7th Obesity & Endocrinology Specialists Congress October 10- 12, 2016 Manchester, UK

A lack of energy balance most often causes overweight and obesity. Energy balance means that your energy IN equals your energy OUT. Overweight and obesity happen over time when you take in more calories than you use. An Inactive Lifestyle- People who are inactive is more likely to gain weight because they don't burn the calories that they take in from food and drinks. Our environment doesn't support healthy lifestyle habits; in fact, it encourages obesity. Some reasons include; Lack of neighborhood sidewalks and safe places for recreation, oversized food portions, lack of access to healthy foods and false food advertisings etc. Genes and Family History-genes have a strong influence on a person's weight. Overweight and obesity tend to run in families. Your chances of being overweight are greater if one or both of your parents are overweight or obese.

Occurrences of monogenic types of obesity are evidence that obesity may be caused by genetic mutations, however, as yet, only 78 cases worldwide have been attributed to mutations of seven distinct genes. The most common forms of obesity are probably the result of variations within a large number of genes. Sequence variations within a pool of 56 different genes have been reported as being related to obesity phenotypes, however, only ten of those genes showed positive results in at least five different studies. Beside these rare cases, many individuals have a genetic predisposition that may lead to obesity. Researchers have found many obesity susceptibility genes and the combination of an obesogenic environment and a genetic predisposition will almost inescapably result in the development of obesity. In brief, current knowledge brings to the conclusion that genetic factors may be involved in the etiology of obesity and, exclusive of very rare severe obesity cases, the genes involved are probably genes that interact with environment factors related to energy intake and expenditure to increase the risk of obesity.

Being obese or overweight can increase the risk of developing a range of serious diseases. The risks rise with BMI, and so are greater for obese individuals.

Overweight and obesity are proven risk factors for:

• Diabetes
• Cardiovascular diseases
• Heart disease
• High cholesterol
• Stroke
• Hypertension
• Gallbladder disease
• Musculoskeletal problems
• Osteoarthritis
• Venous Stasis Disease
• Sleep Apnea and other respiratory illness
• Certain Cancers: uterine, breast, colorectal, kidney, and gallbladder

 Obesity is also associated with:

• Fertility issues
• Complications of pregnancy
• Menstrual irregularities
• Hormone abnormalities
• Urinary stress incontinence
• Psychological disorders (depression)
• Increased surgical risk
• Increased risk of death

Obesity and diabetes are reciprocal. According to the Centre for Disease Control, of the people who are diagnosed with type II diabetes, about 80-90% are also diagnosed as obese. Every three seconds, someone is diagnosed with diabetes. Type II diabetes is a lifelong (chronic) disease in which there are high levels of sugar (glucose) in the blood and the cells ignore the insulin. Type II diabetes is the most common form of diabetes. Weight gain is common in people who take insulin to treat diabetes. That’s because the more insulin we use to maintain our blood glucose level, the more glucose is absorbed into our cells, rather than eliminated by our body. The absorbed glucose is stored as fat, which makes us gain weight.

Childhood obesity has more than doubled in children in the past 30 years. The percentage of children aged 6–11 years in the United States who were obese increased from 7% in 1980 to nearly 18% in 2012. In 2012, more than one-third of children and adolescents were overweight or obese. Childhood obesity is strongly associated with risk factors for cardiovascular disease, type 2 diabetes, orthopedic problems, mental disorders, underachievement in school and lower self-esteem.

Gynoid obesity is characterized by presence of fat at hip and thigh regions. Buttocks of people suffering from this type of obesity will be larger than that of others. Body shape of these people would be pear shaped and hence they are called pear obese or gynoid obese. But despite such, gynoid obesity having individuals are said to be at a much safer position than the android obese individuals for they are less at risk in developing chronic illnesses linked to obesity and overweight. 

BMI is used as a screening tool to indicate whether a person is underweight, overweight, obese or a healthy weight for their height. If a person's BMI is out of the healthy BMI range, their health risks may increase significantly. BMI values are age-independent and the same for both sexes. However, BMI may not correspond to the same degree of fatness in different populations due to different body proportions. The health risks associated with an increasing BMI are continuous, and the interpretation of BMI grading in relation to risk may differ for different populations. BMI is not accurate enough to be used as a diagnostic tool. However, it is used as a screening tool to identify potential weight problems in adults. 

Anorexia Nervosa is a psychological and possibly life-threatening eating disorder defined by an extremely low body weight relative to stature (this is called BMI [Body Mass Index] and is a function of an individual’s height and weight), extreme and needless weight loss, illogical fear of weight gain, and distorted perception of self-image and body. There are two common types of anorexia, which are as follows: Anorexia Nervosa Binge / Purge Type , Restrictive Anorexia Nervosa. Anorexia Nervosa continues to have the highest mortality of all psychiatric conditions. Since anorexia involves both mind and body, a team approach to treatment is often best. Those who may be involved in anorexia treatment include medical doctors, psychologists, counselors, and dieticians.

Treating obesity entails a combination of dietary, physical activity, and lifestyle changes. Medications may also be used. Orlistat, lorcaserin hydrochloride, phentermine, and phentermine/topiramate are FDA approved for treating obesity. Antidepressants, anticonvulsants, and metformin are used off-label. Additionally, group interventions are very effective in decreasing weight and improving glycemic control. Among older adults, group interventions are more successful than one-on-one training. Bariatric Surgery: Approximately 5% of adults are morbidly obese, making them candidates for bariatric surgery. Bariatric surgery leads to significant weight loss, improved glycemic control, decreased hypertension, reduction in depression, improved sexual activity, and decreased sleep apnea. One study showed that after the surgery, 78% of patients had complete resolution of T2DM, and 62% were in remission 1 year after surgery.

The therapeutic essentials for treating obesity are diet, exercise, and lifestyle modification that reduce energy intake and increase energy expenditure.  Pharmacotherapy, Appetite suppressants, Orlistat, Surgery and healthy Dietary Supplements are some of them.

Medical weight loss is not surgery or diet pills. It is weight management based on medical scientific principles that target the root causes of obesity and weight gain to achieve and sustain a healthy weight in the long-term under the care of a medical provider.

The tools that medical weight loss providers use to manage weight are very different from what we find with commercial programs. First, medical weight loss providers use metabolism and body composition (mainly fat percentage) as true indicators of weight loss progress. Second, they can prescribe safe, low-calorie diets that are specifically designed to lose weight while breaking the cycle of food addiction. They prescribe an appetite suppressant.  Finally, they have the ability to view weight loss and maintenance within the context of total health profile.

Diet treatments include fad diets, formulated diets, very-low-energy diets (VLCD) and conventional diets. Fad diets may possibly reduce some weight short-term; however, there is no scientific basis to their long-term use. Formulated diets may be suitable for some individuals but they need to be properly assessed professionally. There are specific guidelines for the use of VLCD, which are only appropriate for short-term use. There is scientific evidence to suggest that conventional diets can produce both short and long-term weight loss. A successful weight-loss depends on a multidisciplinary approach.

Obesity counselling is proven to be very beneficial for those who are overweight. It provides support, guidance and encouragement to the individuals for overcoming the problem and improving their quality of life. Counselling is an effective way to acknowledge and understand the various factors that are adding to obesity. It helps people to take measures that help them achieve and sustain right weight for a life span. Proper counselling for obesity highlights the importance of healthy eating and physical activity for weight loss and maintenance, apart from identifying any other factors like genetic and environment that are becoming an obstacle.

Effective counselling has to go beyond ‘Eat-Less, Exercise-More’ cliché. Here is what proper counselling should highlight: Proper counselling helps obese individuals realize that weight loss is a slow and gradual process that requires hard work and commitment. So, one has to be strong and patient to follow the right weight loss plan.

Interventions for obesity prevention mainly focus on nutrition, physical activity or both aspects in several settings. Multi‐faceted interventions at schools are proven to be effective. Nutrition‐based interventions at schools seem to be effective as well. Economic instruments may have an effect although there is insufficient evidence. Community‐based interventions may be effective. Several European countries have specific national obesity prevention policy documents, such as obesity action plans or obesity prevention strategies, in place. Up to 2007, these were identified in Croatia, Czech Republic, Denmark, Ireland, Netherlands, Poland, Portugal, Slovakia, and Spain. In some countries in Europe, an institution is established to tackle obesity. Most national interventions take place at the school setting and a lot of campaigns aimed at obesity, diet or physical activity are identified.

Endocrinology is a specialty of medicine; some would say a sub-specialty of internal medicine, which deals with the diagnosis and treatment of diseases related to hormones.

Endocrinology covers such human functions as the coordination of metabolism, respiration, reproduction, sensory perception, and movement. Endocrinology also focuses on the endocrine glands and tissues that secrete hormones.

Hormones are chemical messengers that regulate processes in our body. They are one factor in causing obesity. The hormones leptin and insulin, sex hormones and growth hormone influence our appetite, metabolism (the rate at which our body burns kilojoules for energy), and body fat distribution. People who are obese have levels of these hormones that encourage abnormal metabolism and the accumulation of body fat.

A system of glands, known as the endocrine system, secretes hormones into our bloodstream. The endocrine system works with the nervous system and the immune system to help our body cope with different events and stresses. Excesses or deficits of hormones can lead to obesity and, on the other hand, obesity can lead to changes in hormones.

Current research on obesity seeks to identify genetic, behavioral, and environmental causes of obesity; to understand how obesity leads to type 2 diabetes, cardiovascular disease, and other serious health problems; and to build on basic and clinical research findings to develop and study innovative prevention and treatment strategies. The research institutes, other agencies and public and private organizations will all play important roles in reducing the epidemic of obesity.