JACC Focus Seminar: Obesity, Diabetes, And Phenotypes
JACC Focus Seminar
Management of Obesity in Cardiovascular Practice: JACC Focus Seminar

https://doi.org/10.1016/j.jacc.2021.05.035Get rights and content
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Highlights

  • Individual differences in regional body fat distribution are a key factor in determining associated health risks.

  • Excess visceral fat storage is often accompanied by accumulation of fat in normally lean tissues such as the heart, liver, kidneys, pancreas, and skeletal muscle.

  • Elevated waist circumference is associated with hazard to health at any level of body mass index and should be monitored routinely in clinical practice.

  • Patients at cardiovascular risk benefit from lifestyle interventions that reduce waist circumference even without weight loss.

Abstract

Obesity contributes to reduced life expectancy because of its link with type 2 diabetes and cardiovascular disease. Yet, targeting this poorly diagnosed, ill-defined, and underaddressed modifiable risk factor remains a challenge. In this review, we emphasize that the tendency among health care professionals to amalgam all forms of obesity altogether as a single entity may contribute to such difficulties and discrepancies. Obesity is a heterogeneous condition both in terms of causes and health consequences. Attention should be given to 2 prevalent subgroups of individuals: 1) patients who are overweight or moderately obese with excess visceral adipose tissue; and 2) patients with severe obesity, the latter group having distinct additional health issues related to their large body fat mass. The challenge of tackling high-cardiovascular-risk forms of obesity through a combination of personalized clinical approaches and population-based solutions is compounded by the current obesogenic environment and economy.

Key Words

cardiovascular disease
ectopic fat deposition
massive obesity
type 2 diabetes
visceral obesity

Abbreviations and Acronyms

BMI
body mass index
GLP1-RA
glucagon-like peptide 1 receptor agonists
HDL-C
high-density lipoprotein cholesterol
LDL-C
low-density lipoprotein cholesterol
MACE
major adverse cardiovascular events
PCE
Pooled Cohort Equations
T2D
type 2 diabetes
VAT
visceral adipose tissue

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