Obesity in coronary heart disease: An unaddressed behavioral risk factor

Abstract

Obesity is an independent risk factor for the development and progression of coronary heart disease (CHD). Over 80% of patients with CHD are overweight or obese. While obesity is often considered a relatively “minor” CHD risk factor, weight loss is a broadly effective risk-factor intervention. Weight loss can profoundly influence a number of “major” risk factors including: hypertension, dyslipidemia and insulin resistance/type 2 diabetes mellitus. Despite its prominence as a risk factor most cardiac rehabilitation (CR) programs do not have a specific, targeted intervention to assist patients with weight loss. Consequently, the weight loss that occurs during CR is quite small and unlikely to appreciably alter risk factors. Relying on CR associated exercise as a sole intervention is an ineffective strategy to promote weight loss. There is evidence, however, that behavioral weight loss (BWL) interventions can be effectively employed in the CR setting. In contrast to programs that do not offer a targeted intervention, studies show that participants in CR-related BWL programs lose significantly more weight. The additional weight loss from the BWL intervention is associated with greater improvements in insulin sensitivity and other components of the metabolic syndrome such as hypertension and lipid abnormalities. As a means of maximizing CHD risk factor reduction CR programs need to incorporate BWL programs as a standard programming for overweight/obese patients.

Weight management telehealth intervention for overweight and obese rural cardiac rehabilitation participants: A randomised trial

“…A weight loss of 5%-10% weight loss is necessary to achieve clinically significant CVD risk reduction (Ades et al, 2010;Manzoni et al, 2011;Wing et al, 2011). However, typically weight loss interventions are not included in CR (Ades & Savage, 2017;Ades et al, 2010). Although CR participants receive standard nutritional consultations, they are not specific to behavioural weight loss intervention.…”

“…Typically, CR participants only lose ≤2% of their body weight (Ades & Savage, 2017). These small weight losses are not usually sustained after CR (Magalhaes et al, 2013).…”

“…Although CR participants receive standard nutritional consultations, they are not specific to behavioural weight loss intervention. Typically, CR participants only lose ≤2% of their body weight (Ades & Savage, ). These small weight losses are not usually sustained after CR (Magalhaes et al, ).…”

Editorial for the special issue on behavior change, health, and health disparities 2017

“…There is growing recognition of the need to attend to these conditions as part of effective treatment for a wide variety of medical conditions. To address this important development, we invited contributions underscoring the importance of obesity as an unaddressed risk factor for coronary heart disease and the place of weight loss in effective rehabilitation from a cardiac event (Ades and Savage, 2017, in this issue), in the prevention and treatment of type-2 diabetes (Delahanty, 2017, in this issue), as a component of treating advanced cancer (Dittus et al, 2017, in this issue), and in efforts to prevent greater-than-recommended gestational weight gain and the serious adverse impacts of maternal obesity on perinatal outcomes (Phillips and Higgins, 2017, in this issue).…”

Study of Weight Loss Parameters Among Sedentary, Overweight Postmenopausal Females Using Different Time Models of Aquafit

“…Excessive weight is raised throughout the world and more than 80% of patients with coronary heart disease (CHD) suffer from it (1). Weight reduction is "broadly effective" risk factor intervention (1), and physical exercise is defined as a necessary component of the behavioral program in losing weight (2)(3)(4). Some researchers also believe that the risk factors of CHD in people with overweight depend on exercise-induced weight loss (5,6).…”