Knocking out one gene that contributes to insulin resistance appears to prevent much of the cardiovascular damage typically associated with obesity, researchers say.

Cardiovascular disease is the biggest health threat of obesity and Medical College of Georgia researchers trying to understand why have knocked out protein tyrosine phosphatase 1B, or PTP1B, in genetically fat mice that get diabetes.

"Even before you have really bad diabetes, you are walking around obese with your glucose control a little bit off and already beating up your circulation," says Dr. David Stepp, vascular biologist at the MCG Vascular Biology Center and co-director of MCG's Diabetes & Obesity Discovery Institute. "That is the point where you need to be intervening."

If he's right, PTP1B becomes a drug target for obese people who may not yet be diabetic but already have trouble with blood glucose control.

"We have shown cardiovascular function is improved by knocking out this gene. The question is why," says Dr. Stepp, principal investigator on five-year, $2.5 million National Institutes of Health grant that he hopes will help find the answer.

He suspects resistance may again be the problem but this time it's to nitric oxide, a powerful dilator of blood vessels.

A new system proposed by Canadian and US obesity researchers may provide another weapon in the battle against obesity. University of Alberta obesity expert Dr. Arya Sharma, along with a researcher from Northwestern University in Chicago, Illinois, has proposed a classification system to help doctors assess and treat overweight patients.

Until now, obesity has been mostly defined by body measurements. Measurements like body mass index (BMI) and waist size are used as guidelines to tell doctors whether their patients are within a healthy weight range. But these measurements are based on population studies, rather than on individual patients, so they don't provide doctors with a full picture of a patient's health issues.

"We know that obesity can lead to a whole host of health problems, including heart disease, diabetes, cancer, kidney disease, fatty liver disease, osteoarthritis, sleep apnea and depression. But increased body fat alone doesn't necessarily imply or reliably predict these health problems," says Sharma, Chair of Obesity Research and Management at the University of Alberta's Faculty of Medicine & Dentistry and the Medical Director of Weight Wise at Alberta Health Services. "Two patients with the same BMI or waist size can have wildly different health issues that require different treatment approaches; these anthropometric measurements should be complemented by a clinical staging system that provides a meaningful framework for diagnosing and managing obesity."

Two thirds of adults with diabetes in England and Wales are not receiving all their vital annual health checks. The checks to review blood glucose levels (HbA1c), body mass index, blood pressure, cholesterol, feet, and eyesight through retinal screening are crucial for effective diabetes management and early identification of the development of complications.

151 Primary Care Trusts (PCTs) contributed data from 4873 GP practices in England and Wales to the NHS Information Centre report 'National Diabetes Audit - Key findings about the quality of care for people with diabetes in England and Wales, Report for the audit period 2006-7'.

The audit emphasises that although diabetes care has improved in the last year, a great deal more needs to be done to improve access to services to support people with diabetes to self-manage their condition.