Obesity: Its relationship with cardiovascular disease and management

The serious worldwide challenge posed by the prevalent, and increasing, problem of obesity is well known. Obesity places a substantial health burden on affected individuals, including cardiovascular disease, although the complex biopsychosocial pathways linking obesity with cardiovascular disease have yet to be fully explicated. Three primary approaches have been investigated as treatments for obesity, namely, behavioral (lifestyle) weight-loss programs, pharmacotherapy, and bariatric surgery. Behavioral weight-loss programs (and pharmacotherapy) have been found to result in modest weight losses and reductions in cardiovascular risk factors (e.g., a significantly reduced rate of type 2 diabetes). However, the impact of these programs on cardiovascular morbidity and mortality has been inadequately investigated, with the few studies conducted yielding inconsistent results. Any capacity of behavioral weight-loss programs to reduce cardiovascular disease end points is likely to be limited by the transient nature of treatment-induced weight losses, with weight regain the normative response to these programs. Bariatric surgery has been found to yield large and sustained weight losses and, importantly, improved cardiovascular outcomes and yet is limited by its expense and the fact that it is associated with a risk of surgical complications (including the need for operative re-intervention in a sizable number of patients). While the obesity treatment outcome research has elicited pessimistic responses from some researchers and obese patients alike, innovative approaches (e.g., maximizing the support available to obese individuals for sustained weight loss) and integrative responses (that entail shared responsibility for promoting healthy dietary behaviors and physical activity at the individual, interpersonal, and societal levels) are likely needed to meet the obesity challenge.