Abstract
Weight loss favorably modifies most cardiovascular risk factors, in particular the diagnostic criteria for metabolic syndrome, type 2 diabetes mellitus, and hypertension. Treating the spectrum of diabetes by promoting disease control or resolution invariably improves cardiovascular outcomes. However, in clinical trials and routine medical practice, long-term weight loss has been difficult to achieve due to wavering patient motivation, inadequate resources, ineffective medical treatments, lack of psychosocial support, recidivism, or combinations thereof. The issue is not information but rather methods, motivation, and behavioral changes. This article reviews surgical and nonsurgical methods of weight loss and their impact on cardiovascular risk factors, especially the resolution of type 2 diabetes mellitus, and the implications for cardiovascular event reduction in patients with morbid obesity.
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References and Recommended Reading
Yach D, Stuckler D, Brownell KD: Epidemiologic and economic consequences of the global epidemics of obesity and diabetes. Nat Med 2006, 12:62–66.
Shape Up America: Diabesity. Available at http://www.shapeup.org/prof/diabesity.php. Accessed January 12, 2008.
James W, Jackson-Leach R, Mhurchu CN, et al.: Overweight and obesity (high body mass index). In Comparative Quantification of Health Risks: Global and Regional Burden of Disease Attributable to Selected Risk Factors. Geneva: World Health Organization; 2003:497–596.
Pories W, Albrecht R: Etiology of type II diabetes mellitus: role of the forgut. World J Surg 2001, 25:527–531.
Kellum JM, Knemmerle JF, O’Dorisio TW, et al.: Gastrointestinal hormone response to meals before and after gastric bypass and vertical banded gastroplasty. Ann Surg 1990, 211:763–771.
Greenway S, Greenway F, Klein S: Effects of obesity surgery on non-insulin dependent diabetes mellitus. Arch Surg 2002, 137:1109–1117.
Adami GF, Cordera R, Camerono G, et al.: Recovery of insulin sensitivity in obese patients at short term after biliopancreatic diversion. J Surg Res 2003, 113:217–221.
Wickremesekera K, Miller G, Naotunne TD, et al.: Loss of insulin resistance after Roux-en-Y gastric bypass surgery: a time course study. Obes Surg 2005, 15:474–481.
Stevens VJ, Corrigan SA, Obarzanek E, et al.: Weight loss intervention in phase 1 of the Trials of Hypertension Prevention. The TOPH Collaborative Research Group. Arch Intern Med 1993, 53:849–858.
Stevens VJ, Obarzanek E, Cook NR, et al.: Long-term weight loss and prevention, phase II. Ann Intern Med 2001, 134:1–11.
Grundy SM: Metabolic syndrome: connecting and reconciling cardiovascular and diabetes worlds. J Am Coll Cardiol 2006, 47:1093–1100.
Nori Janosz KE, Miller WM, Odom J, et al.: Optimal diabetes management during medical weight loss for cardiovascular risk reduction. Expert Rev Cardiovasc Ther 2005, 3:761–775.
Neter JE, Stam BE, Kok FJ, et al.: Influence of weight reduction on blood pressure: a meta-analysis of randomized controlled trials. Hypertension 2003, 42:878–884.
Klein S, Sheard NF, Pi Sunyer X, et al.: Weight management through lifestyle modification for the prevention of type 2 diabetes: rationale and strategies: a statement of the American Diabetes Association, the North American Association for the Study of Obesity, and the American Society for Clinical Nutrition. Diabetes Care 2004, 27:2067–2073.
Svetkey LP, Stevens VJ, Brantley PJ, et al.: Comparisons of strategies for sustaining weight loss: the Weight Loss Maintenance randomized controlled trial. JAMA 2008, 299:1139–1148.
Franz MJ, Bantle JP, Beeb CA, et al.: Evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications. Diabetes Care 2002, 25:148–198.
American Diabetes Association: National standards for diabetes self-management education. Diabetes Care 2008, 31(Suppl 1):S97–S104.
The Action to Control Cardiovascular Risk in Diabetes Study Group: Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med 2008, 358:2545–2559.
Nori Janosz K, Berris Koenig K, Leff C, et al.: Clinical resolution of diabetes with weight reduction using meal replacements within a medically-monitored program. Vascular Disease Prevention 2008, 5:17–23.
Mayer-Davis EJ, D’Antonio AM, Smith SM, et al.: Pounds off with empowerment (POWER): a clinical trial of weight management strategies for black and white adults with diabetes who live in medically underserved rural communities. Am J Public Health 2004, 94:1736–1742.
Pi-Sunyer X, Blackburn G, Brancati FL, et al.: Reduction in weight and cardiovascular disease risk factors in individuals with type 2 diabetes: one-year results of the Look AHEAD trial. Diabetes Care 2007, 30:1374–1383.
Gastrointestinal Surgery for Severe Obesity. NIH Consensus Statement 1991, Mar 25–27, 9:1–20. Available at http://consensus.nih.gov/1991/1991GISurgeryObesity084html.htm. Accessed on January 15, 2009.
Maclean LD, Rhode BM, Sampalis J, et al.: Results of the surgical treatment of obesity. Am J Surg 1993, 165:155–162.
Buchwald, H, Avidor Y, Braunwald E, et al.: Bariatric surgery: a systematic review and meta-analysis. JAMA 2004, 192:1724–1737.
Zalesin KC, Krause KR, Chengelis DL, McCullough PA: Determinants of the resolution of type 2 diabetes after bariatric surgery. Vascular Disease Prevention 2008, 5:75–80.
Fried LF, Orchard TJ, Kasiske BL: Effect of lipid reduction on the progression of renal disease: a meta-analysis. Kidney Int 2001, 59:260–269.
Morales E, Angeles V, León M, et al.: Beneficial effects of weight loss in overweight patients with chronic proteinuric nephropathies. Am J Kidney Dis 2003, 41:319–327.
Gumbs AA, Irvin IM, Ballantyne GH: Changes in insulin resistance following bariatric surgery: role of caloric restriction and weight loss. Obes Surg 2002, 15:462–473.
Li Z, Hong K, Saltsman P, et al.: Long-term efficacy of soy-based meal replacements vs. and individual diet plan in obese type II DM patients: relative effects of weight loss, metabolic parameters, and C-reactive protein. Eur J Clin Nutr 2005, 59:411–418.
Solerte SB, Fioravanti M, Schifino N, et al.: Effects of diettherapy on urinary protein excretion albuminuria and renal haemodynamic function in obese diabetic patients with overt nephropathy. Int J Obes 1989, 13:203–211.
Sorrentino MJ: Implications of the metabolic syndrome: the new epidemic. Am J Caridol 2005, 96(Suppl):3E–7E.
Vogel JA, Franklin BA, Zalesin KC, et al.: Reduction in predicted coronary heart disease risk after substantial weight reduction after bariatric surgery. Am J Cardiol 2007, 99:222–226.
Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults: Executive summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation and Treatment of High Blood Cholesterol in Adults. JAMA 2001, 285:2486–2498.
Torquati A, Wright K, Melvin W, Richards W: Effect of gastric bypass operation on Framingham and actual risk of cardiovascular events in the class II to III obesity. J Am Coll Surg 2007, 204:776–783.
Adams TD, Gress RE, Smith SC, et al.: Long-term mortality after gastric bypass surgery. N Engl J Med 2007, 357:753–761.
Sjöström L, Narbro K, Sjöström CD, et al.: Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med 2007, 357:741–752.
Sjöström L, Lindroos AK, Peltonene M, et al.: Lifestyle, diabetes and cardiovascular risk factor 10 years after bariatric surgery. N Engl J Med 2004, 351:2683–2693.
Lopez-Jimenez F, Bhatia S, Collazo-Clavell ML, et al.: Safety and efficacy of bariatric surgery in patients with coronary artery disease. Mayo Clin Proc 2005, 80:1157–1162.
Franklin BA: The downside of our technological revolution? An obesity-conducive environment. Am J Cardiol 2001, 87:1093–1095.
Pories WJ, Swanson MS, MacDonald KG, et al.: Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg 1995, 222:339–352.
Schauer PR, Burguera B, Ikramuddin S, et al.: Effect of laparoscopic Roux-en-Y gastric bypass on type 2 diabetes mellitus. Ann Surg 2003, 238:467–485.
Sugerman HJ, Wolfe LG, Sica DA, et al.: Diabetes and hypertension in severe obesity and effects of gastric bypass-induced weight loss. Ann Surg 2002, 237:751–758.
Torquati A, Lutfi R, Abumrad N, et al.: Is Roux-en-Y gastric bypass surgery the most effective treatment for type 2 diabetes mellitus in morbidly obese patients? J Gastrointest Surg 2005, 9:1112–1118.
White S, Brooks E, Jurikova L, et al.: Long-term outcomes after gastric bypass. Obes Surg 2005, 15:155–163.
Dixon JB, O’Brien PE, Playfair J, et al.: Adjustable gastric banding and conventional therapy for type 2 diabetes. JAMA 2008, 299:316–323.
Dixon JB, O’Brien PE: Health outcomes of severely obese type 2 diabetic subjects 1 year after laparoscopic adjustable gastric banding. Diabetes Care 2002, 25:358–363.
Frigg A, Peterli R, Peters T, et al.: Reduction in co-morbidities 4 years after laparoscopic adjustable gastric banding. Obes Surg 2004, 14:216–223.
Ponce J Haynes B, Paynter S, et al.: Effect of Lap-Band-induced weight loss on type 2 diabetes mellitus and hypertension. Obes Surg 2004, 14:1335–1342.
Pontiroli AE, Folli F, Paganelli M, et al.: Laparoscopic gastric banding prevents type 2 diabetes and arterial hypertension and induces their remission in morbid obesity. Diabetes Care 2005, 28:2703–2709.
Spivak H, Hewitt MF, Onn A, et al.: Weight loss and improvement of obesity-related illness in 500 U.S. patients following laparoscopic adjustable gastric banding procedures. J Am Surg 2005, 189:27–32.
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Nori Janosz, K.E., Zalesin, K.C., Miller, W.M. et al. Impact of surgical and nonsurgical weight loss on diabetes resolution and cardiovascular risk reduction. Curr Diab Rep 9, 223–228 (2009). https://doi.org/10.1007/s11892-009-0036-3
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DOI: https://doi.org/10.1007/s11892-009-0036-3