Harveian Oration 2016: Some observations on the causes and consequences of obesity

Metabolic surgery for the treatment of type 2 diabetes in patients with BMI lower than 35 kg/m2: Why caution is still needed

“…This theory also explains the occurrence of very obese individuals with a normal metabolic health in whom the threshold has not been achieved yet, which is aligned with a substantial amount of experimental data suggesting that an increase in fat expandability results in very obese animals with absolutely normal insulin sensitivity . The rationale of the theory is that insulin resistance only develops when the storage capacity of subcutaneous fat is exceeded, resulting in ectopic fat deposition in the skeletal muscle, liver, heart, pancreas, and other organs . Recent studies including lipodystrophic patients and genetic data have confirmed this model by showing that decreased adipose storage capacity in the legs predicts insulin resistance .…”

“…Metabolically unhealthy individuals with normal weight reach such threshold after gaining little weight, while metabolically unhealthy overweight and obese individuals require much more weight gain to reach their thresholds . This theory also explains the occurrence of very obese individuals with a normal metabolic health in whom the threshold has not been achieved yet, which is aligned with a substantial amount of experimental data suggesting that an increase in fat expandability results in very obese animals with absolutely normal insulin sensitivity . The rationale of the theory is that insulin resistance only develops when the storage capacity of subcutaneous fat is exceeded, resulting in ectopic fat deposition in the skeletal muscle, liver, heart, pancreas, and other organs .…”

“…44,45 The rationale of the theory is that insulin resistance only develops when the storage capacity of subcutaneous fat is exceeded, resulting in ectopic fat deposition in the skeletal muscle, liver, heart, pancreas, and other organs. 39,42,46 Recent studies including lipodystrophic patients and genetic data have confirmed this model by showing that decreased adipose storage capacity in the legs predicts insulin resistance. [47][48][49][50] Similarly, fat reduction itself (such as that obtained in aesthetic procedures) is unable to improve metabolic health 51 ; in fact, a small study has shown that leg suction lipectomy may even lead to impaired postprandial hypertriglyceridemia.…”

O Papel Do Reganho De Peso No Contexto Da Cirurgia Bariátrica E No Controle De Doenças Metabólicas Associadas

“…Embora seja altamente relevante a discussão trazida por esse consenso e por estudos apresentados, a recomendação de cirurgia metabólica para pacientes com diabetes melito do tipo 2 não controlado e índice de massa corporal de 30 a 35 kg/m² ainda carece de evidências suficientes diante da escassez de estudos prospectivos randomizados a esse respeito. 34 Estudos recentes com inclusão de pacientes lipodistróficos mostram que a diminuição da capacidade de armazenamento adiposo nos membros inferiores prevê resistência à insulina. 35,36 Pories e colaboradores trazem um estudo de referência acerca da cirurgia metabólica em pacientes com índice médio de massa corporal de 49,7 kg/m², que mostra uma taxa de remissão de 88% e diminuição rápida dos teores de glicose com bypass gástrico.…”

Harveian Oration 2017: Triumphs and challenges in a world shaped by medicine

“…The first is the rising tide of obesity, covered in the outstanding last Harveian Oration by Sir Stephen O'Rahilly. 27 The second is the spread of antibiotic resistance which the chief medical officer, Dame Sally Davies, has highlighted so effectively. 28 Common to both of these is that the underlying drivers, and the main solutions, are behavioural, including in the case of antibiotic resistance behaviours of our own profession.…”