Managing Overweight and Obesity in Adults to Reduce Cardiovascular Disease Risk
Obesity is a leading preventable cause of death and disability worldwide. Obesity increases the risk for clinically identifiable risk factors for cardiovascular disease (CVD) as well as a host of other metabolic, sleep, and orthopedic disorders. Coordinated and systematic interventions are needed to manage obesity and reduce these risks. The Obesity 2 Expert Panel updated the previous guidelines and produced the “Guideline for the Management of Overweight and Obesity in Adults.” The Panel used data from publications from years 1999 to 2011 to address five critical questions, provide evidence statements, and recommend creation of a treatment algorithm to guide decision making about clinical care. The current review discusses the evidence statements pertaining to CVD risk in the assessment and management of patients who are overweight and obese. We summarize the FDA-approved medications for the treatment of overweight and obesity and their impact on CVD risk and risk factors, as well as ongoing clinical trials which will further inform clinical practice.
KeywordsAnti-obesity agents Bariatric surgery Cardiovascular diseases Obesity Overweight Practice guidelines
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.World Health Organization. Obesity and overweight. 2013. http://www.who.int/mediacentre/factsheets/fs311/en/. Accessed 10 April 2014.
- 4.World Health Organization. Global health risks: mortality and burden of disease attributable to selected major risks. WHO Press, Geneva. 2009. http://www.who.int/healthinfo/global_burden_disease/GlobalHealthRisks_report_full.pdf. Accessed 10 April 2014.
- 5.World Health Organization. Global status report on noncommunicable diseases 2010: description of the global burden of NCDs, their risk factors and determinants. 2010. http://www.who.int/nmh/publications/ncd_report2010/en/. Accessed 10 April 2014.
- 7.NHLBI Obesity Education Initiative Expert Panel on the Identification E, Treatment of Obesity in Adults (US). Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: the evidence report. Bethesda: National Heart, Lung, and Blood Institute; 1998. Report no.: 98–4083.Google Scholar
- 8.Institute of Medicine (IOM). Finding what works in health care: standards for systematic reviews. 2011. http://www.iom.edu/Reports/2011/Finding-What-Works-in-Health-Care-Standards-for-Systematic-Reviews.aspx. Accessed 11 April 2014.
- 9.••Jensen MD, Ryan DH, Apovian CM, Loria CM, Ard JD, Millen BE, et al. 2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. J Am Coll Cardiol. 2013. doi:10.1016/j.jacc.2013.11.004. This guideline summarizes the findings of the Obesity 2 Expert Panel providing guidance for the identification, evaluation, and treatment of overweight and obese adults.
- 10.Look AHEAD, Group R, Wing RR. Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus: four-year results of the Look AHEAD trial. Arch Intern Med. 2010;170(17):1566–75. doi:10.1001/archinternmed.2010.334.
- 12.U.S. Food and Drug Administration. FDA approves Belviq to treat some overweight or obese adults. 2012. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm309993.htm?utm_campaign=Google2&utm_source=fdaSearch&utm_medium=website&utm_term=lorcaserin&utm_content=4. Accessed 13 April 2014.
- 13.Weissman NJ, Tighe Jr JF, Gottdiener JS, Gwynne JT. An assessment of heart-valve abnormalities in obese patients taking dexfenfluramine, sustained-release dexfenfluramine, or placebo. Sustained-Release Dexfenfluramine Study Group. N Engl J Med. 1998;339(11):725–32. doi:10.1056/NEJM199809103391103.
- 14.Lam DD, Przydzial MJ, Ridley SH, Yeo GSH, Rochford JJ, O'Rahilly S, et al. Serotonin 5-HT2C receptor agonist promotes hypophagia via downstream activation of melanocortin 4 receptors. Endocrinology. 2008;149(3):1323–8. doi:10.1210/En.2007-1321.
- 15.Thomsen WJ, Grottick AJ, Menzaghi F, Reyes-Saldana H, Espitia S, Yuskin D, et al. Lorcaserin, a novel selective human 5-hydroxytryptamine2C agonist: invitro and invivo pharmacological characterization. J Pharmacol Exp Ther. 2008;325(2):577–87. doi:10.1124/jpet.107.133348.
- 16.Smith SR, Weissman NJ, Anderson CM, Sanchez M, Chuang E, Stubbe S, et al. Multicenter, placebo-controlled trial of lorcaserin for weight management. N Engl J Med. 2010;363(3):245–56. doi:10.1056/NEJMoa0909809.
- 17.Fidler MC, Sanchez M, Raether B, Weissman NJ, Smith SR, Shanahan WR, et al. A one-year randomized trial of lorcaserin for weight loss in obese and overweight adults: the BLOSSOM trial. J Clin Endocrinol Metab. 2011;96(10):3067–77. doi:10.1210/jc.2011-1256.
- 18.O’Neil PM, Smith SR, Weissman NJ, Fidler MC, Sanchez M, Zhang J, et al. Randomized placebo-controlled clinical trial of lorcaserin for weight loss in type 2 diabetes mellitus: the BLOOM-DM study. Obesity. 2012;20(7):1426–36. doi:10.1038/oby.2012.66.
- 19.U.S. Food and Drug Administration. FDA approves weight-management drug Qsymia 2012. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm312468.htm. Accessed 13 April 2014.
- 22.York DA, Singer L, Thomas S, Bray GA. Effect of topiramate on body weight and body composition of osborne-mendel rats fed a high-fat diet: alterations in hormones, neuropeptide, and uncoupling-protein mRNAs. Nutrition. 2000;16(10):967–75.Google Scholar
- 23.Ben-Menachem E, Axelsen M, Johanson EH, Stagge A, Smith U. Predictors of weight loss in adults with topiramate-treated epilepsy. Obes Res. 2003;11(4):556–62. doi:10.1038/oby.2003.78.
- 24.Li Z, Maglione M, Tu W, Mojica W, Arterburn D, Shugarman LR, et al. Meta-analysis: pharmacologic treatment of obesity. Ann Intern Med. 2005;142(7):532–46.Google Scholar
- 25.Gadde KM, Allison DB, Ryan DH, Peterson CA, Troupin B, Schwiers ML, et al. Effects of low-dose, controlled-release, phentermine plus topiramate combination on weight and associated comorbidities in overweight and obese adults (CONQUER): a randomised, placebo-controlled, phase 3 trial. Lancet. 2011;377(9774):1341–52. doi:10.1016/S0140-6736(11)60205-5.
- 26.Allison DB, Gadde KM, Garvey WT, Peterson CA, Schwiers ML, Najarian T, et al. Controlled-release phentermine/topiramatein severely obese adults: a randomized controlled trial (EQUIP). Obesity. 2012;20(2):330–42. doi:10.1038/oby.2011.330.
- 27.Garvey WT, Ryan DH, Look M, Gadde KM, Allison DB, Peterson CA, et al. Two-year sustained weight loss and metabolic benefits with controlled-release phentermine/topiramatein obese and overweight adults (SEQUEL): a randomized, placebo-controlled, phase 3 extension study. Am J Clin Nutr. 2012;95(2):297–308. doi:10.3945/ajcn.111.024927.
- 28.•Ikramuddin S, Korner J, Lee WJ, Connett JE, Inabnet WB, Billington CJ, et al. Roux-en-Ygastric bypass vs intensive medical management for the control of type 2 diabetes, hypertension, and hyperlipidemia: the Diabetes Surgery Study randomized clinical trial. JAMA. 2013;309(21):2240–9. doi:10.1001/jama.2013.5835. Concludes that bariatric surgery is more effective than intensive medical therapy at controlling or alleviating Type 2 Diabetes.
- 29.Schauer PR, Kashyap SR, Wolski K, Brethauer SA, Kirwan JP, Pothier CE, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med. 2012;366(17):1567–76. doi:10.1056/NEJMoa1200225.
- 30.Schauer PR, Bhatt DL, Kirwan JP, et al. Bariatric surgery versus intensive medical therapy for diabetes--3-year outcomes. N Engl J Med. 2014;370(21):2002-2013.Google Scholar