Obesity, however, is a major risk factor for

diabetes, and as many as 80% of patients with type 2 diabetes

mellitus are obese. Weight loss and exercise, even of modest degree,
increase insulin sensitivity and often improve glucose control in
diabetes.

Obesity has long been associated with menstrual abnormalities

in women, particularly in women with upper body obesity
Most obese women with oligomenorrhea have the
polycystic ovarian syndrome (PCOS), with its associated anovulation
and ovarian hyperandrogenism; 40% of women with PCOS
are obese.

Cardiovascular disease
The waist-to-hip ratio may be the best
predictor of these risks
Obesity, especially abdominal obesity, is
associated with an atherogenic lipid profile; with increased lowdensity
lipoprotein cholesterol, very low density lipoprotein, and
triglyceride; and with decreased high density lipoprotein cholesterol
and decreased levels of the vascular protective adipokine
adiponectin
Obesity-induced
hypertension is associated with increased peripheral resistance
and cardiac output, increased sympathetic nervous system tone,
increased salt sensitivity, and insulin-mediated salt retention; it is
often responsive to modest weight loss.

Pulmonary disease
Sleep apnea can be obstructive (most common),
central, or mixed and is associated with hypertension. Weight loss
(10�20 kg) can bring substantial improvement

Obesity is frequently associated with the common disorder nonalcoholic

fatty liver disease (NAFLD)
Obesity is associated with enhanced biliary
secretion of cholesterol, supersaturation of bile, and a higher incidence
of gallstones, particularly cholesterol gallstones
Paradoxically, fasting increases supersaturation
of bile by decreasing the phospholipid component. Fastinginduced
cholecystitis is a complication of extreme diets.

Fad Diets (South beach)

Multiple studies have shown that sustained adherence to
the diet rather than diet type is likely to be the best predictor
of weight-loss outcome.

Physical Activity Therapy Although exercise alone is only

moderately effective for weight loss, the combination of dietary
modification and exercise is the most effective behavioral
approach for the treatment of obesity. The most important
role of exercise appears to be in the maintenance of the weight
loss. The 2008 Physical Activity Guidelines for Americans
recommends that adults should engage in 150 min a week of
moderate-intensity or 75 minutes a week of vigorous-intensity
aerobic physical activity performed in episodes of at least 10 min,
preferably spread throughout the week.