Managing CMR

Managing Cardiometabolic Risk in Abdominally Obese Patients

Despite evidence that intra-abdominal (visceral) obesity is the most dangerous form of obesity, no study has shown that reducing intra-abdominal adipose tissue reduces the risk of coronary heart disease (CHD) and type 2 diabetes. However, the data available suggests that, regardless of the therapy used (diet, exercise, pharmacotherapy), intra-abdominal fat generally decreases when patients with large amounts of this fat lose weight. Although randomized trials with hard endpoints are required to test this hypothesis, a selective reduction of intra-abdominal fat has been shown to improve metabolic markers, lowering the risk of type 2 diabetes and CHD.

Studies have shown that making dietary changes and limiting calorie intake can induce weight loss. The challenge now is to use this knowledge in clinical practice. Most physicians have limited access to additional nutritional expertise to help them reshape the nutritional habits of their patients. The same applies to reshaping exercise habits and prescribing physical activities. Although many studies have shown that regular exercise has a beneficial effect on numerous type 2 diabetes and cardiovascular disease risk factors, few studies have addressed how primary care physicians can implement a lifestyle modification program in the context of a busy clinical practice. However, trials such as the Finnish Diabetes Prevention Study and the American Diabetes Prevention Program have both demonstrated the relevance and value of a lifestyle modification program intended to turn sedentary, abdominally obese, and glucose-intolerant subjects (who are at high risk of type 2 diabetes) into physically active individuals with better nutritional habits. But to successfully lower the risk of diabetes, physicians must be able to refer patients to a multidisciplinary team of dietitians, exercise physiologists, and behaviourists. The move from theory to practice must be made to support patients in their attempts to improve their lifestyle. Providing a supportive, professional environment will enhance the effect of weight loss pharmacotherapy and optimize improvements to cardiometabolic risk factors/markers.