Walmir Coutinho

Consenso latino-americano de obesidade

A obesidade e, atualmente, um dos mais graves problemas de saudepublica. Sua prevalencia vem crescendo acentuadamente nas ulti-mas decadas, inclusive nos paises em desenvolvimento, o que levou adoenca a condicao de epidemia global.Estudos epidemiologicos em populacoes latino-americanas temrelatado dados alarmantes. A medida que se consegue erradicar amiseria entre as camadas mais pobres da populacao, a obesidadedesponta como um problema mais frequente e mais grave que adesnutricao. E o fenomeno da transicao nutricional, que sobrecarreganosso sistema de saude com uma demanda crescente de atendimen-to a doencas cronicas relacionadas com a obesidade, como o dia-betes tipo 2, a doenca coronariana, a hipertensao arterial e diversostipos de câncer. E provavel que 200.000 pessoas morram anualmentena America Latina em decorrencia destas complicacoes.O tratamento da obesidade, entretanto, continua produzindo resulta-dos insatisfatorios, em grande parte por estrategias equivocadas epelo mau uso dos recursos terapeuticos disponiveis.Alem de buscarmos planos terapeuticos mais eficazes, faz-senecessario, tambem, que sejam adotadas medidas de prevencaopara conter o surgimento de casos novos e evitar que a prevalenciada doenca continue crescendo a despeito de todos os esforcos comseu tratamento.Este documento, produzido pelo trabalho conjunto de dezenas deespecialistas de 12 paises latino-americanos, das areas de Medicina,Nutricao, Psicologia e Educacao Fisica, representa uma revisao dosdiversos aspectos relacionados com a obesidade e seu tratamento.Sao apresentados dados sobre a prevalencia, os riscos e os custosassociados com a obesidade, sao sugeridas medidas que possamcontribuir para a prevencao da doenca e, finalmente, sao analisadosos metodos atualmente disponiveis para a avaliacao e o tratamentodo paciente obeso.O Documento do Consenso Latino-Americano em Obesidade e desti-nado principalmente a medicos, nutricionistas, psicologos, professoresde educacao fisica e outros profissionais de saude que lidam compacientes obesos. E dirigido, tambem, a autoridades governamentais,a jornalistas da area de Saude e a todo profissional que possa con-tribuir, direta ou indiretamente, para o combate a este grave proble-ma que e a obesidade.

The burden of hospitalization due to overweight and obesity in Brazil

This article estimates the burden of hospitalization associated with overweight and obesity in Brazil. The analysis of all hospitalizations for men and women from 20 to 60 years of age was based on the National Healthcare Expenditure Database (SIH-SUS), covering more than 70% of all hospital admissions. Data were for the year 2001. Attributable fraction of hospitalizations associated with diseases related to obesity and overweight was based on the combined risks of United States and European cohorts. The population-attributable fraction for each disease studied was multiplied by values reimbursed to the hospitals and summed to obtain total direct costs. Overall costs of overweight and obesity represent 3.02% of total hospitalization costs for men and 5.83% for women, corresponding to 6.8 and 9.3% of all hospitalization (excluding pregnancy). Diseases associated with overweight and obesity had a significant impact on hospitalizations and economic costs in Brazil, and overall percentages were similar to those from developed countries. Since the nutritional transition is still under way in Brazil, overweight had a higher impact than obesity on disease prevalence and costs.

Cirurgia bariátrica: aspectos clínico-cirúrgicos e psiquiátricos

A obesidade grau III e uma doenca cronica, de etiologia multifatorial, que acarreta prejuizos importantes a saude do individuo. Devido a sua gravidade e dificil manejo clinico, novas estrategias de tratamento tem sido propostas, dentre as quais destaca-se a cirurgia bariatrica. O objetivo deste artigo e apresentar uma atualizacao sobre as tecnicas cirurgicas, assim como aspectos clinicos e psiquiatricos envolvidos com este procedimento. Como pacientes com obesidade grave podem apresentar varias complicacoes clinicas e um aumento da psicopatologia, e de extrema importância uma avaliacao multidisciplinar criteriosa visando a reduzir possiveis complicacoes pos-operatorias.Grade III obesity is a multifactorial and chronic disorder associated with great damage to individual health. Due to its severity and difficult management, new treatment strategies are being proposed, with special attention to bariatric surgery. The objective of this study is to present an overview of the surgical techniques, clinical, and psychiatric aspects related to the surgical treatment of obesity. Since morbid obesity is associated with several clinical complications and increased psychopathology, a careful multidisciplinary approach is necessary to reduce possible complications related to obesity surgery.

Assessment of executive functions in obese individuals with binge eating disorder

OBJECTIVE The aim of this study was to assess executive functions of obese individuals with binge eating disorder. METHOD Thirty-eight obese individuals with binge eating disorder were compared to thirty-eight obese controls without binge eating disorder in terms of their executive functions. All individuals were assessed using the following instruments: Digit Span, Trail Making Tests A and B, Stroop Test and the Wisconsin Card Sorting Test. In addition, four subtests from the Behavioral Assessment of the Dysexecutive Syndrome Battery were also used, namely the Zoo Map Test, the Modified Six Elements Test, the Action Program Test and the Rule Shift Cards Test. RESULTS When compared to obese controls, obese individuals with binge eating disorder presented significant impairment in the following tests: Digit Span backward, Zoo Map Test, Modified Six Elements Test, and Action Program Test. Subjects with binge eating disorder also showed significant more set shifting and perseverative errors in the Wisconsin Card Sorting Test. In other measures such as the Digit Span Forward, the Trail Making Test, the Stroop Test and the Rule Shift Cards Test, obese subjects with binge eating disorder did not differ significantly from obese subjects without binge eating disorder. CONCLUSION These results suggest that, in the present sample, obese individuals with binge eating disorder presented executive deficits, especially impairments relating to problem-solving, cognitive flexibility and working memory.

Topiramate use in obese patients with binge eating disorder: An open study

Objective: To assess topiramates efficacy and tolerability in a group of obese binge eaters with no neuropsychiatric comorbidity. Method: We consecutively selected 8 obese patients with binge eating disorder (BED) and no medical or psychiatric comorbidity from individuals seeking treatment for obesity. Treatment with topiramate at 150 mg daily was administered over a 16-week period. To assesss outcome, we employed the days with binge episodes per week (DBE), the Binge Eating Scale (BES), the Beck Depression Inventory (BDI), and body weight evaluation. Results: Of the 6 patients who completed the trial, all showed reduced binge eating. Four patients presented a total remission, and 2 had a marked reduction in binge eating frequency. The mean DBE decreased significantly from 4.3 to 1.1 (P = 0.03), as did the BES scores, which fell from 31.8 to 15.3 (P = 0.04). Moreover, there was a statistically significant weight loss (mean 4.1 kg, P = 0.04). The most frequent side effects were paresthesias, fatigue, and somnolence. Conclusion: Topiramate may be an effective and well-tolerated agent in the treatment of BED in obese patients.

Depression, glycemic control and type 2 diabetes

BackgroundComorbid depression in diabetes has been suggested as one of the possible causes of an inadequate glycemic control. The purpose of this study was to investigate the association between major depression and the glycemic control of type 2 diabetes mellitus (T2DM).MethodsSeventy T2DM patients were evaluated. They underwent a psychiatric examination using the following instruments: Structured Clinical Interview for DSM-IV and Beck Depression Inventory. The diabetes status was assessed in the short-term (glycemia, glycated hemoglobin) clinical control.ResultsThe presence of current depression was observed in 18.6% (13/70). In addition, type 2 diabetes patients who displayed depression evidenced higher levels of glycated hemoglobin (8.6 ± 2.0 vs. 7.5 ± 1.8; p = 0.05) when compared to those who did not exhibit a mood disorder.ConclusionsIn our sample, the presence of depression seems to impact on the short-term control of T2DM. The authors discuss the clinical utility of these findings in the usual treatment of diabetes.

Insulinoma Misdiagnosed as Dumping Syndrome after Bariatric Surgery

Background: Late dumping syndrome is a possible side-effect of gastric bypass. Hypoglycemic symptoms may develop 3-4 hours after certain types of foods.There may exist patients, however, who present hypoglycemia in the absence of dumping syndrome. The presence of only mild symptoms of hypoglycemia may make the evaluation of these patients difficult and delay the identification of other possible sources of hyperinsulinemia, including an insulinoma. Case Report: A 65-year-old woman underwent gastric bypass for continued weight gain and morbid obesity. After surgery, the patient had repeated episodes of hypoglycemia, diagnosed at follow-up as late dumping syndrome. The persistence of hypoglycemic episodes after nutritional counseling and modifications in the feeding pattern led to consideration of an autonomous source of hyperinsulinemia, and MRI and CT identified insulinoma. After a laparotomy and pancreatic tumor resection, she remains free of symptoms. Conclusion: Hypoglycemic episodes after obesity surgery are not always related to dumping syndrome. The persistence of hypoglycemia in spite of nutritional counseling should raise the possibility that there may exist other causes. Insulinoma, the most common cause of endogenous hyperinsulinemia, should be investigated in these patients, since it is a tumor that can be cured.

Psychiatric comorbidity in a Brazilian sample of patients with binge-eating disorder

We compared sociodemographic characteristics and psychiatric status in obese Brazilian patients who did (n=32) and did not (n=33) meet DSM-IV criteria for binge-eating disorder (BED). The samples mean age was 35.0 years (+/-10.5), with 92.3% of individuals being female and 41.5% having some higher education. Obese binge eaters (OBE) were significantly more likely than obese non-binge eaters to meet criteria for a current diagnosis of any axis I disorder, any mood disorder and any anxiety disorder. Specifically, OBE patients were characterized by significantly higher rates of current and lifetime histories of major depressive disorder. Similar to patients from developed countries, Brazilian patients with BED display increased rates of psychiatric comorbidity, particularly mood and anxiety disorders.

Diabetes mellitus e depressão: uma revisão sistemática

The presence of depression in a patient with diabetes mellitus (DM) seems to be related to changes in the clinical course of the disease. The purpose of this study is to perform a systematic review on the association of DM and depression. A bibliographic search was performed using the MEDLINE and LILACS databases to identify relevant articles, published from 1990 to 2001, which evaluate this relationship. Information concerning prevalence, impact and treatment of depression in DM were analyzed. The prevalence of depression varied from 0 to 60.5%. The presence of depressive symptoms were associated with a poor glycemic control, an increase in the number and severity of clinical complications, a worse quality of life and impairment of social, educational and economic aspects related to DM. The treatment of depression is associated with an improvement in glycemic levels, which may contribute to a better control of several aspects related to DM.

Prevalence of eating disorders and psychiatric comorbidity in a clinical sample of type 2 diabetes mellitus patients

BACKGROUND A few studies have shown high rates of eating disorders and psychiatric morbidity in patients with type 2 diabetes mellitus. OBJECTIVE Disturbed eating behavior and psychiatric comorbidity in a sample of T2DM patients. METHODS Seventy type 2 diabetes mellitus patients between 40 and 65 years of age (mean, 52.9 +/- 6.8) from a diabetes outpatient clinic were sequentially evaluated. The Structured Clinical Interview for DSM-IV, Binge Eating Scale and Beck Depression Inventory were used to assess eating disorders and other psychiatric comorbidity. In addition to the descriptive analysis of the data, we compared groups divided based on the presence of obesity (evaluated by the body mass index) or an eating disorder. RESULTS Twenty percent of the sample displayed an eating disorder. Binge eating disorder was the predominant eating disorder diagnosis (10%). Overall, the group of obese patients with type 2 diabetes mellitus presented rates of psychiatric comorbidity comparable to those seen in their nonobese counterparts. However, the presence of an eating disorder was associated with a significant increase in the frequency of anxiety disorders (57.1% x 28.6%; p = 0.044). CONCLUSIONS In our study sample, the occurrence of eating disorders was increased compared to rates observed in the general population, with the predominance of binge eating disorder. The presence of an eating disorder in type 2 diabetes mellitus patients was associated with higher rates of anxiety disorders.