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The occurrence of cardiovascular diseases is a strong predictor of quality of life and longevity. Weight gain is one of the major risk factors for developing cardiovascular disease. According to the American College of Cardiology, the medical rationale for weight loss is that obesity is a progressive disease associated with a significant increase in death and many health problems, including type 2 diabetes mellitus, hypertension, hypercholesterolemia, and coronary heart disease. The body mass index (BMI) is developed to measure body weight in relation to a person’s height. The higher a BMI value is, the higher the body fat is present in most people, and the greater the risk of related health issues including cardiovascular disease or death.
It is thought that the fat deposits around or inside organs increase clotting and inflammation and therefore, they play a key role in the development of cardiovascular disease. Studies have shown that the extent of fat deposits is directly related to the development of cardiovascular and associated diseases.
On the other hand, health benefits have been reported with weight loss of as little as 5 percent of body weight. With a body weight loss of more than 10 percent, there is a significant decrease in the occurrence of cardiovascular disease.
Overweight is defined as a BMI value between 25 and 30 and obesity as a BMI greater than 30 kg/m2. The relationship between BMI and risk for weight-related health complications allows the identification of patients appropriate for weight loss intervention. So, it’s pertinent for individuals to have an annual health examination by their primary care physicians to assess and identify cardiovascular risk factors and create a management plan accordingly. The benefits include reduction or reversing the associated complications like sleep apnea or fatty liver disease.
The goal of the management of obesity is to prevent, treat, or reverse cardiovascular diseases and improve quality of life. Overweight patients should be offered intensive, multicomponent intervention including dietary changes, increased physical activity, and consideration of pharmacologic therapy as additional measures. Finally, individuals with a BMI over 35 kg/m2 are at the highest risk and should receive the most aggressive treatment with consideration of bariatric surgery.
The initial management of individuals who would benefit from weight loss is a comprehensive lifestyle intervention: a combination of diet, exercise, and behavioral modification. Using this approach, lifestyle intervention was more effective for preventing diabetes than pharmacologic intervention. Per Diabetic Prevention Program this includes a low-fat, low-calorie diet and a minimum of 150 minutes of exercise per week as simple as brisk walking. Metabolic studies using state-of-the-art techniques have concluded that most adults will lose weight when fed less than 1000 Cal/day. Dietary adherence is an important predictor of weight loss, regardless of the type of diet chosen.
Return visits with the clinician or nutritionist should be scheduled at regular intervals to monitor progress, assess barriers, and discuss the next steps. Although exercise is less potent than dietary restriction in promoting weight loss, increasing energy expenditure through physical activity is a strong predictor of weight loss maintenance. In addition, physical activity can preserve lean muscle mass during active weight loss.
In the next step, if weight loss goals are not achieved after three to six months of a comprehensive lifestyle intervention, physicians can assess the patients for pharmacotherapy.
For most patients, a glucagon-like peptide 1 agonist such as semaglutide (Ozempic or Wegovy) is the preferred medication. Semaglutide has been shown to lower body weight by up to 16% when used in conjunction with lifestyle recommendations. These medications imitate natural gut hormones and by multiple mechanisms, they adjust blood sugar levels, decrease appetite, and decrease weight. They improve many cardiovascular risk factors such as high blood sugar, insulin resistance, high blood pressure, high blood cholesterol, high body weight, high waist circumference, and fatty liver. A new clinical trial shows this medication also shows a 20% reduction in the risk of heart attack, stroke, or cardiovascular death in obese and overweight patients.
Device therapy may be considered for use in those patients for whom medications are ineffective or not tolerated, for those patients who are unable or unwilling to undergo bariatric surgery, or as bridging therapy prior to bariatric surgery. Per multiple studies on bariatric surgeries, sustained weight loss (−20% to −30% on average) is associated with reduced cardiovascular disease and death.
In conclusion, individuals should be seen at least once a year by their professional health provider for assessment of a healthy weight, weight-related complications, and other cardiovascular risk factors to prevent, treat, or reverse weight-related complications and improve their quality and longevity of life.
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