The Obesity/Diabetes Epidemic:
Adiposopathy & ‘Obesity’- The New
Disease!
Weight Management in Obesity and DM:
Emphasis on New Medical Therapies
Part 3
Stan Schwartz MD, FACP, FACE
Private Practice, Ardmore
Obesity Program
Cardiometabolic Diabetes Center and Affiliate,
Main Line Health System
Emeritus, Clinical Associate Professor
University of Pennsylvania
A Guide to Selecting Treatment
BMI (kg/m2)
Treatment
Diet, exercise, and
behavior therapy
Pharmacotherapy
Bariatric surgery
25–26.9 27–29.9 30–34.9 35–39.9
With
comorbidities
≥40
With
comorbidities
+
+
+
With
comorbidities
+
+
+
With
comorbidities
+
NIH/NHLBI, NAASO. The Practical Guide: Identification, Evaluation, and
Treatment of Overweight and Obesity in Adults. Bethesda, MD: NIH, 2000.
Lifestyle Modification
LowCalorie
Diet
Increased
Physical
Activity
Behavior
Therapy
The “Toxic Environment”
•
supersized
High-Calorie Food is…
– Highly palatable
– Inexpensive
– Heavily advertised
– Near-ubiquitous
Brownell KD & Horgen KB. Food Fight. New York: McGraw-Hill; 2003.
Compliance, Use foods Used to Eating
Cumulative Effect of Small Daily Errors in Energy Balance on
Body Fat Mass
Lb/yr
Leads to ‘100 cal/ day = 1 lb/m’ rule
My Advice: use foods patient used to eating
The “Toxic Environment”
• Physical
Activity is…
– To be avoided
– Nearly
unnecessary
– Limited by
infrastructure
Brownell KD & Horgen KB. Food Fight. New York: McGraw-Hill; 2003.
Burning a lot less energy (per
half hour) in 2004 vs 1984
Calories Burned 2004
Calories Burned 1984
Lift (2 mins)
3
Take Stairs
19
Order take away
1
Cook Meal
70
Load Dishwasher 23
Wash Up
80
Watch TV
35
Play Cards
52
Go to car wash
35
Wash Car
104
Play Video Game 53
Play Basketball 280
Ride Lawn Mower 88
Mow Lawn
193
So… Hard to lose weight with exercise