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Dinner Symposium

Dr. Pi-Sunyer began by showing the increased risk of cardiovascular disease and overall mortality in obese individuals. Obesity and metabolic syndrome (diabetes) are “twin epidemics” in Americans, meaning that the two are linked. Thromobogenic (clotting) factors and inflammatory risk also increase in obese individuals. Adiponectin is a protein with anti-diabetic properties that decreases the uptake of LDL (bad cholesterol) that decreases in concentration in the body as people gain weight and become obese. C - reactive protein is another biomarker for metabolic syndrome, which is produced by the liver during the inflammatory process. Weight loss has been shown to decrease risk factors for metabolic and cardiovascular diseases, including blood pressure and cholesterol levels. “Current therapies often address individual risk factors,” rather than the root cause in metabolic syndromes,” according to Dr. Pi-Sunyer. The RIO Program in Obesity examined the effect of Rimonabant (the first selective C1 blocker) and a hypocaloric diet (600 calories/day) for a year and then half the Rimonabant patients were put on a placebo for a year, while the other half took Rimonabant for another year. After the first year, a significant decrease in weight, a significant increase in HDL (good) cholesterol, a significant drop in triglycerides (fat), and significant drop in fasting insulin (decrease suggests improvement in insulin sensitivity) was seen in the 20 mg group. Overall, the 20 mg Rimonabant group had a decrease in metabolic syndrome. The major adverse effects seen with Rimonabant included depression, anxiety, irritability, headaches, dizziness, and nausea, however, less than 0.5 percent of patients left the study due to these effects. In the second year, the patients who stayed on 20 mg of Rimonabant lost more weight than those who were moved to the placebo, suggesting that the drug should be continued even after the weight is lost. The HDL also continued to rise while triglycerides and fasting insulin continued to drop in the patients who continued on Rimonabant for the second year.