Obesity management: the cardiovascular benefits
1London School of Hygiene and Tropical Medicine, UK
2Public Health Policy Group, UK
3International Obesity TaskForce, UK
4Department of Cardiology, University Hospital Gasthuisberg, Leuven, Belgium
* Corresponding author. Email address: JeanHJames{at}aol.com
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The latest data from the International Obesity TaskForce show a marked trend towards increasing levels of adult overweight and obesity throughout Europe. Obesity rates range from 10–27% in men and up to 38% in women. In parts of Europe, the combination of reported overweight and obesity in men exceeds even the 67% prevalence found in the USA's most recent measured survey. At least nine European countries have male obesity rates above 20% while in at least seven countries, one in five women is obese.
Major health threats associated with overweight and obesity include dyslipidaemia, metabolic syndrome, Type 2 diabetes, and cardiovascular diseases. The recently published INTERHEART study identified nine modifiable risk factors that account for 90% of acute myocardial infarctions globally, across all age groups and races. Importantly, seven of these nine risk factors are linked to obesity and can be positively influenced by effective weight management. INTERHEART shows that not smoking, eating more fruit and vegetables, and taking more exercise each significantly reduces the odds ratio for developing a myocardial infarction.
What INTERHEART did not show was the impact of a reduction in body weight on cardiovascular risk. This subject was discussed at an International Symposium sponsored by Abbott entitled ‘Watchful "Weighting" or Active Intervention?’ held on 2 April 2005 in Cannes, France. The papers in this supplement are based on presentations made at the symposium.
The symposium had three sessions. The first session reviewed current approaches to assessing and managing cardiovascular risk. The prevalence of overweight and obesity is increasing in patients with coronary heart disease. This has a major impact on cardiovascular risk and, importantly, can reduce the response to current antihypertensive and lipid lowering therapy. Study data show that we need to improve our efforts to implement risk management guidelines and achieve therapeutic goals, and also that we must provide better education of both the physician and the public on managing and assessing cardiovascular risk.
The second session discussed the role of weight management in multiple risk factor reduction. There is now a considerable body of research demonstrating that sustained moderate weight loss can improve obesity-related metabolic and cardiovascular risk factors and reduce progression to Type 2 diabetes. There is, as yet, no direct evidence that weight loss reduces cardiovascular events or mortality. Indeed, some observational studies suggest that weight loss might be associated with increased mortality, although this could be explained by the fact that these studies did not distinguish intentional from unintentional weight loss.
The third session assessed the contribution of pharmacologically induced weight loss to improved cardiovascular outcome. We now have strong evidence that currently available anti-obesity drugs can significantly increase the number of patients able to achieve, and perhaps more importantly maintain, weight loss and that therapy has a beneficial impact on a range of metabolic and cardiovascular risk factors. As usage of these drugs increases, safety data continue to accrue. For sibutramine, a serotonin and noradrenaline re-uptake inhibitor, there is increasing evidence of cardiovascular safety.
Although a number of long-term pharmacotherapy studies have been conducted in obese patients, to date, none has been specifically designed or powered to evaluate the effect of weight management on cardiovascular outcome. The landmark SCOUT study will be the first to do this, by evaluating the risk/benefit profile of weight management with or without sibutramine in an at-risk cardiovascular population.
It is hoped that these outcome trials will provide definitive data on the cardiovascular benefits of achieving weight loss. However, results will not be available for several years. In the meantime, and with reference to the question posed in the title of the symposium, we cannot afford to wait and hope that general educational initiatives work. We need to tackle the obesity epidemic by investing time and resources in weight loss strategies that are known to work.
Conflict of interest: W.P.T.J. has consulted for Abbott. Both authors have lectured at Abbott-sponsored symposia.
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