Medical Facts...and Fiction

The goal of this section is to define the problem, the epidemic of obesity in this country in adults and in children. Data in this section are designed for the health care professions as well as for the public, with relevant references. In this regard, we will not re-invent the wheel, but will access all useful sources already published...invoking the "Fair Use Doctrine" for this educational effort when actual citations are not given. Of course, with over 50 years of clinical experience represented among the professional complement of this family enterprise, in addition to the experience of guest contributors, we will often express our own insights and opinions.

GS

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Various Topics for May 25, 2008

May 25, 2008

  • An article in JAMA (3/12/2008) found that, in order to sustain weight loss, monthly brief personal contact with health care personnel was beneficial...but that internet-based contacts were not.  This reflects earlier reports regarding the importance of personal reinforcement.
  • Regarding Diabetes Mellitus, a) glucose control can be too strict, resulting in increased mortality, generally from hypoglycemia.  The new goal is a HbA1c less than 7 (no longer the prior 6).  WATCH OUT FOR LOW BLOOD SUGAR.  One's blood should not be allowed to go below 80; b) Oral hypoglycemic medications have side effects including weight gain.  So, why not use insulin, or the tried and true combination of insulin / sulfonureas?  In fact, a recent report in Lancet (2008; 371:1725-26) found that early intensive insulin treatment achieved normal glucose levels faster than the oral agents, sometimes with extended remissions without the need for oral agents.
  • Bariatric Surgery is rapidly becomming mainstream treatment for excessive obesity and its common diabetic complication.  The Lap-Band procedure is less invasive than the Roux - en - Y procedure, but it is more often associated with reactive hypoglycemia, which occurs promptly after eating and which may be caused by an effect of the food on entry into the duodenum.   In either case, bariatric surgery is curative of type 2 diabetes in over 75% of cases, a remarkable result.  Evaluation and preparation for the surgery, physically and psychologically, may take several months at a tertiary center like Yale New Haven Hospital. 
  • Obesity in childhood greatly increases tyhe risk of such children developing heart disease, diabetes mellitis, liver disease and reduced life expectancy.  A series of articles on this subject appeared in The Day (www.theday.com) on Sunday, May 25, 2008. 
GS

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