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Obesity, weight reduction, and cardiovascular disease

INTRODUCTION

Obesity is a major public health problem in the United States. In the National Health and Nutrition Examination Survey (NHANES III) from 1988 to 1991, 36 percent of the population was identified as obese, compared with 25 percent in NHANES II from 1976 to 1980 [1]. The prevalence of obesity has continued to rise [2]. Compared to NHANES data from 1988 to 1994, data from NHANES 1999 to 2000 demonstrates an increase in the prevalence of overweight and obese adults from 55.9 to 64.5 percent for overweight and from 22.9 to 30.5 percent for obese adults [3].

Similar results have been noted in the United Kingdom. The percentage of the population with a body mass index (BMI) above 30 kg/m2 increased between 1986 and 1993 from 6 to 13 percent in men and from 8 to 16 percent in women [4]. These data and those from other countries are indicative of a major international epidemic [5].

There is a relationship between obesity and age. Approximately 20 percent of Americans between the age of 25 and 34 are obese; another 10 percent of the population becomes obese with each succeeding decade up to the age of 55 [6].

Obesity has long been associated with an increased risk for coronary heart disease (CHD). A recent meta-analysis observed a 29 percent increase in CHD for each five-unit increase in BMI [7]. This association was slightly attenuated after adjustment for blood pressure and cholesterol level. The risk is compounded by the common coexistence of other risk factors associated with obesity such as hypertension, dyslipidemia, and abnormal glucose metabolism. How much of the risk is due to obesity alone has been uncertain. Furthermore, the mechanisms by which obesity, particularly abdominal obesity, cause or accelerate coronary atherogenesis are also uncertain.

Evidence does exist to suggest that obesity, particularly visceral adipose, among adolescents is associated with acceleration of atherosclerosis [8-10]. More recently, long-term follow-up from Denmark demonstrated BMI during childhood was positively associated with increased risk of CHD during adulthood [11].
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