12. Obesity and Type 2 Diabetes Mellitus

Summary

This chapter addresses the prevalence of obesity in young people, which has increased dramatically during the past generation; the problem now affects developing as well as industrialized nations and exacts a heavy toll on medical, social and financial sectors. Obesity in children predisposes to adult obesity and to insulin resistance and type 2 diabetes, dyslipidemia, hypertension, hepatic steatosis/steatohepatitis, focal glomerulosclerosis, ovarian hyperandrogenism, gynecomastia, cholecystitis, pancreatitis, pseudotumor cerebri and obstructive sleep apnea. Long-standing obesity in children and adults increases the risks of subsequent cardiovascular disease and some malignancies. Treatment aims to reduce Body Mass Index and fat mass, to normalize glucose tolerance, plasma lipid concentrations, hepatic and renal function and blood pressure, and to prevent or reverse acute and chronic co-morbidities. These objectives can sometimes be achieved through lifestyle intervention (caloric restriction and exercise). Pharmacological agents or surgical intervention may reinforce the effects of diet and exercise and reduce the risk of, or even reverse, complications. In all cases, the social milieu functions as a critical determinant of therapeutic success.