Weight loss (although apparently modest) and physical exercise: two powerful weapons for the reduction of risk factors for coronary artery disease

EDITORIAL

Weight loss (although apparently modest) and physical exercise: two powerful weapons for the reduction of risk factors for coronary artery disease

José Ernesto dos Santos

Departamento de Clinica Médica - FMRP - USP - Brazil

^{Mailing Address}

Generally identified as an esthetic problem, obesity is little recognized as a health problem. Over the years, its treatment has been neglected, perhaps due to the countless difficulties involved in its clinical approach such as patient compliance with conservative therapeutic proposals requiring changes in life style, and especially the goal of treatment (usually on a short-term basis) which is to reach a desirable weight (BMI >20 and < 25 kg/m²). Obesity is associated with a higher prevalence of risk factors and with greater morbidity and mortality due to cardiovascular disease (CAD)¹. Noradrenergic² and serotoninergic² medications and blockers of intestinal fat absorption² have been used with relative success and for a period of time not exceeding one year. The medications of the first two groups require special care when prescribed to patients with hypertension or with diagnosed CAD. More recently, a significant and increasing number of surgeries³ have been performed in order to provoke weight reduction. These procedures, although promoting a great weight loss (in general 40% of the initial weight), especially during the first years, and an important control of risk factors for CAD, may have several side effects such as protein-calorie malnutrition and specific vitamin deficiencies³.

This issue of Arquivos Brasileiros de Cardiologia contains papers by Barbato et al⁴ and Kasinski et al⁵ which make important contributions to a reflection about the problem. In the first, the authors demonstrate that a 5% weight loss in grade I obese subjects is sufficiently effective to reduce arterial pressure and total cholesterol, LDL cholesterol and plasma renin levels. This apparently small reduction has an important impact of the reduction of glycemia, insulin and HOMA. The weight loss observed in the study by Barbato et al⁴ was achieved with diet therapy and exercise and with changes in behavior. Similar results were recently obtained by Waden et al⁶ in a study comparing pharmacotherapy alone or combined with behavioral therapy for the treatment of obese subjects. Within one year of treatment, patients who had received behavioral therapy had a greater weight loss and fewer adverse effects than those who had received pharmacotherapy alone. Another problem considered is postprandial lipemia and, even though in their study Kasinski et al⁵ did not observe the expected effect of acute exercise, it was clear that fasting lipemia was a predictor of the postprandial lipemia curve.

Taken together, these two studies provide important elements for a rethinking about several aspects of obesity. One of them, and perhaps the most important, is the need to see obesity as a clinical sign or symptom that requires urgent clinical measures for its control, such as long-term (indeed, life-long!!!) clinical treatment. It should be considered that even modest weight losses such as a 5% loss of the initial weight have a profound impact on the control of some risk factors and that successful weight reduction can be obtained by attempts at changing life style using behavioral therapy.

REFERENCES

1. Eckel RH, Barouch WW, Ershow AG. Report of the National Heart, Lung, and Blood Institute-National Institute of Diabetes and Digestive and Kidney Diseases Working Group on the Pathophysiology of Obesity-Associated Cardiovascular Disease. Circulation. 2002; 105: 2923-28.

2. Glazer G. Long-term Pharmacotherapy of Obesity 2000: A Review of Efficacy and Safety. Arch Inter Med. 2001; 161: 1814-24.

3. Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, et al. Bariatric Surgery: A Systematic Review and Meta-analysis. JAMA. 2004; 292: 1724 -37.

4. Barbato KBG, Martins RCV, Rodrigues MLG, Braga JU, Francischetti EA, Genelhu VA. Efeitos da Redução de Peso Superior a 5% nos Perfis Hemodinâmico, Metabólico e Neuroendócrino de Obesos Grau I. Arq Bras Cardiol. 2006; 87: 12-21.

5. Teixeira M, Kasinski N, Izar MC, Barbosa LA, Novazzi JP, Pinto LA, et al. Efeitos do exercício agudo na lipemia pós-prandial em homens sedentários. Arq Bras Cardiol. 2006; 87: 3-11.

6. Wadden TA, Berkowitz RI, Womble LG, Sarwer DB, Phelan S, Cato RK, et al. Randomized trial of lifestyle modification and pharmacotherapy for obesity. N Engl J Med. 2005; 353: 2111-20.

Mailing Address:

José Ernesto dos Santos

Av. Bandeirantes, 3900

14049-900 - Ribeirão Preto - SP - Brazil

Publication Dates

• Publication in this collection
  28 July 2006
• Date of issue
  July 2006