Healthy weight loss modalities with diet and exercise are important
Ma et al1 assessed whether weight loss interventions for adults with obesity affect all cause, cardiovascular, and cancer mortality, cardiovascular disease, cancer, and body weight with Design Systematic review and meta-analysis of randomised controlled trials (RCTs) using random effects, estimating risk ratios, and mean differences. They observed that weight reducing diets, usually low in fat and saturated fat, with or without exercise advice or programmes, may reduce premature all cause mortality in adults with obesity.
Cardiometabolic syndrome consisting of obesity, dyslipidemia of high triglycerides or low high-density lipoprotein cholesterol, pre-hypertension, and pre-diabetes showing fasting glucose >100 mg/dl are major risk factors for cardiovascular diseases (CVD) such as hypertension, diabetes mellitus, coronary heart disease, and heart failure as well as cancer, congenital malformations, and dementia. Obesity is the most important factor among others and also can be controlled by diet and exercise.2-4 Indeed, exercise and many drug interventions are often potentially similar in terms of their mortality benefits in the secondary prevention of coronary heart disease, rehabilitation after stroke, treatment of heart failure, and prevention of diabetes.5 This study points to the importance of therapeutic life style changes compared with drugs intervention. All physicians should think about this message in this time of many drugs being prescribed while elderly population is increasing fast and life expectancy is longer.2,3
Obesity is currently one of the greatest public health issues worldwide. However, despite its known deleterious effects on health, recent findings led to the development of concepts such as the obesity paradox, and protective subcutaneous fat depots have raised a lively debate on the disparate effects of obesity on health outcomes.4,6-8
At the population level, it is clear that obesity is an established risk factor for the development of CVD, cancer, and even dementia and all cause mortality. In addition, multiple biological mechanisms linking obesity and CVD events have been identified. However, the possible existence of a metabolically healthy obese phenotype (which could be more appropriately be referred to as a lower risk form of obesity), the important role of regional body fat distribution and ectopic fat accumulation, and the presence of an obesity (body mass index, BMI) paradox in patients with coronary heart disease are all observations which emphasize the remarkable heterogeneity of obesity. At the population level, these complex obesity-related issues have remained the biggest challenge for clinicians dealing with numerous obese phenotypes. There is, however, robust evidence indicating that a subset of overweight and moderately obese individuals with a high level of fitness may be protected from obesity-related health outcomes.4 Thus, although it is clear that there is a strong link between the BMI and the incidence of various clinical outcomes, whether reducing the BMI should be the primary target at the clinical level remains debated. It has rather been suggested that targeting key behaviors such as improving nutritional quality, usually low in fat and saturated fat, and improving cardiorespiratory fitness through regular physical activity would be legitimate approaches contributing to generate “healthy weight loss modalities”.2-4,9 Further investigations should consider both metabolic risk and cardiorespiratory fitness in addition to the selection of appropriate obesity index to better identify and manage patients who are “at risk” for the development of CVD, cancer, and dementia.
Funding: None, Disclosures: None
REFERENCES
1. Ma C, Avenell A, Bolland M, Hudson J, Stewart F, Robertson C, Sharma P, Fraser C, MacLennan G. Effects of weight loss interventions for adults who are obese on mortality, cardiovascular disease, and cancer: systematic review and meta-analysis. BMJ. 2017;359:j4849.
4. Kim SH, Després JP, Koh KK. Obesity and cardiovascular disease: friend or foe?
Eur Heart J. 2016;37:3560-3568.
5. Naci H, Ioannidis JPA. Comparative effectiveness of exercise and drug
interventions on mortality outcomes: metaepidemiological study. BMJ 2013;347:f5577
6. Oreopoulos A, Padwal R, Kalantar-Zadeh K, Fonarow GC, Norris CM, McAlister FA. Body mass index and mortality in heart failure: a meta-analysis. Am Heart J. 2008;156:13-22.
7. Mariscalco G, Wozniak MJ, Dawson AG, Serraino GF, Porter R, Nath M, Klersy C, Kumar T, Murphy GJ. Body mass index and mortality among adults undergoing cardiac surgery: A nationwide study with a systematic review and meta-analysis. Circulation. 2017;135:850-863.
8. Sundström J, Bruze G, Ottosson J, Marcus C, Näslund I, Neovius M. Weight loss and heart failure: A Nationwide study of gastric bypass surgery versus intensive lifestyle treatment.
Circulation. 2017;135:1577-1585.
9. Koh KK. Letter by Koh Regarding Article, “Predicting the 10-Year Risks of Atherosclerotic Cardiovascular Disease in Chinese Population: The China-PAR Project (Prediction for ASCVD Risk in China)” and “Distribution of Estimated 10-Year Risk of Recurrent Vascular Events and Residual Risk in a Secondary Prevention Population”
(What is the best risk prediction tool in the primary and secondary prevention?) Circulation. 2017;135:e818-e819.
Competing interests:
No competing interests
25 November 2017
Kwabg Kon KOH
Professor of Medicine
Department of Cardiovascular Medicine, Gachon University, Gil Medical Center
Rapid Response:
Healthy weight loss modalities with diet and exercise are important
Ma et al1 assessed whether weight loss interventions for adults with obesity affect all cause, cardiovascular, and cancer mortality, cardiovascular disease, cancer, and body weight with Design Systematic review and meta-analysis of randomised controlled trials (RCTs) using random effects, estimating risk ratios, and mean differences. They observed that weight reducing diets, usually low in fat and saturated fat, with or without exercise advice or programmes, may reduce premature all cause mortality in adults with obesity.
Cardiometabolic syndrome consisting of obesity, dyslipidemia of high triglycerides or low high-density lipoprotein cholesterol, pre-hypertension, and pre-diabetes showing fasting glucose >100 mg/dl are major risk factors for cardiovascular diseases (CVD) such as hypertension, diabetes mellitus, coronary heart disease, and heart failure as well as cancer, congenital malformations, and dementia. Obesity is the most important factor among others and also can be controlled by diet and exercise.2-4 Indeed, exercise and many drug interventions are often potentially similar in terms of their mortality benefits in the secondary prevention of coronary heart disease, rehabilitation after stroke, treatment of heart failure, and prevention of diabetes.5 This study points to the importance of therapeutic life style changes compared with drugs intervention. All physicians should think about this message in this time of many drugs being prescribed while elderly population is increasing fast and life expectancy is longer.2,3
Obesity is currently one of the greatest public health issues worldwide. However, despite its known deleterious effects on health, recent findings led to the development of concepts such as the obesity paradox, and protective subcutaneous fat depots have raised a lively debate on the disparate effects of obesity on health outcomes.4,6-8
At the population level, it is clear that obesity is an established risk factor for the development of CVD, cancer, and even dementia and all cause mortality. In addition, multiple biological mechanisms linking obesity and CVD events have been identified. However, the possible existence of a metabolically healthy obese phenotype (which could be more appropriately be referred to as a lower risk form of obesity), the important role of regional body fat distribution and ectopic fat accumulation, and the presence of an obesity (body mass index, BMI) paradox in patients with coronary heart disease are all observations which emphasize the remarkable heterogeneity of obesity. At the population level, these complex obesity-related issues have remained the biggest challenge for clinicians dealing with numerous obese phenotypes. There is, however, robust evidence indicating that a subset of overweight and moderately obese individuals with a high level of fitness may be protected from obesity-related health outcomes.4 Thus, although it is clear that there is a strong link between the BMI and the incidence of various clinical outcomes, whether reducing the BMI should be the primary target at the clinical level remains debated. It has rather been suggested that targeting key behaviors such as improving nutritional quality, usually low in fat and saturated fat, and improving cardiorespiratory fitness through regular physical activity would be legitimate approaches contributing to generate “healthy weight loss modalities”.2-4,9 Further investigations should consider both metabolic risk and cardiorespiratory fitness in addition to the selection of appropriate obesity index to better identify and manage patients who are “at risk” for the development of CVD, cancer, and dementia.
Funding: None, Disclosures: None
REFERENCES
1. Ma C, Avenell A, Bolland M, Hudson J, Stewart F, Robertson C, Sharma P, Fraser C, MacLennan G. Effects of weight loss interventions for adults who are obese on mortality, cardiovascular disease, and cancer: systematic review and meta-analysis. BMJ. 2017;359:j4849.
2. Koh KK. To take or not to take drugs? That is the question. BMJ 2013, Published 30 December 2013, http://www.bmj.com/content/347/bmj.f5577/rr/679697
3. Koh KK. Reconfirm to follow guidelines to prevent cardiovascular diseases.
BMJ 2016, Published on 5 March 2016, http://www.bmj.com/content/352/bmj.i721/rr-0.
4. Kim SH, Després JP, Koh KK. Obesity and cardiovascular disease: friend or foe?
Eur Heart J. 2016;37:3560-3568.
5. Naci H, Ioannidis JPA. Comparative effectiveness of exercise and drug
interventions on mortality outcomes: metaepidemiological study. BMJ 2013;347:f5577
6. Oreopoulos A, Padwal R, Kalantar-Zadeh K, Fonarow GC, Norris CM, McAlister FA. Body mass index and mortality in heart failure: a meta-analysis. Am Heart J. 2008;156:13-22.
7. Mariscalco G, Wozniak MJ, Dawson AG, Serraino GF, Porter R, Nath M, Klersy C, Kumar T, Murphy GJ. Body mass index and mortality among adults undergoing cardiac surgery: A nationwide study with a systematic review and meta-analysis. Circulation. 2017;135:850-863.
8. Sundström J, Bruze G, Ottosson J, Marcus C, Näslund I, Neovius M. Weight loss and heart failure: A Nationwide study of gastric bypass surgery versus intensive lifestyle treatment.
Circulation. 2017;135:1577-1585.
9. Koh KK. Letter by Koh Regarding Article, “Predicting the 10-Year Risks of Atherosclerotic Cardiovascular Disease in Chinese Population: The China-PAR Project (Prediction for ASCVD Risk in China)” and “Distribution of Estimated 10-Year Risk of Recurrent Vascular Events and Residual Risk in a Secondary Prevention Population”
(What is the best risk prediction tool in the primary and secondary prevention?) Circulation. 2017;135:e818-e819.
Competing interests: No competing interests