2) @FRubinoMD is Professor, Chair of Metabolic and Bariatric Surgery @KingsCollegeLon; Consultant Surgeon, King's College Hospital; Co-Director Diabetes Surgery Summit-DSS. His disclosures and an accreditation statement are at https://t.co/gvXca4GHMU. pic.twitter.com/nmcMxbIO8J
— cardio-met (@cardiomet_CE) January 17, 2025
4) Where are we starting out? Show us your knowledge! Obesity was first recognized as a #disease by @WHO in
— cardio-met (@cardiomet_CE) January 17, 2025
6) Standard laboratory tests for assessment of ALL people with confirmed excess #adiposity should include at least all of the following:
— cardio-met (@cardiomet_CE) January 17, 2025
a. full blood count
b. glycemia and lipid profile
c. CRP or other markers of inflammation
d. renal and liver function tests
8) Obesity was 1st recognized as a disease by WHO in 1948, but there is currently a global obsession with #obesity & obesity treatments. Alas, we lack a clinical definition of just what obesity is & the broad ramifications of it for one's health are generally underappreciated. pic.twitter.com/6ZHe32Qfn2
— cardio-met (@cardiomet_CE) January 17, 2025
10) The Commission of 58 international & interdisciplinary experts and patients sought to define clinical #obesity as a condition of illness that directly results from the effect of excess adiposity on the function of organs & tissues, as in a typical chronic disease model.
— cardio-met (@cardiomet_CE) January 17, 2025
11b) Formally recognizing #obesity as a standalone disease might provide stronger medical & cultural legitimacy to the condition, ⬆️access to care for those in need, & might ⬇️societal stigma. Others are concerned, though, that classing obesity itself as a disease . . .
— cardio-met (@cardiomet_CE) January 17, 2025
11d) In addition, #obesity is a highly heterogenous condition; many ppl w/⬆️adiposity have no signs of ongoing illness. Perhaps obesity is better classed a #riskfactor than a disease? Treating ⬆️BMI as a diagnosis risks . . .
— cardio-met (@cardiomet_CE) January 17, 2025
12) The Commission recognized early on that this dispute ➡️a crucial missing piece in the way #obesity is conceptualized: because the illness directly caused by obesity is yet to be defined, obesity lacks a precise clinical identity. They sought to remedy that.
— cardio-met (@cardiomet_CE) January 17, 2025
13b) … in order to help inform the decision making of clinicians and policy makers to facilitate identification of priorities for clinical interventions and #publichealth strategies. pic.twitter.com/Xif2s47309
— cardio-met (@cardiomet_CE) January 17, 2025
14a) As for the ubiquitous #BMI, the Commission recommends it should be used only as a surrogate marker of health risk at a population level, for epi studies, or for screening purposes, not as an individual measure of health. pic.twitter.com/vn2YW4TCfY
— cardio-met (@cardiomet_CE) January 17, 2025
14d) (1) evidence of ⬇️ organ/tissue function due to obesity (signs, symptoms, diagnostic tests) or (2) substantial, age-adjusted limitations of daily activities reflecting the specific effect of obesity.
— cardio-met (@cardiomet_CE) January 17, 2025
15b) Clinical obesity can further lead to severe end-organ damage, causing life-altering & potentially life-threatening complications (eg, #MI, #stroke, #renalfailure).
— cardio-met (@cardiomet_CE) January 17, 2025
16a) This clinical definition is essential because #obesity is currently conceived & defined as a condition of excess adiposity that presents a “risk to health.” and ~70% of Commissioners held that this is not consistent with the notion of a standalone disease state.
— cardio-met (@cardiomet_CE) January 17, 2025
17a) Another ❓: must abnormal function (metabolic, endocrine, or both) of adipose tissue & excess adipose tissue mass both be present to define obesity? Abnormal function of adipose tissue ➡️several perturbances of physiology eg #insulin resistance . . .
— cardio-met (@cardiomet_CE) January 17, 2025
17c) Consider the physical effects of excess fat mass on organs (restrictive lung capacity, musculoskeletal complications, etc) or the whole individual can affect health in the absence of functional alterations.
— cardio-met (@cardiomet_CE) January 17, 2025
18a) So you are seeing the multiple dilemmas with which the Commission is dealing. The lack of a defined clinical identity of obesity as a disease provides no clear🎯, and ➡️no urgency, for clinical intervention.
— cardio-met (@cardiomet_CE) January 17, 2025
18c) A reframing of the clinical effect of obesity is warranted, to explain how obesity can be both a risk factor for other diseases and a direct cause of illness. pic.twitter.com/z0ueIfbCUn
— cardio-met (@cardiomet_CE) January 17, 2025
19) So what about decision making and treatment? Appropriate assessment is outlined here (the definition of preclinical #obesity is covered below): pic.twitter.com/dZ4hzrDO67
— cardio-met (@cardiomet_CE) January 17, 2025
20b) With current understanding, it is not possible to identify how much wgt loss is necessary to reach such goals; it may be that different clinical manifestations of clinical obesity might require different intensity of tx.
— cardio-met (@cardiomet_CE) January 17, 2025
20d) Choices regarding the types of intervention for clinical obesity (ie, lifestyle, pharmacological, psychological, or surgical) should be individualized decisions . . .
— cardio-met (@cardiomet_CE) January 17, 2025
21a) PRECLINICAL #obesity is a state of excess adiposity w/preserved function of other tissues & organs w/varying but generally ⬆️risk of developing clinical obesity & other non-communicable diseases such as #T2D, #CVS, certain types of #cancer, & mental disorders).
— cardio-met (@cardiomet_CE) January 17, 2025
21c) Health counselling, level of care, and type of intervention for preclinical obesity (lifestyle, pharmacological, psychological, surgical) should be based on individual risk–benefit assessment . . .
— cardio-met (@cardiomet_CE) January 17, 2025
21e) Preclinical obesity identifies ppl with a variable level of health risk but with substantially preserved health at present ➡️approach to care should be to aim for risk ⬇️(prophylactic intent).
— cardio-met (@cardiomet_CE) January 17, 2025
21g) For example: when an individual’s risk is deemed sufficiently low, people with preclinical obesity do not require treatment with drugs or surgery, but appropriate counselling & health monitoring. pic.twitter.com/UWKpqFGYV2
— cardio-met (@cardiomet_CE) January 17, 2025
22b) Public health strategies to ⬇️incidence & prevalence of obesity at population levels must be based on current scientific evidence, rather than unproven assumptions that blame individual responsibility for the development of obesity.
— cardio-met (@cardiomet_CE) January 17, 2025
23) A summary of the Commission’s recommendations appears here: pic.twitter.com/cKe9vnCFrq
— cardio-met (@cardiomet_CE) January 17, 2025
24b) … for prevention versus treatment strategies, and contribute to overcoming misconceptions that reinforce weight-based bias and stigma."
— cardio-met (@cardiomet_CE) January 17, 2025
26) Meanwhile, go NOW and claim your 1⃣hr 🆓CE/#CME at https://t.co/baetTKPpoV. And FOLLOW US right here on @cardiomet_CE for more expert-led education in the #cardiometabolic space!
— cardio-met (@cardiomet_CE) January 17, 2025
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