際際滷

際際滷Share a Scribd company logo

Treating Obesity: The Way Forward

E
ecipenm

Presentation by Josep Vidal, Endocrinology and Nutrition Department Institut de Malaties Digestives i Metab嘆liques Hospital Cl鱈nic Barcelona, Spain during ECIPE Roundtable: Fighting the Burden of Obesity, Brussels 07/02/2017

1 of 19
Downloaded 21 times
Trea%ng Obesity: The Way Forward Josep Vidal Endocrinology and Nutri0on Department Ins0tut de Malal0es Diges0ves i Metab嘆liques Hospital Cl鱈nic Barcelona, Spain
EU Obese Subjects Box Health at a Glance: Europe 2016 Trea0ng Obesity: The Way Forward Prevalence Obesity in EU Member States The preven0on strategy 2011 2014
Health at a Glance: Europe 2016 Prevalence Obesity in EU Member States 2011 2014 The treatment strategy Trea0ng Obesity: The Way Forward
Condi%ons associated with obesity Up to 195 condi0ons have been associated with obesity Trea0ng Obesity: The Way Forward These condi0ons would be less common shall obesity be less prevalent
The End Organ Damage Approach Current Approach to Obesity Related Condi0ons
Therapeu0c Algorithm for Type 2 Diabetes European Associa%ons for the Study of Diabetes (EASD) ≒ Focus on drug combina%ons for glycemic control ≒ Considera%on of weight loss as desirable side e鍖ect of hypoglycemic drugs ≒ No speci鍖c strategies for weight loss
The End Organ Damage Approach Current Approach to Obesity Related Condi0ons Is this the logical approach?
The Common Ground Approach Impact of MODEST weight loss on obesity-related comorbidi%es (% weight loss associated with improvement of di鍖erent condi0ons) Weight loss and Obesity Related Comorbidi0es 0 2 4 6 8 10 12 14 16 Metabolic syndrome Pre-diabetes T2 diabetes Hypertension NAFLD OSA Asthma Urinary incon0nence Weight loss rela0ve to baseline Garvey et al. End Prac:ce 2016
Weight loss and Obesity Related Comorbidi0es Obesity-related cancers Incidence and mortality reduced Doesnt this op%on deserve further aZen%on? The Common Ground Approach Impact of LARGE weight loss on obesity-related comorbidi%es
Weight Loss at 1 Year with High-Intensity Lifestyle Interven%ons or Pharmacotherapy Combined with Low-to-Moderate-Intensity Lifestyle Counseling. Heyms鍖eld SB, Wadden TA. N Engl J Med 2017 Not approved by the EMA Not approved by the EMA Current Op0ons for a Weight Centered Approach
The Look Ahead Trial (RCT: intensive LII versus control group in 5145 subjects with T2D, and BMI 36 kg/m2) High Intensity Lifestyle Interven0on in pa0ents with Diabetes Weight Changes Ini0al bene鍖ts of current lifestyle interven0ons are di鍖cult to sustain The Look Ahead Research Group. N Eng J Med 2013 Fitness Changes
The Look Ahead Trial (RCT: intensive LII versus control group in 5145 subjects with T2D, and BMI 36 kg/m2) High Intensity Lifestyle Interven0on in pa0ents with Diabetes DM remission over 4 years Posi0ve impact of WL but limited because of weight regain Gregg EW et al. JAMA 2012 Is MODEST weight loss worthless in T2D? The Look Ahead Research Group. N Eng J Med 2013 Changes in the incidence of CV disease
The Look Ahead Trial (RCT: intensive LII versus control group in 5145 subjects with T2D, and BMI 36 kg/m2) High Intensity Lifestyle Interven0on in pa0ents with Diabetes Post-hoc analysis based on the achievement of >10% WL irrespec%ve of the study group The Look Ahead Research Group. Lancet 2016 0.4 0.6 0.8 1 1.2 1.4 1.6 <2% loss 2-5% loss 5-10% loss >10% loss p=0.034 Adjusted Hazard ra%o (95% CI) Incidence of CVD at 10 y Weight Loss Category at 1 y follow up 1.00 1.08 1.16 0.79 0 10 20 30 40 50 <2% WL 2-5% WL 5-10% WL > 10% WL Distribu%on of WL categories % ILI 18% 47% 75% 92% % cont 82% 53% 25% 8% ≒ Posi0ve impact of WL on CVD, if >10% WL is achieved ≒ Importance of iden0fying responders and factors associated with likelihood of >10% WL
Fujioka et al. Diabetologia 2014;57(Suppl. 1):Abstract 904-P 63.1 27.1 33.1 10.6 49.6 23.7 24.8 9.9 0 20 40 60 80 Liraglu0de Placebo >5% WL-12 m >10% WL-12 m >5% WL-36 m >10% WL-36 m Scale Prediabetes Trial An0-Obesity Drugs Study Subjects (%) ≒ E鍖ec0ve in facilita0ng the achievement of WL goals
Weight Loss at 1 Year with Bariatric Surgery and Lifestyle Interven%ons as Compared with Lifestyle Interven%ons Alone. Bariatric Surgery Heyms鍖eld SB, Wadden TA. N Engl J Med 2017
Bariatric Surgery and Type 2 Diabetes -0.6賊2.5% -2,5賊1,9% -2,5賊2,1% STAMPEDE Trial-Cleveland Clinic: 3 years FU (n=137, Age 48 y, BMI 36,5 kg/m2, HbA1c preQ 9,3%, DM dura0on 8,3 y, Insulin Rx 43%) Schauer et al. N Eng J Med 2014 Time course of HbA1c Time course of Body Mass Index
Sjostrom L, J Int Med 2013 Swedish Obese Subjects Study Control, n=2037; Bariatric Surgery, n= 2010 (>10 years follow up) 1. Major and sustained weight loss compared to conven0onal treatment 2. Reduc0on of all cause mortality 3. Reduc0on of cardiovascular mortality and incidence of 1st CV event (fatal or no fatal) 4. Preven0on and remission of diabetes 5. Reduc0on of the incidence of myocardial infarc%on in subjects with T2D 6. Reduc0on of obesity-related cancer incidence and mortality (in women) 7. Improved quality of life 8. Reduc0on of health costs (up to 20 years follow up) Health Bene鍖ts Associated with Bariatric Surgery
Approaching an overwhealming task Too many pa0ents! BMI in the obesity range Health Impact Concentrate on Those with the Greatest Health Impact Trea0ng Obesity: The Way Forward
Summary ≒ Tackling the obesity epidemics requires ac0on beyond preven0on ≒ Trea0ng obesity is an e鍖ec0ve means to improve obesity-related comorbidi0es ≒ E鍖orts should be made to make e鍖ec0ve therapies available to obese subjects with obesity-related comorbidi0es Although high-intensity lifestyle interven0ons are e鍖ec0ve, research is needed to beler uon how make these interven0ons feasible More research is needed to substan0ate the bene鍖ts of drug-assissted weight loss E鍖orts should be made to make bariatric surgery to eligible pa0ents

More Related Content

Treating Obesity: The Way Forward