Recognize, treat ‘pre-obesity’ to reduce cardiometabolic risk
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BOSTON — So-called pre-obesity, or a BMI between 25 and 30 kg/m2, is associated with all-cause and cause-specific mortality similar to overt obesity and treatment should begin early to reduce cardiometabolic risk, according to a speaker.
The concept of pre-obesity — which is interchangeable with the term overweight — is similar to more familiar terms like prediabetes and prehypertension that were coined to underscore the risk associated with these progressive conditions, Michelle Look, MD, FAAFP, a family, sports and obesity medicine physician for the San Diego Sports Medicine and Weight and Wellness Center, said during a presentation at the Cardiometabolic Health Congress.
“I like to use the word ‘pre-obesity’ because it medicalizes the term,” Look said. “When we medicalize it, our patients start to take it more seriously than just a description of their weight.”
The COVID-19 pandemic showed a linear increase in rates of hospitalization and death with increasing BMI, beginning at 25 kg/m2 and greater, Look said, calling it a “teaching moment” to show increasing BMI was a risk factor for COVID-19 complications, such as ICU admission, mechanical ventilation and death.
Estimates are that by 2030, 80% of U.S. adults will have pre-obesity or overt obesity, Look said. Trends show that the prevalence of pre-obesity is slightly decreasing, from 32% to 30%, as more people cross the threshold to obesity.
“More people are progressing from pre-obesity to obesity than ever before,” Look said. “Compared with 30 years ago, one in four women and one in eight men will gain at least 40 more pounds. We see our population is increasing in BMI, transitioning from overweight to true obesity.”
Increasing BMI, increasing risk
Unlike previous studies suggesting a so-called obesity paradox, where obesity could be protective, the 2016 Global BMI Mortality Collaboration found that risk for all-cause mortality increased throughout the overweight range, Look said. The study, which assessed 10.6 million adults across 32 countries and controlled for smoking status and chronic disease followed for 5 years, demonstrated a strong association between increasing BMI and all-cause and cause-specific mortality, including for cancers and CVD, among never-smokers, Look said.
“There is a J-shaped curve, and the nadir of the curve is at a BMI of 25 kg/m2, not 30 kg/m2,” Look said. “If we separate this by age, we saw that association was much stronger the younger you are. I like to use the analogy of smoking. We know that the longer someone smokes, the higher the risk. Similarly, the longer someone has an elevated BMI, the higher the risk.”
Assess weight history
The timing for developing obesity affects future risk, Look said; the number of years lived with obesity correlate with mortality compared with current weight or obesity status, and moderate weight gain from early to mid-adulthood is associated with a significant increase in morbidity and mortality.
Look said clinicians should assess maximum body weight or maximum BMI from extended weight histories to reveal a full association with mortality and disease risk. Mortality risks are “substantially higher” for normal-weight adults with a history of obesity compared with those who maintained a normal weight status over time, she said.
“The idea of looking at weight trends is very important,” Look said.
Look said it is crucial to discuss lifestyle interventions and also pharmacotherapy with patients with pre-obesity, while also taking care to avoid prescribing medications that increase weight gain. Close follow-up of these patients is also essential, she said.
“A large population of patients are progressing from pre-obesity to obesity, so bring this topic up and look at the weight trends, especially in the younger population,” Look said. “Early action can have a big effect.”
Reference:
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Look M. Pre-Obesity: Intervening early to decrease future complications. Presented at: Cardiometabolic Health Congress; Oct. 19-22, 2022; Boston.
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