Jonathan Sackner Bernstein, MD: When you are overweight there are a few things that happens. And typically what happens, obviously, this is not going to the kind of thing that is going to happen to everybody that is overweight and this is why you need to talk to your doctor about your specific situation, but typically people who are overweight are going to have difficulties with metabolizing or breaking down and using sugars and fats that they take in through their diet as well as sugars and fats that are made by the body itself, by the liver. So that when you have trouble with sugar and you have trouble with fats what you end up with is abnormalities of how the blood vessels work, your vital organs such as your heart don't necessarily have the energy sources that they are used to, and so the entire system can potentially become strained. And by doing that and having abnormalities as I said of blood vessels as well, that leads you to higher risks of these so-called vascular events, and when I say vascular events I mean things that are caused by blood vessel problems such as heart attacks and strokes. So it's really the abnormalities in metabolism that then eventually lead to abnormalities in function and eventually structure of the blood vessels and vital organs. Because there's that gradual process, losing weight takes a while before it has an effect on functional aspects, which takes more time before it has a structural effect in terms of reversing things, just as the onset from being overweight to then having functional abnormalities to creating the structural problems can take several years, so that the unusual case in my experience of a patient who is on a lot of medicine for risk factors, on medicine for cholesterol, on medicine for diabetes, on medicine for high blood pressure who is very overweight, if over the course of several years, there can be a substantial reduction in weight that is then maintain, you can start to see shifts back towards normal metabolism, normal function of the body, and gradually some changes in those structural abnormalities which means some of those medicines can be removed over time, but that's a long term commitment that requires a very special person to be able to adhere to that kind of treatment plan.