Identifying, treating pre-obesity can reduce mortality risk, improve health outcomes
Click Here to Manage Email Alerts
Discussing weight gain and prescribing weight loss therapies or interventions for people with a BMI of 25 kg/m2 or greater could help reduce mortality risk and slow the progression of obesity, according to a speaker.
Michelle Look, MD, FAAFP, a physician in family practice and obesity medicine at the San Diego Sports Medicine and Family Health Center, said the risk for all-cause and cause-specific mortality rise when a person has “pre-obesity,” and continues to increase as a person’s BMI increases.
“Pre-obesity is a BMI of 25 to 30 kg/m2, previously called overweight,” Look told Healio. “Using the term pre-obesity medicalizes the term, and like pre-diabetes may assist patients and providers in taking their weight more seriously.”
Look discusses pre-obesity and how to address it during a presentation at the Cardiometabolic Health Congress.
Pre-obesity increases mortality risk
More than half of American adults currently have pre-obesity, though the prevalence is decreasing slightly because more people are crossing into the obesity threshold. The National Center for Health Statistics projects about 80% of American adults will have either pre-obesity or obesity by 2030.
Even before people reach the obesity threshold of 30 kg/m2, they face elevated risk for mortality. A study conducted by the Global BMI Mortality Collaboration in 2016 found people with pre-obesity had an increased risk for all-cause mortality compared with those with normal weight, with the risk climbing as BMI increased.
Similar observations have been made with cause-specific mortality. The risk for cancer-related mortality begins to increase at a BMI of 21 kg/m2 for cancer, the risk for diabetes-related mortality starts to rise at 22 kg/m2, the risk for cardiovascular-related mortality begins to elevate at 25 kg/m2 and the risk for musculoskeletal-related mortality starts to increase at 24 kg/m2. According to data from the Global Burden of Disease 2015 Obesity Collaborators, about 39% of cause-specific deaths occur in people with pre-obesity.
BMI does not tell the whole story. Excess body fat, in particular an increase in visceral fat, is more predictive of cardiometabolic risk. This can be assessed when BMI is above 25 kg/m2 by checking waist circumference, percent body fat or waist-to-hip ratio. Look said using the Edmonton Obesity Staging System can help with assessing mortality risk associated with elevated BMI. Providers should also look weight over a lifespan, in particular elevated BMI in early adulthood, and a person’s lifetime maximum BMI to determine one’s risk for poor health outcomes.
“Patients with a BMI of 25 kg/m2 should be told of their diagnosis and the health implications,” Look told Healio. “They should be further screened to assess their obesity comorbidities including waist circumference, metabolic parameters and quality of life impact. There are many evidence-based treatment options for patients with pre-obesity.”
Improving health outcomes
Lifestyle intervention is one way people with pre-obesity can improve health outcomes. In data from the Diabetes Prevention Program, people with pre-obesity engaging in 150 minutes of moderate intensity exercise weekly and eating a low-calorie, low-fat diet lowered their risk for diabetes by 66%. In another study published in the Journal of Applied Physiology, people with pre-obesity were randomly assigned to an exercise group with three to four moderate-intensity exercise sessions per week plus three to four high-intensity sessions, or a diet group with an energy-reduced diet of 600 kcal per day. Both groups had similar weight loss at 12 weeks, with the exercise group also significantly improving triglycerides, LDL cholesterol and apolipoprotein B levels.
There are also a couple drug therapies that can benefit people with pre-obesity. Orlistat (Alli, GlaxoSmithKline), a 60 mg over the counter drug, may induce a modest weight loss, though there are side effects such as oily discharge. Off-label metformin could also induce weight loss in pre-obesity. Data from the Diabetes Prevention Program showed 28.5% of people using metformin lost 5% or more weight at 1 year. Those who lost 5% or more weight at 1 year with metformin had more success maintaining their weight loss long-term than those who lost weight through lifestyle intervention or placebo.
A new FDA device, oral superabsorbent hydrogel is a gel capsule specifically indicated for people with a BMI of 25 kg/m2 or higher. It consists of cross-linked carboxymethylcellulose and citric acid hydrogel particles that promote fullness. A prescription consists of three capsules taken 20 to 30 minutes before a meal. In trial data, participants taking the hydrogel had a 6.4% weight loss at 26 weeks compared with 4.4% with placebo.
“We do have treatment now for a BMI of 25 kg/m2,” Look said during the presentation. “I implore us, especially in primary care, this is a population where we say the diagnosis of pre-obesity can actually help prevent obesity.”
References:
- Apolzan JW, et al. Ann Intern Med. 2019;doi:10.7326/M18-1605.
- Bhaskaran K, et al. Lancet Diabetes Endocrinol. 2018;doi:10.1016/S2213-8587(18)30288-2.
- Di Angelantonio E, et al. The Lancet. 2016;doi:10.1016/S0140-6736(16)30175-1.
- GBD 2015 Obesity Collaborators. New Engl J Med. 2017;doi:10.1056/nejmoa1614362.
- Greenway FL, et al. Obesity. 2018;doi:10.1002/oby.22347.
- Rosenkilde M, et al. J Appl Physiol. 2018;doi:10.1152/japplphysiol.01092.2017.
Collapse
Look M, et al. Session I: Obesity & Lifestyle. Presented at: Cardiometabolic Health Congress; Oct. 14-17, 2021; National Harbor, Md. (hybrid meeting).
Click Here to Manage Email Alerts