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Overweight and obesity are rapidly growing to epidemic proportions in the United States and globally. Since sustainable weight loss is only achieved by bariatric surgery, medicine has seen an explosion in the diversity and number of bariatric procedures performed over the past few years. Systematic studies of postoperative outcomes and investigations into the physiology and biology of weight loss provide a more comprehensive understanding of the sequelae of bariatric surgery. Adipose tissue is the predominant site of fat stores. Increasing obesity results in an overload of lipids within the body's natural storage sink (i.e., the adipocyte) followed by the necessary deposition of fat within ectopic sites such as muscle, liver, and pancreas. The resulting metabolic derangements are associated with insulin resistance, central obesity, and chronic inflammation as adipose tissue acts as an endocrine organ, producing and secreting a host of biologic mediators. Whereas there are conflicting data on the cardiovascular effects of peripheral, subcutaneous liposuction, malabsorptive bariatric procedures result almost universally in significant amelioration of insulin resistance, hypertension, dyslipidemia, and hepatic steatosis. Concomitant changes in adipocyte-derived hormones may provide mechanistic explanations to the observed improvements.
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PMID:Results of bariatric surgery. 1670 54

Overweight and obesity are epidemic in the United States, particularly among minority populations. This epidemic contributes to the development of chronic conditions that occur later in life such as type 2 diabetes and hypertension. Therefore, it is important to identify factors associated with the development of obesity during young adulthood. We conducted a cross-sectional survey among students graduating from a Historically Black College or University (HBCU) in the Mid-Atlantic region. Participants were 392 predominantly African American seniors graduating in the spring of 2003. Data were collected using a self-administered paper and pencil questionnaire which focused on weight, weight management activities, individual and familial weight history, and health status indicators. Participants were on average 24 +/- 5 years of age and 69% female; over 90% identified as African American or Black. According to NIH guidelines, about 30% of males and 28% of females were considered overweight, 12% of males and 7% of females were considered obese, and 7% of males and females were considered extremely obese. Significant correlates of being more overweight were being married, having children, lower socio-economic status, weight-loss attempts, personal and family history of overweight, and poorer health status. These data suggest that among this sample, the prevalence of overweight and obesity is similar to other populations of young African American adults. Familial factors such as socio-economic status and family weight history were important correlates of overweight. Overweight is a significant problem in this population, and these data should be useful for developing weight loss interventions aimed at young adults.
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PMID:The College Health and Wellness Study: baseline correlates of overweight among African Americans. 1673 74

Overweight and obesity are associated with increased cardiovascular risk. Some studies have demonstrated that they also can result in renal damage. The aim of this study was to assess the prevalence of renal insufficiency (RI), defined as a GFR <60 ml/min per 1.73 m2, in a cohort of 4585 patients who attended primary care with essential hypertension and a body mass index > or =25 kg/m2. The patients were classified as overweight and obese according to body mass index (25 to 29.9 and > or =30 kg/m2, respectively). Abdominal obesity was defined as a waist circumference > or =88 and 102 cm in women and men, respectively. Both groups had a high prevalence of metabolic syndrome (Adult Treatment Panel III). The prevalence of RI was high in both the overweight group (22.7%; 95% confidence interval [CI] 20.6 to 24.9) and in the obese group (22.8%; 95% CI 21.0 to 24.7). The presence of diabetes increased the risk for RI (odds ratio 1.83; 95% CI 1.55 to 2.16). The prevalence of RI was greater in patients with abdominal obesity (23 versus 17%; P < 0.001). In the presence of abdominal obesity, cardiovascular risk factors and components of the metabolic syndrome also were more prevalent. The higher risk for RI with abdominal obesity persisted even after adjustment for dyslipidemia, elevated blood glucose levels, and other variables that are associated with RI (adjusted odds ratio 1.40; 95% CI 0.84 to 2.33). It was concluded that patients who have hypertension and visceral obesity and attend primary care present a higher prevalence of metabolic syndrome and RI.
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PMID:Prevalence of renal insufficiency in individuals with hypertension and obesity/overweight: the FATH study. 1713 Feb 61

Obesity is recognized as a serious problem in the industrialized and developed countries of the world. However, little attention is paid to the fact that obesity is becoming an increasing problem in developing countries too, with some countries showing increasing rates of obesity in the midst of the persisting occurrence of childhood malnutrition and stunting. As developing countries embrace the dominant western economic ways of development, industrialization and urbanization they contribute to improvements in living standards, with consequent dramatic changes in diets and lifestyles leading to weight gain and obesity which in turn poses a growing threat to the health. Overweight and obesity is associated with an increased likelihood of non-insulin dependent diabetes mellitus, hypertension, hyper-lipidaemia, and cardiovascular disease. It is also associated with increased rates of breast, colo-rectal and uterine cancer. Obesity is thus an important factor in the increasing morbidity and mortality due to chronic, non-communicable diseases (NCDs) and thereby contributes to premature mortality in the population. Thus, while the problem of undernutrition persists in much of the developing world, overweight and obesity and its related co-morbidities are posing an increasingly important public health problem both in the developed and developing world.
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PMID:Introductory lecture the epidemiology and determinants of obesity in developed and developing countries. 1724 77

In the past 25 years, obesity and diabetes mellitus have overtaken cigarette smoking, dyslipidemia, and hypertension as risk factors for coronary heart disease. Data from a Centers for Disease Control and Prevention (CDC) survey of 50 states revealed that, in 2000, the prevalence of obesity among US adults was approximately 20%, a 61% increase from the 1991 prevalence rate. Currently, most adults (> or =56%) are overweight, approximately 1 in 5 is obese, and 7.3% have diabetes. Overweight and obesity increase the risk for hospitalization and death from cardiovascular disease (CVD) and type 2 diabetes at all levels of risk and independently of other risk factors. In particular, abdominal obesity (assessed indirectly by measuring waist circumference) may be associated with clustering of cardiovascular and metabolic risk factors (i.e., hypertriglyceridemia, low high-density lipoprotein [HDL] cholesterol levels, high blood pressure, and elevated levels of fasting glucose) known as the metabolic syndrome. Patients with even minimal abnormalities in any 3 of the 5 risk factors for the metabolic syndrome are at heightened risk for CVD or diabetes. It is estimated that 47 million US adults, 25% of the population, have > or =3 metabolic syndrome components. Abdominal obesity is the most common, followed by low HDL cholesterol levels, high blood pressure, and high levels of triglycerides. The risk for disease increases over time as the number of metabolic syndrome characteristics accumulates; therefore, early intervention is warranted. Given the prevalence and potentially deadly consequences of the metabolic syndrome, it is imperative for physicians to recognize the presence of these risk factors in their patients and to familiarize themselves with the recommended treatment strategies.
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PMID:Multiple risk factors for cardiovascular disease and diabetes mellitus. 1732 May 20

In 2005, more than 56 percent of Massachusetts adults were overweight, a 40 percent increase from rates reported in 1990. Overall, nearly 21 percent of Massachusetts adults are obese. Both Blacks and Hispanics in the state are more likely than whites to be both overweight and obese, whereas Asians are the least likely to be overweight or obese. Nationally, rates of overweight and obesity are even higher. Obesity is a risk factor for multiple serious health problems in adults, including heart disease, hardening of the arteries, high cholesterol, high blood pressure, certain types of cancer, stroke, diabetes, muscle and bone disorders and gallbladder disease. In Massachusetts, it is estimated that direct costs for obesity-related medical expenditures came to a total of $1.8 billion (4.7% of total medical expenditures) in 2003. Medical expenditures for obese people are estimated to be 25-27% higher than normal weight people, and 44% higher among people who are very obese. Costs are largely attributed to higher rates of coronary heart disease, hypertension and diabetes, and longer hospital stays. Indirect costs associated with obesity approached $3.9 billion in 1995 reflecting 39.2 million lost workdays, 239 million restricted activity days, 89.5 million hospital bed-days, and 62.6 million physician visits. Causes of obesity include the wide availability of unhealthy foods, increased consumption, changing eating habits, high-calorie beverages, advertising and lack of physical activity. Although a number federal, state and local programs, policies and initiatives aimed at curbing the obesity epidemic have been implemented, more needs to be done. What is the responsibility of government in curbing the obesity epidemic, and how much of the burden should be left up to the individual? These important questions will be discussed at the Massachusetts Health Policy Forum on January 23, 2007. Overweight and obesity continue to climb steadily in the United States among both adults and children, increasing the risk for a host of physical, psychosocial and economic problems. This paper details the issues associated with being overweight or obese, with a focus on Massachusetts. The discussion begins with a general description and definition of this public health epidemic. Next, an examination of factors that contribute to overweight and obesity and associated costs to individuals, families and society is given, followed by a discussion of programs and policy options, both nationally and in the Commonwealth that are aimed at addressing this crisis.
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PMID:Overweight and obesity in Massachusetts: epidemic, hype or policy opportunity? 1732 23

The purpose of this study was to determine the nature of the relationships among stress, coping, social support, and weight class in premenopausal African American women as risk factors for coronary heart disease. Overweight and obesity are significant problems for African American women who are at an increased risk of weight-related diseases, such as diabetes, hypertension, cardiovascular disease, and cancer. Of these women, those who are premenopausal have a significantly higher coronary heart disease mortality rate than their white counterparts. There are gaps in current knowledge concerning the role that stress and other psychosocial factors play in weight control of premenopausal African American women. Data were obtained from 178 women with eligible data sets from a larger study of 236 subjects (Genetic Predictors of Coronary Heart Disease in Premenopausal African American Women). The measures for stress, coping, and social support included the Perceived Stress Scale, the Norbeck Social Support Questionnaire, and the Jalowiec Coping Scale. The weight class of the women was determined as: normal weight-body mass index (BMI) of 18.5-24.9 kg/m, overweight-BMI of 25-29.9 kg/m, or obese-BMI > or = 30 kg/m. Statistical analysis conducted included Spearman's rho, Chi-square, and regression analysis. Confrontive coping was shown to be used more often to a "high" degree in normal-weight African American women than in overweight and obese African American women (chi = 24.024; P = .0001). Confrontive coping was the only independent predictor of weight class in a regression model that included perceived stress, life events, social support, and optimistic, self-reliant, and evasive coping strategies. Therefore, African American women who use confrontive coping to a high degree were more likely to confront problems, such as weight control issues, than those who use this coping strategy to a low or medium degree.
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PMID:The relationships among stress, coping, social support, and weight class in premenopausal African American women at risk for coronary heart disease. 1758 78

This cross-sectional study assessed the prevalence of malnutrition and several metabolic risk factors for cardiovascular disease in 287 apparently healthy older adults from Northwest Mexico. Also, the impact of overweight and obesity on metabolic risk factors was assessed. Nutritional status was determined using serum albumin levels and anthropometry. Vitamin status was also assessed. Metabolic risk factors for cardiovascular disease were evaluated. The prevalence of undernutrition was 15.3%. Also, vitamin E deficiency was common (18%). On the contrary, 44.9% of men and women were in overweight and 24% were obese. A 50.9% of the older adults had hypertension, 52.6% hypercholesterolemia (HC), 38.3% hypertriglyceridemia (HTG), 26.1% impaired fasting glucose and 26.1% impaired glucose tolerance (IGT). HC and low-density-lipoprotein-cholesterol (LDL-C) were significantly more prevalent in women than in men. Mean adjusted values of fasting glucose, high-density-lipoprotein-cholesterol (HDL-C), total cholesterol (TC)/HDL-C ratio > or = 5, triglycerides (TG) and diastolic blood pressure (DBP) were significantly higher in subjects with body mass index (BMI) > or = 25.0 kg/m(2). Undernutrition, obesity and vitamin E deficiency, as well as several metabolic risk factors for cardiovascular disease coexisted in this studied group. Overweight and obesity were the most prevalent findings. BMI > or = 25 kg/m(2) was the common factor explaining most of the metabolic abnormalities. However, due to the sample size and the design of the study, the results must be seen with caution and cannot be generalized.
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PMID:Prevalence of malnutrition and associated metabolic risk factors for cardiovascular disease in older adults from Northwest Mexico. 1759 34

Aim of the study was to detect the prevalence of hypertension among 11-14 years old schoolchildren (n. 487, mean age 12.7 +/- 0.9). The influence on blood pressure (BP) of body mass index (BMI), dietary habits (frequency of breakfast and food items consumption) and life-style was also investigated. Hypertension was defined according to blood pressure tables for children and adolescents of the NIH-Fourth Report (systolic and diastolic BP >95th percentile for age and sex). Overweight and obesity were determined according to the International Obesity Task Force Dietary habits and life-style were investigated by specific questionnaires. The prevalence of overweight and obesity was respectively 31.8% and 10.3% of the subjects studied. Moreover 10.3% of them showed BP values between 90th and 95th percentile and 10.1% was hypertensive. In general the prevalence of overweight (p < 0.05), obesity (p < 0.001) and sedentary activity (p < 0.05) was higher in hypertensive adolescents. The multivariate logistic regression analysis showed a direct association between obesity (OR = 4.35; IC 95% = 2.24-8.44), sedentary life-style (OR = 2.38; IC 95% = 1.17-4.63) and hypertension. Food habits were not associated with BP levels. The results confirmed that an increase of cardiovascular risk in early age was correlated with the increase of the prevalence of obesity and sedentary life-style. Regular measurement of BP together with healthy dietary and life-style indications are recommended to overweight/obese children and adolescents.
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PMID:[Elevated blood pressure in adolescents from Rome, Italy. Nutritional risk factors and physical activity]. 1765 8

Overweight and obesity have been rising dramatically worldwide and are associated with numerous co-morbidities such as cardiovascular disease (CVD), type 2 diabetes mellitus, hypertension, certain cancers, and sleep apnea. In fact, obesity is an independent risk factor for CVD and CVD risks have also been documented in obese children. The majority of overweight and obese patients who achieve a significant short-term weight loss do not maintain their lower bodyweight in the long term. This may be due to a lack of intensive counseling and support from a facilitating environment including dedicated healthcare professionals such as nutritionists, kinesiologists, and behavior specialists. As a result, there has been a considerable focus on the role of adjunctive therapy such as pharmacotherapy for long-term weight loss and weight maintenance. Beyond an unfavorable risk factor profile, overweight and obesity also impact upon heart structure and function. Since the beginning, the quest for weight loss drugs has encountered warnings from regulatory agencies and the withdrawal from the market of efficient but unsafe medications. Fenfluramine was withdrawn from the market because of unacceptable pulmonary and cardiac adverse effects. Nevertheless, there is extensive research directed at the development of new anti-obesity compounds. The effect of these molecules on CVD risk factors has been studied and reported but information regarding their impact on the cardiovascular system is sparse. Thus, instead of looking at the benefit of weight loss on metabolism and risk factor management, this article discusses the impact of weight loss medications on the cardiovascular system. The potential interaction of available and potential new weight loss drugs with heart function and structure is reviewed.
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PMID:Impact of weight-loss medications on the cardiovascular system: focus on current and future anti-obesity drugs. 1769 68


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