Weight Control in Individuals With Diabetes
- Zachary T. Bloomgarden, MD, is a practicing endocrinologist in New York, New York, and is affiliated with the Division of Endocrinology, Mount Sinai School of Medicine, New York, New York
- 2-AG, 2-arachidonyl glyceryl
- ADA, American Diabetes Association
- CB, cannabinoid
- EC, endocannabinoid
- GABA, γ-aminobutyric acid
- GDM, gestational diabetes mellitus
- MCH, melanin concentrating hormone
- OSA, obstructive sleep apnea
- RIO, rimonabant in obesity
- WBC, white blood cell
This is the third in a series of articles on presentations at the American Diabetes Association’s 66th Scientific Sessions, Washington, DC, 9–13 June 2006.
A pilot project is underway to offer the Perspectives on the News commentaries as a monthly Web-based CME activity. Please access www.diabetes.procampus.net to view our initial efforts. We look forward to your comments.
Bariatric surgery
Carroll M. Harmon, Birmingham, Alabama, reviewed the topic of bariatric surgery in children. A typical response to the topic, he said, is of disbelief that such an approach would even be considered. Yet more than one million adolescents and young adults have BMI >40 kg/m2, and obesity is by far the most common nutritional disorder among children in the U.S. Childhood obesity is associated with poor self-esteem, steatohepatitis, and a variety of cardiovascular and endocrine complications, with 80% of overweight children with one obese parent becoming obese adults. Harmon reviewed representative studies, showing that by standard measures, the quality of life of an obese child is similar to that of a child with cancer and fivefold worse than that of a healthy normal-weight child. Parent proxy reports suggest even greater impairment. Obstructive sleep apnea (OSA) is present in 55% of severely obese children with BMI >50 kg/m2. Overweight children have a sevenfold greater risk of hypertriglyceridemia, and 86% of children diagnosed with diabetes are overweight or obese. The prevalence of childhood obesity among blacks and Hispanics is higher than among whites, with the likelihood of diabetes particularly great for African-American and Hispanic children. There is undoubtedly, Harmon concluded, interplay between genetic and environmental factors, with >600 genetic loci linked to obesity phenotypes and multiple single-gene mutations identified.
Treatment options for pediatric obesity are limited, with diet, exercise, and drugs, at best, able to produce moderate success. Thus, Harmon suggested, …
