Chapter 11 - The fundamental role of obesity management in cardiometabolic risk reduction: nonpharmacological, pharmacological, and surgical approaches

Abstract

Obesity or Adiposity-Based Chronic Disease (ABCD) is a chronic disease of positive energy balance driven by dysregulated interactions involving satiety factors and the central nervous system resulting in excess adiposity. Abnormalities in the mass, distribution, and/or function of adipose tissue produce complications that confer morbidity and mortality and impair the quality of life. ABCD exacerbates insulin resistance and impels the progression cardiometabolic disease first to prediabetes, metabolic syndrome, dyslipidemia, prehypertension, hepatic steatosis, and ultimately to its end-stage manifestations, cardiovascular disease, congestive heart failure, stroke, hypertension, type 2 diabetes, nonalcoholic steatohepatitis, and chronic kidney disease. Weight loss is a single, highly effective, intervention that prevents progression of cardiometabolic disease and can be used to treat its end-stage outcomes. In considering the degree of weight loss required to optimally ameliorate these common complications in ABCD, interventions are needed that reliably produce 10%–20% weight loss. Obesity medications combined with structured lifestyle interventions are helpful in this regard, and the advent of second-generation medications with increased efficacy enables active management of % weight loss into a range known to be associated with effective treatment and prevention of cardiometabolic disease outcomes. Weight loss represents important first-line therapy in patients with ABCD/obesity and cardiometabolic disease for prevention and treatment of metabolic and vascular complications. Second-generation medications allow active management of % weight loss as a biomarker into ranges that will effectively ameliorate specific complications, thus enabling a personalized approach to the management of ABCD/obesity as a chronic disease.