Clinical Review

Treatment of obesity: need to focus on high risk abdominally obese patients

BMJ 2001; 322 doi: http://dx.doi.org/10.1136/bmj.322.7288.716 (Published 24 March 2001) Cite this as: BMJ 2001;322:716
  1. Jean-Pierre Després ([email protected]), professora,
  2. Isabelle Lemieux, PhD studentb,
  3. Denis Prud'homme, professorc
  1. a Quebec Heart Institute, Laval Hospital Research Centre, Sainte-Foy, Quebec, Canada G1V 4G5
  2. b Lipid Research Centre, CHUQ Research Centre, Sainte-Foy, Quebec, Canada G1V 4G2
  3. c Physical Activity Sciences Laboratory, Laval University, Sainte-Foy, Quebec, Canada G1K 7P4
  1. Correspondence to: J-P Després

    Editorial by Little and Byrne

    It is generally accepted that obesity is a health hazard because of its association with numerous metabolic complications such as dyslipidaemia, type 2 diabetes, and cardiovascular diseases.1 On that basis, health agencies 2 3 have proposed that obesity should be defined on the basis of weight in kg expressed over height in m2, the so called body mass index,4 initially described by Quetelet in 1869 (table). Epidemiological studies have reported a progressive increase in the incidence of chronic diseases such as hypertension, diabetes, and coronary heart disease with increasing body mass index.1-3 However, despite this well documented evidence, physicians are, in their daily practice, perplexed by the remarkable heterogeneity found in their obese patients. For instance, some patients show a relatively “normal” profile of metabolic risk factors despite the presence of substantial excess body fat, whereas others who are only moderately overweight can nevertheless be characterised by a whole cluster of metabolic complications, increasing the risk of type 2 diabetes, coronary atherosclerosis, and cardiovascular disease.

    View this table:

    Classification of obesity based on body mass index (BMI)2 3

    Summary points

    A simple measurement such as waist circumference can indicate accumulation of abdominal fat

    Viscerally obese men are characterised by an atherogenic plasma lipoprotein profile

    A triad of non-traditional markers for coronary heart disease found in viscerally obese middle aged men (hyperinsulinaemia, raised apolipoprotein B concentration, and small LDL particles) increases the risk of coronary heart disease 20-fold

    Four out of five middle aged men with a waist measurement ≥90 cm and triglyceride concentrations ≥2 mmol/l are characterised by this triad

    Even in the absence of hypercholesterolaemia, hyperglycaemia, or hypertension, obese patients could be at high risk of coronary heart disease if they have this “hypertriglyceridaemic waist” phenotype

    In this regard, epidemiological and metabolic studies …

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