The Management of Obesity and Related Disorders

By Peter G. Kopelman | Go to book overview

management of obese subjects with type 2 diabetes.

The management of the obese diabetic patient should combine strategies which aim at reducing weight excess, lowering chronic hyperglycaemia and correcting other risk factors. Weight loss is a major target in treating obese patients with type 2 diabetes as it allows simultaneous improvement in both glycaemic control and associated risk factors, whereas specific anti-hyperglycaemic treatment, with sulphonylureas or insulin (but not metformin), usually favours weight gain and may worsen the risk profile. Aggressive weight reduction programmes may be used in severely obese individuals with type 2 diabetes, refractory to conventional diet and drug treatment. In particular, bariatric surgery may be helpful in diabetic subjects with morbid obesity. However, even if weight loss appears to be the cornerstone of successful treatment, long-term prospective studies are still required to determine more precisely the place of each strategy in the overall management of obese diabetic patients (evidence-based medicine). Obviously, the prevention of obesity should be considered a key objective by medical practitioners and public health authorities in order to limit the expected epidemic of type 2 diabetes mellitus in this early new millennium.


References
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Scheen AJ, Lefèbvre PJ, Pathophysiology of type 2 diabetes. In: Kuhlmann J, Puls W, eds, Handbook of Experimental Pharmacology, Oral Antidiabetics (Springer Verlag: Berlin, 1996) 7-42.
2
DeFronzo RA, Pathogenesis of type 2 diabetes: metabolic and molecular implications for identifying diabetes genes, Diabetes Rev (1997) 5:177-269.
3
Pi-Sunyer FX, Weight and non-insulin-dependent diabetes mellitus, Am J Clin Nutr (1996) 63(Suppl):426S-9S.
4
Willett WC, Dietz WH, Colditz GA, Guidelines for healthy weight, N Engl J Med (1999) 341:427-34.
5
Björntorp P, Abdominal obesity and the development of non-insulin-dependent diabetes mellitus, Diabetes Metab Rev (1988) 4:615-22.
6
Chan JM, Stampfer MJ, Ribb EB et al, Obesity, fat distribution and weight gain as risk factors for clinical diabetes in man, Diabetes Care (1994) 17:961-9.
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Wannamethee SG, Shaper AG, Weight change and duration of overweight and obesity in the incidence of type 2 diabetes, Diabetes Care (1999) 22:1266-72.
8
Sakurai Y, Duration of obesity and risk of non-insulin-dependent diabetes mellitus, Biomed Pharmacother (2000) 54:80-4.
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Scheen AJ, Aggressive weight reduction treatment in the management of type 2 diabetes, Diabetes Metab (1998) 23:116-23.
10
Scheen AJ, Lefèbvre PJ, Management of the obese diabetic patient, Diabetes Rev (1999) 7:77-93.
11
Scheen AJ, Lefèbvre PJ, Antiobesity

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The Management of Obesity and Related Disorders
Table of contents

Table of contents

  • Title Page iii
  • Contents v
  • Preface x
  • 1 - Defining Overweight and Obesity 1
  • References 7
  • I - The Complications of Obesity 9
  • 2 - Obesity and Diabetes 11
  • References 36
  • 3 - Obesity and Hyperlipidemia 45
  • 4 - Obesity and Cardiovascular Disease and Hypertension 65
  • 5 - Obesity and Abnormalities of Haemostasis 85
  • 6 - Obesity and Respiratory Complications 103
  • References 123
  • II - Management Approaches 127
  • 7 - Dietary Management of Obesity 129
  • References 156
  • Appendix 1 159
  • 8 - Behavior Therapy 165
  • 9 - The Physical Activity Approach to the Treatment of Overweight and Obesity 179
  • 10 - Pharmacological Approaches 203
  • References 219
  • 11 - Surgery 221
  • 12 - An Integrated Approach to the Management of Overweight and Obesity 235
  • Index 247
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