Most Important Outcomes Research Papers on Body Weight, Obesity and Cardiovascular Outcomes

Abstract

Body weight, and its extreme of obesity, has emerged as a major public health concern. Nearly 1/3 of the adult US population is now estimated to be obese, as defined by a body mass index (BMI, the weight in kilograms divided by the square of the height in meters) ≥ 30.1 The cost of obesity on the healthcare system is substantial; an estimated $147 billion in medical costs were attributed to obesity alone in US in 2008.2 Furthermore, the prevalence of childhood and adolescent obesity, which now affects 17% of children and adolescents,1 raises concerns for its impact on adulthood obesity and long-term health outcomes. In this month’s topic review in Circulation: Cardiovascular Quality and Outcomes , we concentrate on contemporary issues around body weight, obesity, and cardiovascular outcomes. Many hurdles remain in evaluating the relationship between body weight and cardiovascular (CV) outcomes. Debate continues as to the optimal measure of adiposity; body mass composition, and specifically excess adiposity, is perhaps a more appropriate marker of cardiovascular risk compared to body weight. BMI, although widely used, is an imperfect measure of excess adiposity with evidence favoring central obesity, as measured by the waist circumference, as a more sensitive indicator of adverse long-term cardiovascular events.3 Moreover, the effects of obesity on cardiovascular outcomes are complex. Studies have suggested that patients with higher BMIs had better survival compared with those with low BMIs; a phenomenon frequently referred to as the obesity-risk paradox.4 Obesity itself is often associated with multitude of other cardiovascular risk factors such as hyperlipidemia, diabetes, and hypertension; untangling the independent effects of obesity on outcomes thus remains challenging. Lastly, while evidence now suggests obesity is an independent risk factor for long-term adverse cardiovascular events, weight reduction remains an extremely challenging exercise for obese patients. …