Role of the cardiologist in the management of the morbidly obese patient

According to the December 2007 annual report on US health statistics, 67% of US adults are overweight and 34% are obese (Slide 1), representing a 75% increase since 1991. Surplus body weight is associated with excess morbidity and mortality and the worsening situation suggests that for the first time since the US Civil War, American life expectancy is projected to decrease in the years ahead owing to the increased risk of diseases and disorders associated with obesity (Slide 2), including hypertension, dyslipidemia, heart disease, diabetes, stroke, and some types of cancer. Like adults, the prevalence of childhood obesity is increasing rapidly, too. For preschoolers, prevalence of overweight increased from 5.0% in 1976-1980 to 13.9% in 2003-2004; for the same periods, prevalence increased from 6.5% to 18.8% for those ages 6-11 years; and from 5.0% to 17.4% for those ages 12-19 years. Among children and adolescents, overweight is associated with an increased risk of high cholesterol, liver abnormalities, diabetes, and becoming an overweight adult. Also, it should be emphasized, the problem of obesity is not restricted to the United States; prevalence of overweight is increasing at an alarming rate worldwide. The International Obesity Task Force recently estimated that at least 1.1 billion adults are overweight. At the 2007 European Society of Cardiology meeting, data were presented from the third report of EUROASPIRE (European Action on Secondary Prevention through Intervention to Reduce Events). Compared with previous surveys, EUROASPIRE I and II, the trends in lifestyle were disappointing, with no change in smoking and a dramatic increase in obesity (one-third of patients had a body mass index [BMI] >30 kg/M²), as well as in waist circumference (>50% of patients being centrally obese).