Obesity, classified by the American Medical Association in 2013 as a disease, is an epidemic that is drawing serious global attention. It is the most common preventable disease and the most common modifiable risk factor for several chronic diseases. It is an independent cause of increased morbidity and mortality. Obesity is spreading across most countries, socio-economic strata, age groups, gender groups, and races, albeit to variable degrees. It is concerning that both adults and children are increasingly afflicted by obesity. Both incidence and prevalence of the disease are on the rise. The direct and indirect costs attributable to obesity have reached billions of US dollars. Obesity management involves a multi-disciplinary approach that includes the patient and his or her family, the primary care provider, a dietician or nutrition specialist and physical trainer. It may also require specialist care in the use of pharmacological and surgical interventions. Currently available anti-obesity drugs are indicated for those who are obese (BMI of 30 kg/m(2)) or overweight (BMI of 27 kg/m(2)) with at least one weight-related comorbid condition. This article focuses on the FDA-approved antiobesity drugs, their mechanisms of action, chemical structures, efficacy, safety profiles and known side effects.
Patients with pre-diabetes have a tenfold higher risk of developing Type 2 DM and a twofold higher risk of developing coronary heart disease compared to non-diabetics. Interventions targeted at those in an early stage of impaired glucose metabolism can delay or prevent diabetes. Effects of these interventions on cardiovascular outcome are unknown. This article aims to review current and available data on lifestyle intervention, specifically physical activity, on cardiovascular outcomes in populations at risk for diabetes. We searched PubMed database from 1990 to present with focus on more recent literature published over the last 2 years. Various permutations of keywords used included glucose intolerance, pre-diabetes, diabetes, lifestyle modifications, physical activity, and cardiovascular disease. Intensive glycemic control, specific medications, and lifestyle intervention including increase in physical activity have been evaluated in diabetes and pre-diabetes. Most studies we reviewed showed that these interventions prevented progression of pre-diabetes to diabetes and improved cardiovascular risk surrogate measures. Direct decrease in cardiovascular mortality, non-fatal stroke, and non-fatal myocardial infarctions was shown in one recent trial. Increase in physical activity has a positive effect on decreasing cardiovascular risk by modifying several important risk factors and may decrease risk of events in pre-diabetics. More randomized high power trials are needed to verify and characterize these effects.
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