Journal of Public Health

, Volume 16, Issue 1, pp 21–29 | Cite as

Long-term effects of non-surgical therapy for obesity on cardiovascular risk management: a weighted empirical review

  • Kurt Laederach-Hofmann
  • Nadine Messerli-Burgy
  • Katharina Meyer
Review Article

Abstract

Weight loss affects cardiovascular risk profiles in obese patients. Surgery is not a plausible or viable response to the public health problem of obesity, given that more than 30% of adults are obese in some countries. However, most studies investigating the effects of weight loss on the cardiovascular risk profile are focussed on weight loss and limited to short-term effects. Since newer data show a rebound of cardiovascular risks in studies that complete a short-term follow-up, the question arises whether, and to what extent, long-term treatments offer a more sustained cardiovascular benefit beside the extensive or less marked weight loss. Aims The purpose of this article is to critically review existing data on the long-term cardiovascular effects of weight loss in obese and overweight patients treated with dietary interventions, physical activity programmes, behavioural therapy and pharmacological treatments and their combination. Method Inclusion criteria were peer-reviewed, randomized controlled trials (RCT) in the English language which presented data on cardiovascular effects at a follow-up of at least 18 months during or after weight reduction interventions. The search was limited to adults and the publication years between 1990 and 2007. Studies of patients with diagnoses such as coronary heart disease and cancer, and medically treated diabetes and hypertension were excluded. Results Twenty-three studies measured cardiovascular risk factors after 18 months or more. Mean BMI was 33.9 kg/m2 including 13,733 patients. Mean duration of the studies was 37 months with a dropout rate of 16.1% on average. Regardless of the absolute amount of weight loss a positive effect on cardiovascular risk factors such as blood pressure, lipids and glucose tolerance was found.

Keywords

Cardiovascular risk profile Weight loss Non-surgical therapy RCTs 

Abbreviations

BMI

body mass index

RCTs

randomized controlled trials

LDL cholesterol

low-density lipoprotein cholesterol

HDL cholesterol

high-density lipoprotein cholesterol

Notes

Acknowledgements

We thank Prof. Andrew Steptoe for his invaluable help and assistance and Dr. Samantha Dockray for her proof-reading. We thank the Swiss National Foundation for the support of Dr. Nadine Messerli-Bürgy.

Conflict of interest statement

None for all authors.

References

  1. Aronne LJ, Thornton-Jones ZD (2007) New targets for obesity pharmacotherapy. Clin Pharmacol Ther 81(5):748–752PubMedCrossRefGoogle Scholar
  2. Berenson GS, Srinivasan SR (2001) Emergence of obesity and cardiovascular risk for coronary artery disease: the Bogalusa Heart Study. Prev Cardiol 4(3):116–121PubMedCrossRefGoogle Scholar
  3. Chiasson JL, Josse RG, Gomis R, Hanefeld M, Karasik A, Laakso M, for The STOP-NIDDM Trial Research Group (2003) Acarbose treatment and the risk of cardiovascular disease and hypertension in patients with impaired glucose tolerance. JAMA 290:486–494PubMedCrossRefGoogle Scholar
  4. Curioni C, Andre C (2006) Rimonabant for overweight or obesity. Cochrane Database Syst Rev 4:CD006162PubMedGoogle Scholar
  5. Davidson MH, Hauptman J, DiGirolamo M, Foreyt JP, Halsted CH, Heber D, Heimburger DC, Lucas CP, Robbins DC, Chung J, Heymsfield SB (1999) Weight control and risk factor reduction in obese subjects treated for 2 years with orlistat: a randomized controlled trial. JAMA 281(3):235–242PubMedCrossRefGoogle Scholar
  6. Deedwania PC, Gupta R (2006) Management issues in the metabolic syndrome. J Assoc Physicians India 54:797–810PubMedGoogle Scholar
  7. Despres JP, Golay A, Sjostrom L (2005) Effects of rimonabant on metabolic risk factors in overweight patients with dyslipidemia. N Engl J Med 353(20):2121–2134PubMedCrossRefGoogle Scholar
  8. Diabetes Prevention Program Research Group (2002) Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 346:393–403CrossRefGoogle Scholar
  9. Ditschuneit HH, Fletchner-Mors M, Johnson TD, Adler G (1999) Metabolic and weight-loss effects of a long-term dietary intervention in obese patients. Am J Clin Nutr 69:198–204PubMedGoogle Scholar
  10. Douketis JD, Macie C, Thabane L, Williamson DF (2005) Systematic review of long-term weight loss studies in obese adults: clinical significance and applicability to clinical practice. Int J Obes (Lond) 29(10):1153–1167CrossRefGoogle Scholar
  11. Ebbeling CB, Leidig MM, Feldman HA, Lovesky MM, Ludwig DS (2007) Effects of a low-glycemic load vs low-fat diet in obese young adults. JAMA 297:2092–2102PubMedCrossRefGoogle Scholar
  12. Eckel RH, Kahn R, Robertson RM, Rizza RA (2006) Preventing cardiovascular disease and diabetes: a call to action from the American Diabetes Association and the American Heart Association. Circulation 113(25):2943–2946PubMedCrossRefGoogle Scholar
  13. Esposito K, Marfella R, Ciotola M, Di Palo C, Giugliano F, Giugliano G, D’Armiento M, D’Andrea F, Giugliano D (2004) Effect of a Mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome: a randomized trial. JAMA 292(12):1440–1446PubMedCrossRefGoogle Scholar
  14. Fogelholm M, Kukkonen-Harjula K, Nenonen A, Pasanen M (2000) Effects of walking training on weight maintenance after a very-low-energy diet in premenopausal obese women: a randomized controlled trial. Arch Intern Med 160(14):2177–2184PubMedCrossRefGoogle Scholar
  15. Goldstein DJ (1992) Beneficial health effects of modest weight loss. Int J Obes Relat Metab Disord 16(6):397–415PubMedGoogle Scholar
  16. Hauptman J, Lucas C, Boldrin MN, Collins H, Segal KR (2000) Orlistat in the long-term treatment of obesity in primary care settings. Arch Fam Med 9(2):160–167PubMedCrossRefGoogle Scholar
  17. Heska S, Anderson JW, Atkinson RL, Greenway FL, Hill JO, Phinney SD, Kolotkin RL, Miller-Kovach K, Pi-Sunyer FX (2003) Weight loss with self-help compared with a structured commercial program. JAMA 289:1792–1798CrossRefGoogle Scholar
  18. Hollander P (2007) Endocannabinoid blockade for improving glycemic control and lipids in patients with type 2 diabetes mellitus. Am J Med 120(2 Suppl 1):S18–28; discussion S29–32PubMedCrossRefGoogle Scholar
  19. Hypertension Prevention Trial Research Group (1990) The hypertension prevention trial: three-year effects of dietary changes on blood pressure. Arch Intern Med 150(1):153–162CrossRefGoogle Scholar
  20. Itoh H (2003) What is ’metabolic domino effect’?–new concept in lifestyle-related diseases. Nippon Rinsho 61(10):1837–1843PubMedGoogle Scholar
  21. James WP, Astrup A, Finer N, Hilsted J, Kopelman P, Rossner S, Saris WH, Van Gaal LF (2000) Effect of sibutramine on weight maintenance after weight loss: a randomised trial. STORM study group. Sibutramine trial of obesity reduction and maintenance. Lancet 356(9248):2119–2125PubMedCrossRefGoogle Scholar
  22. Kannel WB, Wilson PW, Nam BH, D’Agostino RB (2002) Risk stratification of obesity as a coronary risk factor. Am J Cardiol 90(7):697–701PubMedCrossRefGoogle Scholar
  23. Krempf M, Louvet JP, Allanic H, Miloradovich T, Joubert JM, Attali JR (2003) Weight reduction and long-term maintenance after 18 months treatment with orlistat for obesity. Int J Obes (Lond) 27:591–597CrossRefGoogle Scholar
  24. Kuller LH, Simkin-Silverman LR, Wing RR, Meilahn EN, Yves DG (2001) Women’s healthy lifestyle project: a randomized clinical trial: results at 54 months. Circulation 103:32–37PubMedGoogle Scholar
  25. Lean ME (1998) Obesity-what are the current treatment options? Exp Clin Endocrinol Diabetes 106(Suppl 2):22–26PubMedCrossRefGoogle Scholar
  26. Lee M, Aronne LJ (2007) Weight management for type 2 diabetes mellitus: global cardiovascular risk reduction. Am J Cardiol 99(4A):68B–79BPubMedCrossRefGoogle Scholar
  27. Lindholm LH, Ekbom T, Dash C, Eriksson M, Tibblin G, Scherstén B (1995) The impact of health care advice given in primary care on cardiovascular risk. CELL Study Group. BMJ 310 (6987): 1105–1109Google Scholar
  28. McTigue KM, Harris R, Hemphill B, Lux L, Sutton S, Bunton AJ, Lohr KN (2003) Screening and interventions for obesity in adults: summary of the evidence for the US Preventive services task force. Ann Intern Med 139(11):933–949PubMedGoogle Scholar
  29. Mensink M, Blaak EE, Corpeleijn E, Saris WH, de Bruin TW, Feskens EJ (2003) Lifestyle intervention according to general recommendations improves glucose tolerance. Obes Res 11(12):1588–1596PubMedGoogle Scholar
  30. Orzano AJ, Scott JG (2004) Diagnosis and treatment of obesity in adults: an applied evidence-based review. J Am Board Fam Pract 17(5):359–369PubMedCrossRefGoogle Scholar
  31. Pan XR, Li GW, Hu YH, Wang JX, Yang WY, An ZX, Hu ZX, Lin J, Xiao JZ, Cao HB, Liu PA, Jiang XG, Jiang YY, Wang JP, Zheng H, Zhang H, Bennett PH, Howard BV (1997) Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study. Diabetes Care 20(4):537–544PubMedCrossRefGoogle Scholar
  32. Pardo Silva MC, De Laet C, Nusselder WJ, Mamun AA, Peeters A (2006) Adult obesity and number of years lived with and without cardiovascular disease. Obesity (Silver Spring) 14(7):1264–1273Google Scholar
  33. Pi-Sunyer FX, Aronne LJ, Heshmati HM, Devin J, Rosenstock J (2006) Effect of rimonabant, a cannabinoid-1 receptor blocker, on weight and cardiometabolic risk factors in overweight or obese patients: RIO-North America: a randomized controlled trial. JAMA 295(7):761–775PubMedCrossRefGoogle Scholar
  34. Reisin E, Abel R, Modan M, Silverberg DS, Eliahou HE, Modan B (1978) Effect of weight loss without salt restriction on the reduction of blood pressure in overweight hypertensive patients. N Engl J Med 298(1):1–6PubMedCrossRefGoogle Scholar
  35. Richelsen B, Tonstad S, Rossner S, Toubro S, Niskanen L, Madsbad S, Mustajoki P, Rissanen A (2007) Effect of orlistat on weight regain and cardiovascular risk factors following a very-low-energy diet in abdominally obese patients. Diabetes Care 30:27–32PubMedCrossRefGoogle Scholar
  36. Rossner S, Sjostrom L, Noack R, Meinders AE, Noseda G (2000) Weight loss, weight maintenance, and improved cardiovascular risk factors after 2 years treatment with orlistat for obesity. European Orlistat Obesity Study Group. Obes Res 8(1):49–61PubMedCrossRefGoogle Scholar
  37. Scaglione R, Argano C, Di Chiara T, Licata G (2004) Obesity and cardiovascular risk: the new public health problem of worldwide proportion. Expert Rev Cardiovasc Ther 2(2):203–212PubMedCrossRefGoogle Scholar
  38. Serra-Majem L, Roman B, Estruch R (2006) Scientific evidence of interventions using the Mediterranean diet: a systematic review. Nutr Rev 64(2 Pt 2):S27–S47PubMedCrossRefGoogle Scholar
  39. Shaw K, Gennat H, O’Rourke P, Del Mar C (2007a) Exercise for overweight or obesity. (No. CD003817. DOI  10.1002/14651858.CD003817.pub3.) Hamilton, US. The cochrane database of systematic reviews
  40. Shaw K, O’Rourke P, Del Mar C, Kenardy J (2007b) Psychological interventions for overweight or obesity. (No. CD003818. DOI  10.1002/14651858.CD003818.pub2.). Hamilton, US: The cochrane database of systematic reviews
  41. Stevens V, Obarzanek E, Cook NR, Lee IM, Appel LJ, Smith West D, Milas NC, Mattfeldt-Beman M, Belden L, Bragg C, Millstone M, Raczynski J, Brewer A, Singh B, Cohen J (2001) Long-term weight loss and changes in blood pressure: results of the Trials of Hypertension Prevention, phase II. Ann Intern Med 134(1):1–11PubMedGoogle Scholar
  42. Swinburn B, Metcalf PA, Ley SJ (2001) Long-term (5-year) effects of a reduced-fat diet intervention in individuals with glucose intolerance. Diabetes Care 24(4):619–624PubMedCrossRefGoogle Scholar
  43. Torgerson JS, Hauptman J, Boldrin MN, Sjostrom L (2004) XENical in the prevention of diabetes in obese subjects (XENDOS) study: a randomized study of orlistat as an adjunct to lifestyle changes for the prevention of type 2 diabetes in obese patients. Diabetes Care 27(1):155–161PubMedCrossRefGoogle Scholar
  44. Van Gaal LF, Rissanen AM, Scheen AJ, Ziegler O, Rossner S (2005) Effects of the cannabinoid-1 receptor blocker rimonabant on weight reduction and cardiovascular risk factors in overweight patients: 1-year experience from the RIO-Europe study. Lancet 365(9468):1389–1397PubMedCrossRefGoogle Scholar
  45. Various (2001) Detection, evaluation, and treatment of high blood cholesterol in adults. Rev Panam Salud Publica 9(5):338–344Google Scholar
  46. Wilson PW, Kannel WB, Silbershatz H, D’Agostino RB (1999) Clustering of metabolic factors and coronary heart disease. Arch Intern Med 159(10):1104–1109PubMedCrossRefGoogle Scholar
  47. Wing RR, Venditti E, Jakicic JM, Polley BA, Lang W (1998) Lifestyle intervention in overweight individuals with a family history of diabetes. Diabetes Care 21(3):350–359PubMedCrossRefGoogle Scholar
  48. Yan LL, Daviglus ML, Liu K, Stamler J, Wang R, Pirzada A, Garside DB, Dyer AR, Van Horn L, Liao Y, Fries JF, Greenland P (2006) Midlife body mass index and hospitalization and mortality in older age. JAMA 295(2):190–198PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Kurt Laederach-Hofmann
    • 1
    • 5
  • Nadine Messerli-Burgy
    • 2
    • 3
  • Katharina Meyer
    • 4
  1. 1.Center for Obesity, Nutritional Psychology, and Prevention of Eating Disorders, Division of EndocrinologyDiabetology, and Clinical Nutrition, Inselspital, University of BerneBerneSwitzerland
  2. 2.Psychobiology Group, Department of Epidemiology and Public HealthUniversity College LondonLondonUK
  3. 3.Institute of Psychology, Clinical Psychology and Psychotherapy UnitUniversity of BerneBerneSwitzerland
  4. 4.Swiss Health Observatory and University of BerneBerneSwitzerland
  5. 5.ZAEP, University of Berne, InselspitalBerneSwitzerland

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