Saturday, June 9, 2012
KEYNOTE SPEAKER
Severe obesity is a congenital disease
In the present global epidemic the more severe is obesity the more rapid is its progression and the more severe the worst its effects on quality of life and longevity. Ever since I have been involved in the care of these patients I have sympathized with them for the discrimination they are the subject and for the blame they receive for treatment failure. Convinced that severe obesity was a congenital disease we set as a goal its demonstration. Taking advantage of a favourable practice set up and with the help of a large group of researchers we are finally able to demonstrate why severe obesity must be seen as a congenital disease. This is the object of this presentation. We have studied 183 children born after maternal bariatric surgery (Bilio pancreatic diversion) during the last 20 years. We have compared their growth evolution with their siblings born before maternal surgery. It was realized that the beneficial effects of surgery seen in the mother were all transmitted to their children. Children were the mirror of their mothers. Children born after maternal surgery were less obese, in better health, with almost no severe obesity. This new generation was characterized by better insulin sensitivity. Insulin level in relation to body weight and to glycemia was about half. Insulin strongly correlates with mothers both before and after surgery. Insulin resistance is the best predictor of obesity and dyslipidemia. These data show that in utero not only there is transfer of regular generic characters but also the transfer of insulin resistance occurs which aggravate the progression of obesity in the child. The child inherits his parents’ genome of obesity plus an additional susceptibility to become further obese. Insulin resistance has the key role in this deterioration. This transfer of insulin resistance would also explain the acceleration in the progression of obesity and the vicious cycle of intergenerational transfer of obesity. How the transfer occurs is still unclear would be from an epigenetic phenomenon which is the object of our present research. Preventive measure to curb the present epidemic should be directed toward mothers.
Learning objectives
After the presentation, one will recognize severe obesity as a congenital disease due to the transfer of insulin resistance from mother to child. To curb the present epidemic, preventive measures should be address to mothers. The new knowledge will influence medical practice before pregnancies.
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Dr. Picard Marceau
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