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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.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\u003EObesity has a multitude of adverse effects on the lungs, many of which remain poorly understood, according to speakers at a session that was devoted to various aspects of the problem. Virtually all of the knowledge relates to obesity\u0027s effect on pulmonary function. Though structural effects are widely suspected, scant evidence exists to support the suspicion.\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\u003ESleep Disorders\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EAcute Lung Injury \u0026amp; Respiratory Failure\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EChronic Obstructive Pulmonary Disease\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EObesity has a multitude of adverse effects on the lungs, many of which remain poorly understood, according to speakers at a session that was devoted to various aspects of the problem. Virtually all of the knowledge relates to obesity\u0027s effect on pulmonary function, said Greg King, MB ChB, PhD, Woolcock Research Institute, Sydney, Australia. Though structural effects are widely suspected, scant evidence exists to support the suspicion.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EIn contrast, obesity\u0027s effects on lung function have been documented in multiple studies. The emerging clinical picture consists of preserved FEV\u003Csub\u003E1\u003C\/sub\u003E\/FVC ratio, small airway caliber, increased airway closure that occurs during tidal breathing that leads to reduced oxygen saturation (particularly in supine posture), and suggestions of decreased compliance in the lung and chest wall [Pelosi P et al. \u003Cem\u003EAnaesth Analg\u003C\/em\u003E 1998; Douglas FG et al. \u003Cem\u003EJ Appl Physiol\u003C\/em\u003E 1972; Zerah F et al. \u003Cem\u003EChest\u003C\/em\u003E 1993].\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EObese individuals have reduced lung volume and reduced airway diameter at rest. With increasing obesity, there is reduced compliance throughout the respiratory system. The increased stiffness seems to be more related to reduced compliance in the lung than in the chest wall, said Dr. King.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EObesity also is associated with clinically relevant airway closure and increasing flow limitation. Airway smooth muscle function could be altered in obese individuals, given their impaired bronchodilatory responses to deep inspiration; however, the effect on airway hyperresponsiveness is minimal since the association between obesity and airway hyperresponsiveness is weak. With respect to clinical consequences, recent studies have shown that obesity is a risk factor for asthma diagnosis and asthma severity [Buether DA and Sutherland ER. \u003Cem\u003EAm J Respir Crit Care Med\u003C\/em\u003E 2007].\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003E\u201cObesity has a dose-dependent effect on the risk of developing asthma,\u201d said Anne Dixon, BM BCh, University of Vermont, Burlington, Vermont, USA. \u201cThe risk is slightly higher for women, and the risk is higher for nonallergic asthma.\u201d\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EObese mice exhibit increased airway hyperreactivity, and cell counts are reduced in response to allergen challenge [Johnston RA. \u003Cem\u003EAm J Respir Crit Care Med\u003C\/em\u003E 2007]. In humans, airway eosinophilia and exhaled nitric oxide are inversely related to body mass index (BMI) [Van Veen IH. \u003Cem\u003EAllergy\u003C\/em\u003E 2008].\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EDr. Dixon and colleagues examined the effects of bariatric surgery on airway hyperreactivity and inflammation. Among 41 obese asthmatic patients, 21 patients underwent bariatric surgery and bronchoscopy and were followed for at least 12 months [Dixon et al. \u003Cem\u003EIn press\u003C\/em\u003E]. Comparing patients who had surgery with those who did not, investigators found that bariatric surgery was associated with improved asthma control, improved airway hyperreactivity, increased lymphocyte counts, and increased cytokine production by peripheral CD4 cells. Obesity is not associated with increased lymphocyte-mediated airway inflammation but is associated with improved airway hyperreactivity in nonatopic individuals.\u003C\/p\u003E\u003Cp id=\u0022p-9\u0022\u003EData from a Canadian community health survey showed that the prevalence of chronic obstructive pulmonary disease (COPD) is significantly increased among obese individuals, defined as a BMI \u226530 kg\/m\u003Csup\u003E2\u003C\/sup\u003E, said Denis O\u0027Donnell, MD, Kingston General Hospital, Kingston, Ontario, Canada. Obesity also is associated with decreased operating lung volumes [O\u0027Donnell DE et al. \u003Cem\u003EAm J Respir Crit Care Med\u003C\/em\u003E 2001]. Nonetheless, obese individuals with COPD have diminished exercise-induced dyspnea ratings at any given ventilation, reflecting the mechanical advantage of breathing at lower operating lung volumes.\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003E\u201cObese COPD patients are more inactive and utilize more health services than normal-weight patients with COPD,\u201d Dr. O\u0027Donnell said. \u201cCommon pulmonary function tests are influenced by obesity and need to be considered in clinical interpretation.\u201d\u003C\/p\u003E\u003Cp id=\u0022p-11\u0022\u003ECycle exercise endurance and exertional dyspnea are not increased in obese compared with lean COPD patients, despite increased metabolic and ventilator demand. Lower operating lung volumes and increased inspiratory capacity counterbalance the negative mechanical effects of obesity. Additionally, obese patients with COPD appear to benefit from pulmonary rehabilitation to a similar degree as normal-weight patients with COPD [Sava F et al. \u003Cem\u003EBMC Pulm Med\u003C\/em\u003E 2010].\u003C\/p\u003E\u003Cp id=\u0022p-12\u0022\u003EAn abnormality that is closely associated with obesity is abdominal compartment syndrome, which is an abnormal rise in intraabdominal pressure (IAP). Normally, IAP is a steady-state pressure (0 mm Hg). The condition arises from the intransient response of the skeleton to weight gain and the gradual stretching of the peritoneal cavity. When IAP reaches 12 mm Hg, a patient has intraabdominal hypertension.\u003C\/p\u003E\u003Cp id=\u0022p-13\u0022\u003E\u201cAcute abdominal compartment syndrome occurs when a patient has sustained intraabdominal pressure exceeding 20 mm Hg in association with new organ dysfunction or failure,\u201d said John D. Kress, MD, University of Chicago, Chicago, Illinois, USA.\u003C\/p\u003E\u003Cp id=\u0022p-14\u0022\u003EChronically elevated IAP is closely associated with obesity-related comorbidities [Sugerman HJ et al. \u003Cem\u003EJ Intern Med\u003C\/em\u003E 1997]. IAP correlates with sagittal abdominal diameter, a measure of visceral obesity. In a study of morbidly obese patients who were undergoing surgery, mean IAP was 12 mm Hg and was associated with increased rates of gastroesophageal reflux disease, stress urinary incontinence, diabetes, hypertension, and venous insufficiency as compared with a control group of normal-weight patients that had a significantly lower mean IAP (p\u0026lt;0.02) [Lambert DM et al. \u003Cem\u003EObes Surg\u003C\/em\u003E 2005]. Moreover, IAP continued to increase in the early postoperative period, reaching a maximum of 15 mm Hg on postoperative Day 2.\u003C\/p\u003E\u003Cp id=\u0022p-15\u0022\u003EAn evaluation of mortality risk among intensive care unit patients showed that abdominal obesity was a better predictor of mortality than BMI [Paolini JB et al. \u003Cem\u003ECrit Care Med\u003C\/em\u003E 2010]. Sagittal abdominal diameter appears to be a better indicator than BMI with regard to elevated intraabdominal pressure, occurrence of abdominal compartment syndrome, and mortality.\u003C\/p\u003E\u003Cp id=\u0022p-16\u0022\u003EAlthough difficult to achieve, weight loss can help improve pulmonary function in obese individuals. Several lifestyle changes (ie, increased physical activity, decreased energy intake, increased consumption of fruits and vegetables; small, realistic, achievable goals) have consistently shown potential for effecting weight loss, according to Susan J. Bartlett, PhD, McGill University, Montreal, Quebec, Canada.\u003C\/p\u003E\u003Cp id=\u0022p-17\u0022\u003E\u201cA reasonable initial goal for weight loss is 10% of body weight,\u201d said Dr. Bartlett. \u201cIf that is successful, further weight loss can be attempted, if it is warranted. A reasonable weight loss goal is 1 to 2 pounds per week.\u201d\u003C\/p\u003E\u003Cp id=\u0022p-18\u0022\u003EEstablishing good lifestyle practices in children plays a major role in maintenance of those habits in adulthood. Examples of small but effective steps include eating at home (instead of out) more often, sitting down as a family for meals, and eliminating flavored milks and sugary drinks. Physical activity of some sort should be built into the daily routine, and restrictions should be placed on computer and television time.\u003C\/p\u003E\u003Cp id=\u0022p-19\u0022\u003EBariatric surgery has demonstrated the ability to achieve dramatic weight loss that also is durable in many instances. Recently, numerous studies have shown that surgically induced weight loss is associated with multiple health benefits, said Matthew T. Naughton, MD, Monash University, Melbourne, Australia.\u003C\/p\u003E\u003Cp id=\u0022p-20\u0022\u003EA randomized comparison of laparoscopic adjustable gastric banding (LAGB) and intensive medical weight loss therapy showed a significant advantage for the surgery. The 2-year mean weight loss was 21.6% of excess BMI with surgery versus 5.5% with medical therapy [O\u0027Brien PE. \u003Cem\u003EAnn Intern Med\u003C\/em\u003E 2006]. A meta-analysis of studies of three types of bariatric surgery procedures showed a direct correlation between the amount of excess weight loss and remission of type 2 diabetes. LAGB achieved an average 47.5% loss of excess weight, which was associated with a 47.9% remission rate for diabetes. The corresponding figures for Roux-en-Y gastric bypass were 61.6% and 83.7% and 70.1% and 98.9% for biliopancreatic diversion [Buchwald H et al. \u003Cem\u003EJAMA\u003C\/em\u003E 2004].\u003C\/p\u003E\u003Cp id=\u0022p-21\u0022\u003ESeveral studies have documented resolution of obstructive sleep apnea in obese patients who undergo bariatric surgery. For example, a recent meta-analysis showed that bariatric surgery led to a mean weight loss of 81 kg and a decrease in mean BMI from 50 to 33 kg\/m\u003Csup\u003E2\u003C\/sup\u003E, which was associated with a 62% reduction in the mean apneahypopnea index score and a decline in continuous positive airway pressure requirements from 11 to 7 cm H\u003Csub\u003E2\u003C\/sub\u003EO [Greenberg DL et al. \u003Cem\u003EAm J Med\u003C\/em\u003E 2009].\u003C\/p\u003E\u003Cp id=\u0022p-22\u0022\u003ESwedish investigators showed that bariatric surgery has a favorable impact on the hardest endpoint of all: mortality. A study of 4047 obese patients showed that those who underwent weight loss surgery had a 24% reduction in mortality risk during follow-up for as long as 15 years [Sjostrom L. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2007].\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2011 MD Conference Express\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\/11\/4\/4.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_openurl.js?nzn2m1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}