Varalakshmi Niranjan's research while affiliated with UConn Health Center and other places

Background Compared to other races/ethnicities, individuals from South Asia with obesity are strikingly susceptible to the presence of CVD risk factors and onset of CVD events – in part due to adiposopathic anatomic and metabolic responses to positive caloric balance. Pathogenic endocrine and immune effects of adipocyte hypertrophy and visceral fat accumulation both directly and indirectly promote among the most common metabolic diseases encountered in clinical practice – many being major cardiovascular disease (CVD) risk factors. This is especially applicable to those from South Asia – largely due to genetics, epigenetics, unhealthful nutrition, and physical inactivity. Methods This roundtable discussion included 4 obesity specialists engaged in the clinical management of obesity among patients of South Asian descent. Results Patients with obesity from South Asia have increased adipocyte size, fewer (functional) adipocytes, and increased visceral adiposity accompanied by functional endocrine and immune abnormalities. This helps explain the increased CVD risk factors and increased CVD risk among this unique population. These CVD risk factors include increased prevalence of metabolic syndrome (even at lower body mass index relative to other races), insulin resistance, type 2 diabetes mellitus, increased lipoprotein (a), and adiposopathic dyslipidemia [(i.e., elevated triglyceride levels, reduced high density lipoprotein cholesterol levels, increased low density lipoprotein (LDL) particle number, and increased prevalence of smaller and denser LDL particles]. Conclusion The four panelists of this roundtable discussion describe their practical diagnostic processes and treatment plans for patients from South Asia, with an emphasis on a patient-centered approach to obesity in this unique population.

Objective The aim of this study is to examine the effectiveness of a single physician-led weight loss program in a primary care. Methods This is a retrospective analysis of 300 patients with a BMI >30 kg/m2 in an outpatient weight loss program. Weight loss interventions included lifestyle counseling and pharmacotherapy. Outcomes were assessed based on percentage weight change during a time period of two consecutive visits less than 90 days. Results We found that 57.7%, 43.3% and 16.1% patients who attended the clinic 5 or more times, 4-5 times, 2-3 times respectively achieved 5% weight loss (p < 0.0001). In regard to achieving 10% weight loss, 42.3%, 8.7% and 4.3% patients who attended the clinic 5 or more times, 4-5 times and 2-3 times did it respectively (p<0.0001). Moreover 60% of patients achieved 5% of weight loss in about 200 days, and 40% achieved 10% weight loss in 350 days. Patients who achieved 5% weight loss, their average A1c was reduced to 5.8 at their last visit from 6.4 at the first visit. Conclusions A single physician-led weight loss program is effective and can be created within a primary care setting to achieve 5-10% weight loss.