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Multifaceted approach required to fight CV consequences of obesity
Individual and community interventions are required to prevent CV consequences from the obesity epidemic, according to a review paper published as part of a health promotion series in the Journal of the American College of Cardiology.
Approximately three-quarters of U.S. adults are overweight or obese, and in 2016, 39.6% were obese (BMI 30 kg/m2) and 7.7% had class III obesity (BMI 40 kg/m2), according to the authors.
“While some individuals have a genetic predisposition to obesity, the most common causes are poor diet choices and even more so a lack of physical activity,” Carl J. Lavie, MD, director of exercise laboratories at the John Ochsner Heart and Vascular Institute in New Orleans, said in a press release. “Rising obesity rates have been shown to parallel the increasing consumption of refined carbohydrates and added sugars and probably more importantly an increase in sedentariness and a decrease in physical activity.”
Getting individuals to improve their diet must be a major part of prevention strategies, and the recent shift away from restricting or eliminating certain foods and toward adopting specific dietary eating patterns such as the Mediterranean diet may help, the authors wrote.
Promote fitness
Promotion of physical and cardiorespiratory fitness is key, as is targeting excessive sedentary behavior, they wrote, noting that pharmacological interventions and bariatric surgery may be necessary in some cases.
In addition, more policy-, system-, and environmental-level interventions may remove barriers to a healthier lifestyle, Lavie and colleagues wrote.
“While there is debate over whether responsibility for curbing the current obesity trends should fall on individuals or policymakers and lobbyists, it is clear that stronger initiatives are needed,” Lavie said in the release. “Ultimately, reconciling the obesity crisis will require a greater commitment from both sides to create a proactive culture of health and wellness that aspires to prevent chronic disease rather than treating it.”
Although metabolically healthy obesity is associated with better long-term outcomes than metabolically unhealthy obesity, people with it are more likely to face CV consequences than metabolically healthy people with normal weight, Lavie and colleagues wrote.
“Accumulating evidence overall suggests that individuals with [metabolically healthy obesity] have a better CVD prognosis than do their [metabolically unhealthy obesity] counterparts, but worse than individuals with [metabolically healthy normal weight], supporting the notion that obesity, even if metabolically healthy, has long-term negative consequences on CV health,” they wrote.
The obesity paradox
There is evidence that the obesity paradox, in which among patients with the same CVD condition, those with obesity have better survival rates than those without it, “only exists in the low-fit patients with thin unfit CHD and HF patients having a particularly poor prognosis,” Lavie and colleagues wrote.
“[Physical activity] and exercise training to improve levels of [cardiorespiratory fitness] should be strongly encouraged for patients with CVD and may be even more important than weight loss, at least for overweight and mildly obese CVD patients,” they wrote.
“A multimodality approach and intervention will be required to reduce the devastating consequences of progressive obesity in our society and, especially, for the prevention and treatment of cardiovascular disease,” Lavie and colleagues concluded. – by Erik Swain
Disclosure: One author reports he has served on advisory boards for Novo Nordisk, Retrofit and Weight Watchers.