1. The Obesity/Diabetes Epidemic: Adiposopathy & ‘Obesity’- The New Disease! Weight Management in Obesity and DM: Emphasis on New Medical Therapies 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 Part 1

2. Outline Epidemiology and Economics of obesity/diabetes Perspectives on Obesity Consequences of Obesity, Prediabetes, Obesity Obesity/ Diabetes Risk Factors, Obesity/ Diabetes Onset can be Prevented or Delayed – Early Risk Identification and Intervention. Medical Benefits to Weight Loss Treatment- –Basics, Generalities –Obesity Lifestyle- Diet, Activity, Behavior Medications –Weight Control, WEIGHT REDUCTION in DIABETES

3. - Metabolically Healthy Obese Yes, but…Healthy Obese= OXYMORON

5. Obesity Paradox: Metabolically Healthy Obese Patients still has Increased CV rates and All Cause mortality And have other adverse outcomes related to DJD and Sleep Apnea, for example

7. Date of download: 12/14/2013 Copyright © American College of Physicians. All rights reserved. Are Metabolically Healthy Overweight and Obesity Benign Conditions?: NO!! THUS= OXYMORON Ann Intern Med. 2013;159(11):758-769. doi:10.7326/0003-4819-159-11-201312030-00008 Meta-analyses of various clinical characteristics, by metabolic–body mass index categories. Data shown as weighted mean difference compared with metabolically healthy normal- weight persons (reference). To convert cholesterol, triglyceride, and glucose values to traditional units (mg/dL), divide by 0.0259, 0.0113, and 0.0555, respectively. HOMA-IR = Homeostasis Model Assessment of Insulin Resistance.* P < 0.05.

8. Medical Complications of Obesity Phlebitis venous stasis Metabolic Non-metabolic

10. Outline Epidemiology and Economics of obesity/diabetes Perspectives on Obesity Consequences of Obesity, Prediabetes, Obesity Obesity/ Diabetes Risk Factors, Obesity/ Diabetes Onset can be Prevented or Delayed – Early Risk Identification and Intervention. Medical Benefits to Weight Loss Treatment- –Basics, Generalities –Obesity Lifestyle- Diet, Activity, Behavior Medications –Weight Control, WEIGHT REDUCTION in DIABETES