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The value of current interventions for obesity

Nature Clinical Practice Cardiovascular Medicine volume 5, pages S3–S9 (2008)Cite this article

Abstract

Obesity greatly increases risk of cardiovascular disease, metabolic syndrome, and diabetes mellitus. Most obese patients are unable to sustain appreciable weight loss; the body has a natural tendency to return to its previous weight. Although bariatric surgery is effective, it is not without risk. Until better treatments for obesity are available, management remains focused on lifestyle changes, drug therapy, and treating the metabolic complications of obesity. The main cause of metabolic dysfunction in obesity is visceral fat. Fat deposition in and around organs, skeletal muscle, and other tissues is thought to occur when subcutaneous adipose tissue stores are full. Creation of additional adipose-tissue stores is prevented by the mature adipocytes, which inhibit the differentiation of preadipocytes in a negative feedback loop. This inhibition is mediated, in part, by the renin–angiotensin system. Indeed, angiotensin II blockade has been shown to promote adipogenesis in vitro. Clinical studies are currently underway to investigate whether the angiotensin-II-receptor blocker telmisartan can stimulate adipogenesis, with the aim of diverting intramuscular fat back into adipose tissue and thereby restoring insulin sensitivity. If this effect can be demonstrated in humans, this type of agent might become the treatment of choice for obese or overweight people at risk of type 2 diabetes.

Key Points

  • Obesity is a complex disorder that is difficult to control because various biological and environmental factors promote weight gain and regain

  • Although lifestyle changes have traditionally been the cornerstone of obesity management, weight loss is difficult to maintain in the long term

  • Matching the choice of intervention with lifestyle changes, pharmacotherapy, surgical approaches, or a combination of these, to the degree of adiposity seems to improve treatment success

  • Angiotensin II blockade with telmisartan might reduce the amount of intramuscular fat deposition and improve blood pressure control in obese patients

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Figure 1: Association of waist-to-hip ratio with risk of myocardial infarction in a variety of BMI ranges.
Figure 2: Central role of obesity in metabolic syndrome and cardiovascular risk.
Figure 3: Metabolic changes after weight gain or loss in adults.
Figure 4
Figure 5: The hypothetical role of the renin–angiotensin system on adipogenesis.

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References

  1. Yusuf S et al. (2005) Obesity and the risk of myocardial infarction in 27,000 participants from 52 countries: a case-control study. Lancet 366: 1640–1649

    Article  Google Scholar 

  2. Franzosi MG (2006) Should we continue to use BMI as a cardiovascular risk factor? Lancet 368: 624–625

    Article  Google Scholar 

  3. Stevens J et al. (1998) The effect of age on the association between body-mass index and mortality. N Engl J Med 338: 1–7

    Article  CAS  Google Scholar 

  4. Despres JP et al. (1990) Regional distribution of body fat, plasma lipoproteins, and cardiovascular disease. Arteriosclerosis 10: 497–511

    Article  CAS  Google Scholar 

  5. Sharma AM et al. (2002) Adipose tissue: a mediator of cardiovascular risk. Int J Obesity 26 (Suppl 4): S5–S7

    Article  CAS  Google Scholar 

  6. National Cholesterol Education Program (2002) Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 106: 3143–3421

  7. Katzmarzyk PT (2002) The Canadian obesity epidemic, 1985-1998. CMAJ 166: 1039–1040

    PubMed  PubMed Central  Google Scholar 

  8. Martorell R et al. (2000) Obesity in women from developing countries. Eur J Clin Nutr 54: 247–252

    Article  CAS  Google Scholar 

  9. Mokdad AH et al. (2003) Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA 289: 76–79

    Article  Google Scholar 

  10. Wyatt SB et al. (2006) Overweight and obesity: prevalence, consequences, and causes of a growing public health problem. Am J Med Sci 331: 166–174

    Article  Google Scholar 

  11. Haslam DW and James WP (2005) Obesity. Lancet 366: 1197–1209

    Article  Google Scholar 

  12. Wynne K et al. (2005) Appetite control. J Endocrinol 184: 291–318

    Article  CAS  Google Scholar 

  13. Levin BE (2005) Factors promoting and ameliorating the development of obesity. Physiol Behav 86: 633–639

    Article  CAS  Google Scholar 

  14. MacLean PS et al. (2004) Metabolic adjustments with the development, treatment, and recurrence of obesity in obesity-prone rats. Am J Physiol Regul Integr Comp Physiol 287: R288–R297

    Article  CAS  Google Scholar 

  15. Elfhag K and Rossner S (2005) Who succeeds in maintaining weight loss? A conceptual review of factors associated with weight loss maintenance and weight regain. Obes Rev 6: 67–85

    Article  CAS  Google Scholar 

  16. Leibel RL et al. (1995) Changes in energy expenditure resulting from altered body weight. N Engl J Med 332: 621–628

    Article  CAS  Google Scholar 

  17. Lakka TA and Bouchard C (2005) Physical activity, obesity and cardiovascular diseases. Handb Exp Pharmacol 170: 137–163

    Article  CAS  Google Scholar 

  18. Merchant A et al. (2006) A cardiologist's guide to waist management. Heart 92: 865–866

    Article  CAS  Google Scholar 

  19. Stevens VJ et al. (2001) Long-term weight loss and changes in blood pressure: results of the Trials of Hypertension Prevention, phase II. Ann Intern Med 134: 1–11

    Article  CAS  Google Scholar 

  20. Lindstrom J et al. (2003) The Finnish Diabetes Prevention Study (DPS): Lifestyle intervention and 3-year results on diet and physical activity. Diabetes Care 26: 3230–3236

    Article  Google Scholar 

  21. Knowler WC et al. (2002) Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 346: 393–403

    Article  CAS  Google Scholar 

  22. Latner JD (2001) Self-help in the long-term treatment of obesity. Obes Rev 2: 87–97

    Article  CAS  Google Scholar 

  23. Crookes PF (2006) Surgical treatment of morbid obesity. Annu Rev Med 57: 243–264

    Article  CAS  Google Scholar 

  24. Buchwald H et al. (2004) Bariatric surgery: a systematic review and meta-analysis. JAMA 292: 1724–1737

    Article  CAS  Google Scholar 

  25. Halford JC (2006) Pharmacotherapy for obesity. Appetite 46: 6–10

    Article  CAS  Google Scholar 

  26. Wadden TA et al. (2005) Randomized trial of lifestyle modification and pharmacotherapy for obesity. N Engl J Med 353: 2111–2120

    Article  CAS  Google Scholar 

  27. James WPT (2005) The SCOUT study: risk–benefit profile of sibutramine in overweight high-risk cardiovascular patients. Eur Heart J Suppl 7 (Suppl L): L44–L48

    Article  CAS  Google Scholar 

  28. Curioni C et al. (2006) Rimonabant for overweight or obesity. The Cochrane Database of Systematic Reviews, Issue 4, Art. No CD006162, doi:10.1002/14651858.CD006162.pub2

  29. Iacobellis G et al. (2003) Relationship of insulin sensitivity and left ventricular mass in uncomplicated obesity. Obes Res 11: 518–524

    Article  Google Scholar 

  30. Manco M et al. (2000) Insulin resistance directly correlates with increased saturated fatty acids in skeletal muscle triglycerides. Metabolism 49: 220–224

    Article  CAS  Google Scholar 

  31. Mingrone G et al. (2002) Skeletal muscle triglycerides lowering is associated with net improvement of insulin sensitivity, TNF-alpha reduction and GLUT4 expression enhancement. Int J Obes Relat Metab Disord 26: 1165–1172

    Article  CAS  Google Scholar 

  32. Cree MG et al. (2004) Intramuscular and liver triglycerides are increased in the elderly. J Clin Endocrinol Metab 89: 3864–3871

    Article  CAS  Google Scholar 

  33. Heilbronn L et al. (2004) Failure of fat cell proliferation, mitochondrial function and fat oxidation results in ectopic fat storage, insulin resistance and type II diabetes mellitus. Int J Obes Relat Metab Disord 28 (Suppl 4): S12–S21

    Article  CAS  Google Scholar 

  34. Sharma AM et al. (2002) Angiotensin blockade prevents type 2 diabetes by formation of fat cells. Hypertension 40: 609–611

    Article  CAS  Google Scholar 

  35. Janke J et al. (2002) Mature adipocytes inhibit in vitro differentiation of human preadipocytes via angiotensin type 1 receptors. Diabetes 51: 1699–1707

    Article  CAS  Google Scholar 

  36. Ailhaud G et al. (2000) Angiotensinogen, angiotensin II and adipose tissue development. Int J Obes Relat Metab Disord 24 (Suppl 4): S33–S35

    Article  CAS  Google Scholar 

  37. Weber M (2003) The telmisartan Programme of Research tO show Telmisartan End-organ proteCTION (PROTECTION) programme. J Hypertens Suppl 21: S37–S46

    Article  CAS  Google Scholar 

  38. Sharma AM et al. (2005) Comparison of the antihypertensive efficacy of telmisartan/hydrochlorothiazide vs valsartan/hydrochlorothiazide in high-risk overweight/obese patients with hypertension and type 2 diabetes [abstract #PC.11]. Hypertension 46: 898–899

    Google Scholar 

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Acknowledgements

PAREXEL MMS provided writing assistance, comprising preparation of a draft from slides and audio transcript, preparation of figures and obtaining copyright permissions, proofreading, and reference checking.

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  1. Department of Medicine, McMaster University, Hamilton General Hospital, 237 Barton Street East, ON L8L 2X2, Canada sharma@ccc.mcmaster.ca

Authors and Affiliations

  1. AM Sharma is a Canada Research Chair for Cardiovascular Obesity Research and Management in the Michael deGroote School of Medicine, McMaster University, Hamilton, ON, Canada.,

    Arya M Sharma

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The author declares no competing financial interests.

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Sharma, A. The value of current interventions for obesity. Nat Rev Cardiol 5 (Suppl 1), S3–S9 (2008). https://doi.org/10.1038/ncpcardio0854

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