COURSE GUIDE - International Association for the Study of Obesity

Speaker Presentation Summarieswith different intensity and duration, on obstructive sleep apnoea.Below two cases from our study are presented. In our study weinvestigated the effect of a very low energy diet (VLED) for nineweeks 3 followed by a weight maintenance programme for a totalduration of one year in obese men with moderate to severeobstructive sleep apnoea.Case 1 The first case was a 43y old man with a body weight of126 kg and a BMI of 38.8 kg/m 2 . During the VLED phase thepatient lost 30 kg, BMI was reduced to 29.5 kg/m 2 and AHI wasreduced from 37 to 12 events/h. Over the one year treatmentprogramme he lost 26% of his initial weight, AHI was improvedby 60% and he went from severe (AHI >30) to mild (AHI 5-15)sleep apnoea and no longer needed treatment with CPAP.Case 2 The second case was a 54y old man with a weight of 87kg and BMI of 32.1 kg/m 2 . During the VLED phase the patient lost14 kg, BMI was reduced to 26.9 kg/m 2 and AHI was reduced from56 to 21 events/h. Over the one year treatment programme he lost10% of his initial weight. His AHI improved by 66% and he wentfrom severe (AHI >30) to moderate (AHI 15-30) sleep apnoea.References1. Tuomilehto HP, Seppa JM, Partinen MM, Peltonen M, GyllingH, Tuomilehto JO, et al. Lifestyle intervention with weightreduction: first-line treatment in mild obstructive sleep apnea.Am J Respir Crit Care Med 2009;179(4):320-7.2. Foster GD, Borradaile KE, Sanders MH, Millman R, Zammit G,Newman AB, et al. A randomized study on the effect of weightloss on obstructive sleep apnea among obese patients withtype 2 diabetes: the Sleep AHEAD study. Arch Intern Med2009;169(17):1619-26.3. Johansson K, Neovius M, Lagerros YT, Harlid R, Rossner S,Granath F, et al. Effect of a very low energy diet on moderateand severe obstructive sleep apnoea in obese men: arandomised controlled trial. BMJ 2009;339:b4609.Arya SharmaWhen is surgical treatment for obesity appropriateBariatric surgery should be considered for obese patients at highrisk of morbidity and mortality who have not achieved adequateweight loss with lifestyle and medical management and who aresuffering from the complications of obesity. Bariatric surgerycan result in substantial weight loss, resolution of comorbidconditions, and improved quality of life. The patient’s weightlosshistory; his or her personal accountability, responsibility, andcomprehension; and the acceptable level of risk must be takeninto account. Complications include technical failure, bleeding,abdominal pain, nausea or vomiting, excess loose skin, bowelobstruction, ulcers, and anastomotic stricture. Success withbariatric surgery is more likely when multidisciplinary careproviders, in conjunction with primary care providers, assess,treat, monitor, and evaluate patients before and after surgery.Lifelong monitoring by a multidisciplinary team is essential.Family physicians will play a critical role in counselling patientsabout bariatric surgery and will need to develop skills in managingthese patients in the long-term.Lucy JonesCase studies: Weight loss before surgeryHere, we discuss 2 examples of where weight loss prior tobariatric surgery has been able to improve the treatmentpathway or patient outcome. Weight loss before surgery canimprove insulin sensitivity, cardio respiratory fitness, mobility,blood pressure and reduce dosages of various medications. Thisshould ensure that seriously challenged obese and super-obesepatient’s experience of surgery is less hazardous.Charles CapperThe challenges of weight management in primary carepracticeObesity in adults rose from 15% in 1993 to 24.5% in 2008. If itcontinues at this rate is predicted to rise to 50% by 2050.The challenges to prevention and treatment of obesity include:• Understanding the causes of the present epidemic such asabundance of calorie dense foods, poor food labelling, attractionof sedentary pursuits at the expense of activity, chaotic eatingpatterns and loss of nuclear family life.• Treating adult obesity with interventions that fit with pressuresof modern living.• Identifying and treating childhood obesity since it is now wellaccepted that obese children become obese adults.• Awareness of the need to refer children earlier than at present.• Role of schools.• Understanding of the respective roles of aerobic and resistanceexercise and changing perceptions on exercise versus caloriecontrol.• Overcoming health professionals’ reluctance to prescriberegimens to create weight loss in children for fear of negativeimpact on growth.• Addressing parental perceptions.• Improved local support services and role of government actionand public health measures.• Recognition by health professional of obesity as a treatabledisease and overcoming perceived impotence in treating it.• Greater awareness of the role of very low calorie diets andbariatric surgery.• Greater emphasis on obesity in the medical school curriculumI hope to expand on the above, consider how primary carepractice can address these challenges and encourage discussionwith regard to recent evidence in these areas.Pia ChristensenBody composition changes and adverse effectsThere has been concern about the loss of lean body massduring Very Low Energy Diet (VLED) and Low Energy Diet (LED)treatments. Several studies have shown that with the use of LED’s,the lean body mass: fat-mass ratio of the lost mass is approximately25:75. The loss of lean body mass, in the osteoarthritis and weight24