Obesity

A 92-year-old woman presented with a 6-month history of progressively worsening fatigue, weight loss, generalized bone pain, and dyspnea on exertion. A skeletal survey found lytic lesions in the pelvis, sacrum, and calvarium (shown here).

A 57-year-old obese woman with known and poorly controlled type 2 diabetes presented with the sudden onset of “yellow bumps all over.” Representative lesions on the back and elbows are shown.

Diagnostic colonoscopy revealed innumerable polyps carpeting the mucosa from the rectum to the cecum. Endoscopic findings and family history were most consistent with familial adenomatous polyposis.

The husband of this 50-year-old obese woman noted that her back was discolored. Review of past medical history disclosed long-standing low back pain from partially herniated vertebral disks.

Drinking sugar-sweetened beverages is known to cause weight gain and heightens the risk of type 2 diabetes mellitus. Here to put the issue into perspective are Drs Christopher Cannon and Payal Kohli.

A 28-year-old woman presents with a 4-month history of diarrhea and a 15-lb weight loss. She reports starting “another new diet” a few months ago but was in good health until these symptoms began. There is no family history of GI disease and no sick contacts. She denies recent travel.

Diabetic peripheral neuropathy may develop in patients who have normal or impaired fasting blood glucose or impaired glucose tolerance, precursors to frank diabetes.

A 61-year-old obese, man with type 2 diabetes presented with the gradual onset of a mildly tender lesion on the dorsum of the right arm.

Do you consider an LDL of 100 and a non-HDL of 150 significant? What is your diagnosis? Would you consider medication in addition to recommending lifestyle changes? Answers to these quiz questions here.

A 47-year-old man sees you for a check-up. He complains only of low energy and attributes it to recent weight gain. But, there is much more.

Geriatric anorexia might be a sign of illness-or simple oral discomfort

Patients with IBD may have discomfort for 3 to 5 years before a diagnosis is made. Many are treated unsuccessfully with antibiotics, anti-spasmodics, or narcotics. Here, read 5 important tips, plus a bonus point, to help streamline diagnosis and management.

In his second podcast, Dr Louis Kuritzky discusses the classes of incretin-based therapies now available for patients with type 2 diabetes mellitus.

Would you worry about neoplastic transformation of these lesions, or would your concerns be focused more specifically on their midline location? If so, why? Would you pursue further investigation? We invite your comments. Click here for more details.

Congenital hairy nevi in this location are often associated with-and act as signs of-abnormalities of the vertebrae, spinal cord or both.

Louis Kuritzky, MD, talks about this relatively new treatment option.

“Nonspecific” intertrigo: the morphology (borders that aren’t sharp, absence of satellite lesions) is a key diagnostic clue.

Is obesity really leading to an increase in GERD? Or, has GERD just become a catch-all phrase for all sorts of upper GI distress? Has GERD become the new "dyspepsia"? G. Richard Locke, MD, FACG, from the Mayo Clinic, Rochester, MN, discusses his findings as presented at the ACG 2011 program.

A 52-year-old woman presents with severe intra-oral ulceration and oral pain. She reports that several years earlier, she had been taking cephalexin when severe intra-oral ulceration developed.

Clostridium difficile infection is a serious, life-threatening nosocomial infection that can follow on the heels of broad-spectrum antibiotic use. It affects over 500,000 Americans annually, with 15,000 deaths. Infection recurs in 15% to 25% of those initially treated successfully; infection subsequently redevelops in 40% to 50% of those an initial recurrence.

If ACG 2011 had a recurrent theme, it was nicely summed up in this lecture: probiotic treatments are coming. Scientific evidence is accumulating for this approach, and patients will likely embrace it as a “natural” remedy. Primary care physicians should carefully follow this emerging trend-it holds promise for some of our most challenging patients with chronic disease.

Following on the heels of the obesity epidemic, a second epidemic has become apparent-sleep-disordered breathing and its effect on esophageal conditions, primarily gastroesophageal reflux disease (GERD). Many, many primary care providers have heard the following complaint: “I gained 10 pounds and now I have heartburn/cough/worsening asthma” (take your pick). What’s going on?

Prevalence for overweight (BMI 24.9 to 29.9) and obesity (BMI > 30) have been steadily rising for the past 30 years-two-thirds of Americans now qualify as overweight or heavier. Hypertension, hyperlipidemia, coronary artery disease, type 2 diabetes, sleep apnea, and GERD prevalence are following this epidemic. Obesity is now the second most common preventable cause of death, exceeded only by smoking.

How does the chronic care model of diabetes care differ from the acute care model-and how might this approach work for you and your patients?

Dr Robert Gabbay discusses strategies to improve patient compliance with insulin therapy.