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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThe dual pandemics of obesity and diabetes threaten to overwhelm the health systems of countries the world over. What can we do about abdominal obesity? This article addresses challenges and options for dealing with abdominal obesity-related conditions.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EObesity\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EDiabetes Mellitus\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiometabolic Disorder\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EThe dual pandemics of obesity and diabetes threaten to overwhelm the health systems of countries the world over. What can we do about abdominal obesity? Luc Van Gaal, MD, PhD, Antwerp University Hospital, Antwerp, Belgium, addressed challenges and options for dealing with abdominal obesity-related conditions.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EConventional antidiabetes therapies often increase weight (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E) [UK Prospective Diabetes Study 34. \u003Cem\u003ELancet\u003C\/em\u003E 1998; Kahn SE et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2006]. A cross-sectional evaluation of participants with type 2 diabetes in the Look AHEAD trial showed that adipose tissue distribution is significantly altered in these patients [Gallagher D et al. \u003Cem\u003EAm J Clin Nutr\u003C\/em\u003E 2009].\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/11\/8\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Weight Increase With Conventional Approaches for the Treatment of Type 2 Diabetes.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-2053755868\u0022 data-figure-caption=\u0022Weight Increase With Conventional Approaches for the Treatment of Type 2 Diabetes.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/11\/8\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/11\/8\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/12\/11\/8\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14197\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-4\u0022 class=\u0022first-child\u0022\u003EWeight Increase With Conventional Approaches for the Treatment of Type 2 Diabetes.\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EReprinted from The \u003Cem\u003ELancet\u003C\/em\u003E, Vol 351\/9112, Kahn H et al., Prenatal exposure to famine and health in later life, 1360\u20131, Copyright (1998), with permission from Elsevier.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-5\u0022\u003EAccording to Prof. Van Gaal, 3 key actions to address this problem include 1) assess risk (ie, visceral fat and comorbid conditions), 2) initiate interventions to reduce total and visceral fat, such as lifestyle changes, pharmacotherapy, and weight loss surgery, and 3) institute preventive measures.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EIn a recent meta-analysis, Ismail et al. [\u003Cem\u003EObes Rev\u003C\/em\u003E 2012] assessed the efficacy of exercise interventions on visceral adipose tissue (VAT) content and volume in overweight and obese adults. Data suggested that aerobic exercise in this population is central for exercise programs aimed at reducing VAT. Albu et al [\u003Cem\u003EDiabetes\u003C\/em\u003E 2010] found that changes in overall weight (adipose tissue mass) and hepatic fat were the most important determinants of metabolic improvements.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EPharmacotherapy includes central-acting drugs (eg, sibutramine and topiramate\/phentermine combination); lipase inhibition (ie, orlistat); and glucose-lowering drugs. In 1998, Van Gaal et al. [\u003Cem\u003EInt J Obes Relat Metab Disord\u003C\/em\u003E 1998] reported that sibutramine produced statistically and clinically significant decreases in waist circumference and waist-to-hip ratio, and preferentially reduced visceral fat levels. Last year, Gadde et al. [\u003Cem\u003ELancet\u003C\/em\u003E 2011] found significant improvements in comorbid conditions with a topiramate\/phentermine combination.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003ENew and future drugs that target intra-abdominal fat include second-generation peripheral cannabinoid 1 antagonists, 11 \u03b2 hydroxysteroid dehydrogenase inhibitor, glucagon-like peptide (GLP)-1 analogs\/mimetics, sodium glucose cotransporter (SGLT)-2 inhibitors, and leptin-pramlintide combination.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EIn an investigation of the effects of GLP-1 analog liraglutide, Inoue et al. [\u003Cem\u003ECardiovasc Diabetol\u003C\/em\u003E 2011] found that liraglutide significantly reduced estimated visceral fat compared with no significant change before medication induction (p\u0026lt;0.005). A study on dapagliflozin, a SGLT-2 inhibitor, showed a decrease in total body weight at Week 24, predominantly by reducing fat mass, VAT, and subcutaneous adipose tissue in patients with type 2 diabetes inadequately controlled by metformin [Bolinder J et al. \u003Cem\u003EJ Clin Endocrinol Metab\u003C\/em\u003E 2012].\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EResolution of type 2 diabetes is known to be an additional benefit of surgical treatment for severe obesity [Pories WJ et al. \u003Cem\u003EAnn Surg\u003C\/em\u003E 1995], with glycemic control often occurring long before significant weight loss [Mingrone G et al. \u003Cem\u003EDiabetologia\u003C\/em\u003E 1997]. Buchwald et al. [\u003Cem\u003EJAMA\u003C\/em\u003E 2004] reported 98.9% resolution of diabetes with the biliopancreatic diversion or duodenal switch technique and 83.7% for gastric bypass. Data from a subanalysis of the European Hepatic and Adipose Tissue and Functions in the Metabolic Syndrome project found decreases of 25.4\u00b15.9% in weight (kg) and 50\u00b18% in VAT (cm) after bariatric surgery (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E) [Van Gaal LJ et al. Subanalysis of EU HEPADIP Project].\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/14198\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/14198\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14198\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-11\u0022 class=\u0022first-child\u0022\u003EVisceral Fat Loss After Weight-Loss Surgery.\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2012 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/12\/11\/8.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nznbyq\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nznbyq\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nznbyq\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}