Obesity and diabetes

Obesity, particularly truncal obesity, is closely correlated to the prevale nce of diabetes and cardiovascular disease. Plasma leptin, tumour necrosis factor-alpha and non-esterified fatty acid levels are all elevated in obesi ty and play a role in causing insulin resistance. Diabetic glycaemic contro l and insulin resistance improve with reductions in obesity, but the treatm ent of obesity is difficult, and sustained weight reduction rarely occurs w ith dietary management alone. Hypocaloric diets should be combined with edu cation and low-impact exercise, as well as behavioural techniques used to e ncourage long-term changes. Weight-reducing drugs have a role in the manage ment of obesity but only as part of such a total package. Newer anti-obesit y drugs such as orlistat and sibutramine are well tolerated and have been s hown to improve glycaemic control in diabetes. It is probable that drugs de veloped in the future will act at different sites in the pathways regulatin g body weight, but they may have to be used in combination.