2) 292
Conclusions 296
References 296
14 Management of Diabesity in Primary Care: a Multidisciplinary Approach 303
Prevalence of obesity in primary care 303
Current approach to diabetes care in primary care 304
Early treatment with hypoglycaemic agents 305
Integrating obesity management with diabetes 305
A multidisciplinary approach 305
Dietary treatment of diabetes 306
Clinical assessment 308
Treatment groups 308
Physical activity 309
Behavioural change 311
Use of medication to aid weight loss in primary care 312
Summary 313
References 313
Index 315

Rezensionen

"An easily readable
text suitable to general pediatricians and family physicians."
(Pediatric Endocrinology Reviews (PER), Vol. 3: September
2005)

"...recommended for all professionals with an interest in
this field...the book features many suggestions of practical
value." (E-STREAMS, September 2005)

"...a great reference book, is clearly laid out, offers
practical guidance and is a very interesting read..." (Practical
Diabetes International, Vol 22 (6) July 2005)

Produkt-Details

• Erscheint lt. Verlag: 8.4.2005
• Reihe/Serie: Practical Diabetes
• Reihe/Serie: Wiley Diabetes in Practice Series
• Reihe/Serie: Wiley Diabetes in Practice Series
• Sprache: englisch
• Themenwelt: Sachbuch/Ratgeber ► Gesundheit / Leben / Psychologie
• Themenwelt: Medizin / Pharmazie ► Gesundheitsfachberufe ► Diätassistenz / Ernährungsberatung
• Themenwelt: Medizinische Fachgebiete ► Innere Medizin ► Diabetologie
• Schlagworte: across • Age • Cardiovascular • Cardiovascular Disease • Chronic • Common • Day • Diabetes • Disease • dramatic • endocrinology • Endokrinologie • Form • groups • Health • important • increase • increases • Issue • Kardiovaskuläre Erkrankungen • Kardiovaskuläre Erkrankungen • Medical Science • Medizin • metabolic • Obesity • obesityrelated • Populations • present • Prevalence • Public • significant • Type • World • Zuckerkrankheit
• ISBN-10: 0-470-01109-2 / 0470011092
• ISBN-13: 978-0-470-01109-6 / 9780470011096