Short-term weight loss improves cardiovascular risk in morbidly obese individuals

Nutrition Research Newsletter, Sept, 2004

It is known that a modest weight loss of 5% to 10% of body weight in obese individuals with type 2 diabetes, hypertension, or dyslipidemia leads to improved glycemic control, lower blood pressure, and a better lipid profile. Current guidelines state that the initial goal of weight loss therapy should be to reduce body weight by ~10%. However, this statement is based on data collected in people with overweight or moderate obesity. The extent of weight loss needed to achieve a clinically meaningful effect on the cardiovascular risk factors in severe obesity is not well understood.

A study was performed to investigate metabolic cardiovascular risk factors in a large group of morbidiy obese patients undergoing laparoscopic gastric banding. Subjects included 830 consecutive patients, consisting of 647 women (77.9%) and 183 men (22.1%), underwent laparoscopic gastric banding at one particular institution. Only patients with BMI > 40 kg/[m.sup.2] were considered for surgery. Less severely obese patients (BMI 35 to 40 kg/[m.sup.2]) also were considered if they had high-risk comorbidity or had physical problems interfering with lifestyle. Laparoscopic gastric banding was performed with the Lapband System. A complete cardiovascular risk factors profile was collected on subjects both before and 12 to 18 months following surgery (mean follow-up time: 15.3 [ or -] 2.1 month).

Mean weight loss was 22.7 [ or -] 20.4 kg. Normalization of the metabolic alteration was observed in 67.3% of patients with diabetes, 38.3% of patients with hypercholesterolemia, 72.5% of patients with low HDL-cholesterolemia, 723% of patients with hypertriglyceridemia, and 46.7% of patients with hypertension. PROCAM score fell from 31.4 [ or ] 11.6 to 28.0 [ or -] 12.0 points (p < 0.001). The modifications of total cholesterol and blood pressure were unrelated to percentage weight loss. Percentage weight loss was significantly related to the reductions of fasting blood glucose, triglyceride level, and the PROCAM score and to the increase of HDL-cholasterol concentrations observed after surgery. The strength of these four relationships, however, was generally low. The variations of HDL-cholesterol concentrations and blood pressure levels were more influenced by actual energy balance than by the extent of weight loss.

In this study, weight loss achieved in the first 12 to 18 months after using gastric banding was associated with a significant improvement of single cardiovascular risk factors and global risk. However, the extent of weight loss was poorly related to the magnitude of improvement in cardiovascular risk, suggesting that modest weight loss can significantly reduce cardiovascular disease.

L. Busetto, G. Sergi, G. Enzi, et al. Short-term effects of weight loss on the cardiovascular risk factors in morbidly obese patients. Obes Res; 12:12156-1263 (August, 2004). [Correspondence: Dr. Luca Busetto, Clinica Medica L Policlinco Universitario, Via Giustiniani 2, 35128 Padova, Italy. E-mail: luca.busetto@unipd.it].