Clinical medicine (London, England)
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Obesity is a chronic disease associated with increased morbidity and mortality. Bariatric surgery can lead to sustained long-term weight loss (WL) and improvement in multiple obesity-related complications, but it is not scalable at the population level. ⋯ Tirzepatide, a dual agonist of GLP1 and GIP receptors, marks a new era in obesity pharmacotherapy in which a combination of gut hormones could approach the WL achieved with bariatric surgery. In this review, we discuss emerging obesity treatments with a focus on gut hormone combinations and the concept of a multimodal approach for obesity management.
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Case Reports
Secondary hemophagocytic lymphohistiocytosis: an unusual complication in disseminated Mycobacterium tuberculosis.
Tuberculosis-associated hemophagocytic lymphohistiocytosis (TB-HLH) is a rare and life-threatening complication of tuberculosis infection. Early recognition and treatment of TB-HLH is crucial for improving outcomes. Treatment typically involves a combination of antituberculosis therapy and immunosuppressive therapy to control the immune system's overreaction. ⋯ The patient responded well to treatment and made a full recovery without any lasting complications. This case highlights the importance of promptly recognising HLH and identifying the underlying cause. In critically ill patients, it is crucial not to delay HLH-specific treatment while working up for differential diagnosis.
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Obesity research is advancing swiftly, but the increase in obesity prevalence is faster. Over the past three decades, researchers have found that biopsychosocial factors determine weight gain much more than personal choices and responsibility. Various genes have found to predispose people to obesity by interacting with our obesogenic environment. In this review, we discuss the impact of physical inactivity, excessive caloric intake, intrauterine environment, postnatal influences, insufficient sleep, drugs, medical conditions, socioeconomic status, ethnicity, psychosocial stress, endocrine disrupting chemicals and the gastrointestinal microbiome, on the occurrence of obesity.
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Across the UK, people's lives are being cut short because of obesity, and the lives of the most deprived members of our communities are being cut the most. The role of the medical professional in managing overweight and obesity is extensive, but, for many patients, maintaining a healthy weight needs to be supported by creating environments that help people to stay healthy in the first place. ⋯ Clinicians have the skills to create change, they often hold power in organisations with local to international impact and there are actions, big or small, that every clinician can take to improve obesity prevention. Here, we outline an environmental-behavioural framework for the primary prevention of obesity and consider the role of clinicians in catalysing change.
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Obesity is a chronic, progressive and relapsing disease, characterised by the presence of abnormal or excess adiposity that impairs health and social wellbeing. It is associated with obesity-related disease complications, health inequalities and premature death. ⋯ Increased awareness and knowledge will help reduce weight stigma and biases. A focused non-judgemental assessment will help guide further investigations, timely referral and management.