Point/CounterpointObesity and Cardiovascular Disease: Weight Loss Is Not the Only Target
Section snippets
Defining Obesity: Limitations of the Body Mass Index
The most commonly used anthropometric index to make a diagnosis of obesity has been a legacy of the late Ancel Keys, who provided evidence that the body mass index (BMI) (expressed as weight in kg/height in m2) was related to body fat content and associated comorbidities.5 Since then, many large prospective observational studies have shown a relationship between the BMI and mortality. However, although it is clear that a very high BMI increases mortality, the shape of the relationship between
Beyond the BMI: Body Shape Matters
Another aspect that can no longer be ignored in 2013 considering the abundant literature available is the importance of considering individual differences in regional body fat distribution.11, 12 Almost 25 years ago, we reported that there are remarkable differences in the way people accumulate energy in regional adipose tissue depots.13 We now have considerable evidence from several large cardiometabolic imaging studies that among equally overweight or obese individuals, those with a selective
Body Fat Distribution and Health: The Notion of Ectopic Fat
In that regard, we have recently published results from a large international cardiometabolic imaging study involving 4144 patients from 29 countries in which we assessed using computed tomography abdominal visceral adiposity at L4-L5 and estimated liver fat content on the basis of liver density (the latter variable being expressed in Hounsfield units: the lower the liver density, the greater the liver fat content).18, 19 As also reported in the Dallas Heart Study,20 we found in men and women a
Excess Visceral Adiposity/Ectopic Fat: Revisiting Weight Loss Studies
Thus, if excess weight alone is not enough to assess health risk, should not we pause for a moment and at least revisit the relevance of weight loss through voluntary caloric restriction as a primary therapeutic target? A couple of recently published large lifestyle trials might help us obtain at least partial answers to this question. One of these studies is the Look Action for Health in Diabetes (AHEAD) trial published in the New England Journal of Medicine23 which tested the hypothesis that
Acknowledgements
The author is the Scientific Director of the International Chair on Cardiometabolic Risk which is based at Université Laval.
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2021, iScienceCitation Excerpt :This strongly suggests that the impact of exercise on vascular function is largely independent of weight loss. Ectopic fat, including VAT and fat stores in the liver and other lean tissues, is associated with increased risk of CVD and T2D (Piche et al., 2018; Despres, 2015). Sedentary individuals with obesity typically have high levels of ectopic fat, and this may contribute in large part to the higher mortality risk associated with obesity.
Management of Obesity in Cardiovascular Practice: JACC Focus Seminar
2021, Journal of the American College of CardiologyCitation Excerpt :Discordant changes in body weight vs visceral adiposity with regular exercise are expected, with some high responders for VAT loss showing no or trivial weight loss. This phenomenon may be explained by skeletal muscle mass accretion with exercise in some sedentary patients (76,77). Lifestyle modification should be the cornerstone of any prevention strategy for CVD in all obesities and stages of chronic disease (Figure 5).
Food for Thought: A “Low-Tech” Road to Improved Primary Cardiovascular Prevention: Adherence to Dietary Guidelines
2018, Canadian Journal of Cardiology
See article by Kramer, pages 211-215 of this issue.
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