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Ideal body weight is not realistic goal for lifestyle intervention

  1. John Wilding, senior lecturer in medicine (j.p.h.wilding@liv.ac.uk),
  2. Gareth Williams, professor
  1. University Clinical Departments, University Hospital Aintree, Liverpool L9 7AL
  2. Department of Clinical Pharmacology, Division of Medicine and Therapeutics, Leicester Royal Infirmary, Leicester University, Leicester LE2 7LX
  3. Department of Public Health and Epidemiology, University of Birmingham, Birmingham B15 2TT
  4. Macklin Street Surgery, Derby DE1 1JX
  5. Areva International, Portola Valley, CA 94028, USA
  6. Heartlands Diabetes Centre, Birmingham Heartlands Hospital, Birmingham B9 5SS
  7. Department of Public Health and Primary Health Care, University of Bergen, N-5009 Bergen, Norway
  8. 2 Lesley Court, Strutton Ground, London, SW1P 2HZ
  9. Balmoral Surgery, Deal, Kent CT14 7AU
  10. Departments of Medicine, Epidemiology and Health Services, University of Washington, Seattle, WA 88101, USA
  11. Department of Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
  12. University of Sheffield, Sheffield S10 2TN
  13. B Williams
  14. University of Leicester School of Medicine, Leicester Royal Infirmary, Leicester LE2 7LX
  15. Queen's University of Belfast, Belfast BT7 1NN
  16. Department of Medicine, St George's Hospital, London SW17 0RE
  17. Department of Obstetrics and Gynaecology, St Thomas's Hospital, London SE1 7EH
  18. Imperial College School of Medicine, London W2 1NY
  19. North Staffordshire Royal Infirmary, Stoke on Trent ST4 7LN

    EDITOR—Ramsay et al have produced a clear and authoritative document with their recent guidelines for the treatment of hypertension.1 The section on lifestyle modification, however, includes the statement that weight loss to achieve an ideal body weight will lower blood pressure.

    Although this is undoubtedly true, it undermines most recent guidelines that recognise the practical near impossibility of achieving ideal body weight in most obese subjects2–4 and evidence that suggests that more modest (and achievable) reductions in weight of 5-10% of body weight can be effective at lowering systolic and diastolic blood pressure in the range of 4–7 and 3–6 mm Hg respectively.5 It should be made explicit in the guidelines that this degree of weight loss is likely to be beneficial in reducing cardiovascular risk, rather than perpetuating the myth that “ideal” body weight is a realistic goal of lifestyle modification in overweight and obese subjects.

    Footnotes

    • Competing interests Both authors have received honoraria for speaking at lectures, consultancy fees, and grant support from a number of companies that produce, or are developing, pharmacological treatments for obesity.

    References

    1. 1.↵
      1. Ramsay LE,
      2. Williams B,
      3. Johnston GD,
      4. MacGregor GA,
      5. Poston L,
      6. Potter JF,
      7. et al
      .British Hypertension Society guidelines for hypertension management 1999: summary. BMJ 1999;319: 630–635. (4 September.)
      OpenUrlFREE Full Text
    2. 2.↵
      1. Royal College of Physicians
      . Clinical management of overweight and obese patients, with particular reference to the use of drugs. London: Royal College of Physicians, 1998.
    3. 3.
      Obesity in Scotland: integrating prevention with weight management. Edinburgh: SIGN, 1996.
    4. 4.↵
      Clinical guidelines on the identification, evaluation and treatment of overweight and obesity in adults. Bethesda, MD: National Institutes of Health, 1998.
    5. 5.↵
      1. Trials of Hypertension Collaborative Research Group
      .Effects of weight loss and sodium reduction intervention in blood pressure incidence in overweight people with high-normal blood pressure: the trials of hypertension prevention, phase 2. Arch Intern Med 1997;157: 657–667.
      OpenUrlFREE Full Text

    Patients from ethnic minorities are at greater risk

    1. Garfield Drummond, specialist registrar in clinical pharmacology
    1. University Clinical Departments, University Hospital Aintree, Liverpool L9 7AL
    2. Department of Clinical Pharmacology, Division of Medicine and Therapeutics, Leicester Royal Infirmary, Leicester University, Leicester LE2 7LX
    3. Department of Public Health and Epidemiology, University of Birmingham, Birmingham B15 2TT
    4. Macklin Street Surgery, Derby DE1 1JX
    5. Areva International, Portola Valley, CA 94028, USA
    6. Heartlands Diabetes Centre, Birmingham Heartlands Hospital, Birmingham B9 5SS
    7. Department of Public Health and Primary Health Care, University of Bergen, N-5009 Bergen, Norway
    8. 2 Lesley Court, Strutton Ground, London, SW1P 2HZ
    9. Balmoral Surgery, Deal, Kent CT14 7AU
    10. Departments of Medicine, Epidemiology and Health Services, University of Washington, Seattle, WA 88101, USA
    11. Department of Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
    12. University of Sheffield, Sheffield S10 2TN
    13. B Williams
    14. University of Leicester School of Medicine, Leicester Royal Infirmary, Leicester LE2 7LX
    15. Queen's University of Belfast, Belfast BT7 1NN
    16. Department of Medicine, St George's Hospital, London SW17 0RE
    17. Department of Obstetrics and Gynaecology, St Thomas's Hospital, London SE1 7EH
    18. Imperial College School of Medicine, London W2 1NY
    19. North Staffordshire Royal Infirmary, Stoke on Trent ST4 7LN

      EDITOR—The latest guidelines by the British Hypertension Society aim to address the incomplete detection, treatment, and control of hypertension prevalent across all sections of the community.1 The emphasis on the assessment and reduction of cardiovascular risk rather than just the maintenance of an optimal blood pressure is to be welcomed.

      One group at high risk is, however, hardly mentioned. Sections of the ethnic community, particularly Afro-Caribbeans and South Asians, are at greatly increased risk of end organ damage owing to hypertension. They also exhibit an increased incidence of concomitant cardiovascular risk factors such as diabetes and obesity.

      The guidelines note that differences in average response between drug groups are related to ethnic group, but the reader is …

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