Review: Implications of obesity for diabetes and coronary heart disease in clinical practice

Abstract

Obesity is a powerful risk factor for both type 2 diabetes and for coronary heart disease (CHD). The prevalence of obesity has risen rapidly in most populations across the world, in both developing and developed countries, and as a result the prevalence of type 2 diabetes and CHD is rising. In patients with established type 2 diabetes or CHD, obesity is also a clinical problem. Weight loss has been shown clearly to improve glycaemic control in overweight patients with type 2 diabetes, yet the present approach to management pays little attention to this. Similarly, weight loss in overweight patients with established CHD improves risk factors, and reduces symptoms of angina and fatigue. At the public health level, an active approach to obesity prevention would reap substantial rewards in terms of reducing future prevalence of diabetes and CHD. Recent investigations have shown that sustained weight loss of just 3—4 kg in overweight individuals with impaired glucose tolerance resulted in 58% risk reduction for diabetes at four years. Prevention and management should therefore play a far greater role in treating overweight and obese individuals, preferably before diabetes or CHD are manifest.