Advances in the Science,Treatment, and Prevention of the Disease of Obesity: Reflections From a Diabetes Care Editors’ Expert Forum

As obesity rates increase, so too do the risks of type 2 diabetes, cardiovascular disease, and numerous other detrimental conditions. The prevalence of obesity in U.S. adults more than doubled between 1980 and 2010, from 15.0 to 36.1%. Although this trend may be leveling off, obesity and its individual, societal, and economic costs remain of grave concern. In June 2014, a Diabetes Care Editors’ Expert Forum convened to review the state of obesity research and discuss the latest prevention initiatives and behavioral, medical, and surgical therapies. This article, an outgrowth of the forum, offers an expansive view of the obesity epidemic, beginning with a discussion of its root causes. Recent insights into the genetic and physiological factors that influence body weight are reviewed, as are the pathophysiology of obesity-related metabolic dysfunction and the concept of metabolically healthy obesity. The authors address the crucial question of how much weight loss is necessary to yield meaningful benefits. They describe the challenges of behavioral modification and predictors of its success. The effects of diabetes pharmacotherapies on body weight are reviewed, including potential weight-neutral combination therapies. The authors also summarize the evidence for safety and efficacy of pharmacotherapeutic and surgical obesity treatments. The article concludes with an impassioned call for researchers, clinicians, governmental agencies, health policymakers, and health-related industries to collectively embrace the urgent mandate to improve prevention and treatment and for society at large to acknowledge and manage obesity as a serious disease.Obesity is a crucial public health concern given its contribution to the risk of diabetes, cardiovascular disease (CVD), and other comorbidities. The prevalence of obesity (BMI ≥30.0 kg/m²) in U.S. adults more than doubled between 1980 and 2010, from 15.0 to 36.1% (1,2). More than two-thirds (68.7%) of all American adults are overweight or obese (BMI ≥25.0 kg/m²) (1). Although recent data suggest a leveling off in this trend, persistently high obesity rates remain of grave concern (3). Obesity rates are now also climbing in developing countries; worldwide, obesity has nearly doubled since 1980, affecting >500 million adults (4).As obesity rates increase, so too do the risks of type 2 diabetes, CVD, hypertension, arthritis, cognitive impairment, and some cancers (5). In the U.S., diagnosed diabetes increased from 7.8 million in 1993 to 21 million in 2012, >8 million people remain undiagnosed, and an estimated 86 million adults have prediabetes (6,7). Population-based studies have suggested that ∼75% of hypertension is attributable to obesity (8), and approximately one-third of cancer deaths are linked to poor nutrition, excess weight, and sedentary lifestyle (9). Worldwide, 44% of the diabetes burden, 23% of ischemic heart disease, and 7–41% of certain cancers are attributable to excess weight (4). Obesity also decreases both health-related quality of life (10) and life expectancy (11).The medical costs of obesity in the U.S. were estimated at $190 billion in 2012 (12). A recent systematic review found that, worldwide, obesity-related medical costs accounted for 0.7–2.8% of a country’s total health care expenditure and that people with obesity had medical costs ∼30% higher than their normal-weight peers (13).With these alarming statistics in mind, a Diabetes Care Editors’ Expert Forum convened in June 2014 to review the state of obesity research and discuss prevention and treatment initiatives. This article summarizes the proceedings of that forum.     

The STAR Study: A Real-World,International, Observational Study of the Safety and Tolerability of,and Adherence to,Serum-Free Subcutaneous Interferon β-1a in Patients With Relapsing Multiple Sclerosis

BackgroundAdverse reactions, particularly injection site reactions (ISRs), are common reasons for nonadherence to injectable multiple sclerosis (MS) treatments. Adherence to MS treatment is important to ensure good treatment outcomes.ObjectiveThe aim of this study was to assess the local tolerability of subcutaneous (SC) serum-free interferon (IFN) β-1a in patients with relapsing MS over 1 year in a real-life, international setting. The study also assessed safety, disease activity, and adherence.MethodsThis was a prospective, international, multicenter, observational study of 251 patients with relapsing-remitting MS treated with SC serum-free IFN β-1a 44 μg or 22 μg 3 times weekly for 12 months or until early discontinuation. The primary end point was the proportion of patients with ISRs. Secondary end points included proportion of patients with adverse events (AEs); annualized relapse rate (ARR); proportion of patients remaining relapse-free; and adherence to treatment.ResultsDuring the observation period, 27.5% (69 of 251) of patients experienced nonserious ISRs, which was consistent with the incidence reported in clinical studies. Five patients discontinued treatment and 2 patients suspended treatment because of ISRs. Mean age was 35.8 years; patients were predominantly white (94.8%), and two thirds (66.1%) were female. The overall incidence of AEs was 63.7% (160 of 251), and overall safety and tolerability were assessed as excellent, very good, or good in >85% of patients. More than 70% of patients remained relapse-free, and the mean ARR was 0.4. More than 90% of patients had very good or good adherence to treatment; a significantly greater proportion of these were relapse-free at 12 months compared with those with fair or poor adherence (77.6% vs 50.0%; P = 0.0107), and their ARR was significantly lower (0.3 vs 0.9; P = 0.0055). Patients with fair or poor adherence had 4.6 times higher odds of experiencing a relapse than those with very good or good adherence.ConclusionsThe incidence of ISRs and the overall safety profile in this observational study, in an international population in a real-life setting, confirm the good local tolerability of SC serum-free IFN β-1a reported in clinical studies. The association between good adherence and a lower ARR underlines the importance of good adherence. The good local and general tolerability of SC IFN β-1a may help ensure a high level of adherence, which is associated with better clinical outcomes. ClinicalTrials.gov identifier: NCT01080027.     

A Review of: “Losing a Parent to Death in the Early Years: Guidelines for the Treatment of Traumatic Bereavement in Infancy and Early Childhood by Alicia F. Lieberman,Nancy C. Compton,Patricia Van Horn,and Chandra Ghosh Ippen”

Abstract

This article addresses the need for improved clergy-mental health professional collaboration in the assessment and treatment of elderly suicide. Millions of older adults with personal problems seek the counsel of clergy. A recent Gallup survey found that elders are more willing to turn to their clergy than their medical doctor or a mental health specialist for help when a friend is contemplating suicide (Gallup Organization, 1992). Elder suicide prevention presents the mental health and religious communities with unique opportunities to work together in the best interests of those they serve.