Racial Disparities in Obesity Treatment Byrd, Angel S.; Toth, Alexander T.; Stanford, Fatima Cody
Current obesity reports,
06/2018, Volume:
7, Issue:
2
Journal Article
Peer reviewed
Open access
Purpose of Review
Obesity rates in the USA have reached pandemic levels with one third of the population with obesity in 2015–2016 (39.8% of adults and 18.5% of youth). It is a major public health ...concern, and it is prudent to understand the factors which contribute. Racial and ethnic disparities are pronounced in both the prevalence and treatment of obesity and must be addressed in the efforts to combat obesity.
Recent Findings
Disparities in prevalence of obesity in racial/ethnic minorities are apparent as early as the preschool years and factors including genetics, diet, physical activity, psychological factors, stress, income, and discrimination, among others, must be taken into consideration. A multidisciplinary team optimizes lifestyle and behavioral interventions, pharmacologic therapy, and access to bariatric surgery to develop the most beneficial and equitable treatment plans.
Summary
The reviewed studies outline disparities that exist and the impact that race/ethnicity have on disease prevalence and treatment response. Higher prevalence and reduced treatment response to lifestyle, behavior, pharmacotherapy, and surgery, are observed in racial and ethnic minorities. Increased research, diagnosis, and access to treatment in the pediatric and adult populations of racial and ethnic minorities are proposed to combat the burgeoning obesity epidemic and to prevent increasing disparity.
Obesity and the Obesity Paradox in Heart Failure Horwich, Tamara B.; Fonarow, Gregg C.; Clark, Adrienne L.
Progress in cardiovascular diseases,
July-August 2018, 2018 Jul - Aug, 2018-07-00, Volume:
61, Issue:
2
Journal Article
Peer reviewed
Obesity continues to be a public health problem in the general population, and also significantly increases the risk for the development of new-onset heart failure (HF). However, in patients with ...already-established, chronic HF, overweight and mild to moderate obesity is associated with substantially improved survival compared to normal weight patients; this has been termed the “obesity paradox”. The majority of studies measure obesity by body mass index, but studies utilizing less-frequently used measures of body fat and body composition, including waist circumference, waist-hip ratio, skinfold estimates, and bioelectrical impedance analysis also confirm the obesity paradox in HF. Other areas of investigation such as the relationship of the obesity paradox to cardiorespiratory fitness, gender, and race are also discussed. Finally, this review explores various explanations for the obesity paradox, and summarizes the current evidence for intentional weight loss treatments for HF in context.
Obesity Statistics Smith, Kristy Breuhl; Smith, Michael Seth
Primary care,
03/2016, Volume:
43, Issue:
1
Journal Article
Peer reviewed
Obesity is a chronic disease that is strongly associated with an increase in mortality and morbidity including, certain types of cancer, cardiovascular disease, disability, diabetes mellitus, ...hypertension, osteoarthritis, and stroke. In adults, overweight is defined as a body mass index (BMI) of 25 kg/m(2) to 29 kg/m(2) and obesity as a BMI of greater than 30 kg/m(2). If current trends continue, it is estimated that, by the year 2030, 38% of the world's adult population will be overweight and another 20% obese. Significant global health strategies must reduce the morbidity and mortality associated with the obesity epidemic.
Obesity increases a number of cardiovascular disease (CVD) risk factors, but patients with many types of CVD may have a better prognosis if classified as overweight or obese, a phenomenon known as ...the “obesity paradox”. This paradoxical benefit of a medically unfavorable phenotype is particularly strong in the overweight and class I obesity, and less pronounced in the more severe or morbidly obese populations (class II–III and greater). Rather than an obesity paradox, it is possible that this phenomenon may represent a “lean paradox”, in which individuals classified as normal weight or underweight may have a poorer prognosis with respect to CVD, as a result of a progressive catabolic state and lean mass loss.
Cardiorespiratory fitness (CRF) is a fundamental part of this discussion. A greater CRF is associated with lower CVD risk, regardless of body mass index (BMI). Also, the assessment of body composition compartments (i.e., fat mass, fat-free mass, lean mass) and the presence of metabolic derangements may be better indicators of CVD risk than BMI alone.
The focus of this review is to summarize the current evidence of the obesity paradox. Moreover, we discuss the utility and limitations of BMI for cardiometabolic risk stratification, in addition to concepts such as “metabolically healthy obesity” (MHO) and the “fat but fit” phenomenon, which describe patients who are diagnosed with obesity using BMI, but without major metabolic derangements and with greater CRF, respectively. Finally, we propose that obese patients presenting with an excess body fat, yet without metabolic abnormalities, should still be viewed as an “at risk” population, and as such should receive advice to change their lifestyle to improve their CRF and to prevent the development of impaired fasting glucose, diabetes mellitus and other CVD risk factors as a form of primary prevention.
•The obesity paradox seems strongest in those who are overweight or mildly (class I) obese.•Many unfavorable physiologic and hemodynamic changes associated with obesity are reversible with weight loss.•CRF is a better predictor of CVD outcomes and independently reduces mortality, regardless of BMI.•"Metabolically healthy" obese patients should be treated as an "at risk" population to prevent development of CVD.
Introduction A decreased ventilatory response to hypoxia and hypercapnia is a common finding in patients with obesity hypoventilation syndrome (OHS). We aimed to test the hypothesis that exercise ...ventilatory response is also damaged in OHS patients. Methods Eleven patients with OHS, twenty-three obese patients with moderate-to-severe OSA and twenty obesity subjects without OSA performed incremental cycle exercise. Oxygen consumption (VO2), ventilation (VE), ventilatory equivalents for oxygen (VE/VO2) and carbon dioxide (VE/VCO2), as well as slope of VE/VO2 and VE/VCO2 were measured. Results The VO2 response to exercise was comparable among the three groups. The slope, the nadir as well as end-exercise of VE/VCO2 and VE/VO2 were not significantly different among the three groups. Conclusion Ventilatory response to exercise testing is preserved in patients with OHS. This may reflect different ventilatory regulation mechanisms during sleep and exercise for patients with OHS. Support (If Any)
Obesity is a major risk factor for many leading causes of illness and death worldwide. Data are needed regarding the efficacy and safety of the nonpeptide glucagon-like peptide-1 (GLP-1) receptor ...agonist orforglipron as a once-daily oral therapy for weight reduction in adults with obesity.
In this phase 2, randomized, double-blind trial, we enrolled adults with obesity, or with overweight plus at least one weight-related coexisting condition, and without diabetes. Participants were randomly assigned to receive orforglipron at one of four doses (12, 24, 36, or 45 mg) or placebo once daily for 36 weeks. The percentage change from baseline in body weight was assessed at week 26 (primary end point) and at week 36 (secondary end point).
A total of 272 participants underwent randomization. At baseline, the mean body weight was 108.7 kg, and the mean body-mass index (the weight in kilograms divided by the square of the height in meters) was 37.9. At week 26, the mean change from baseline in body weight ranged from -8.6% to -12.6% across the orforglipron dose cohorts and was -2.0% in the placebo group. At week 36, the mean change ranged from -9.4% to -14.7% with orforglipron and was -2.3% with placebo. A weight reduction of at least 10% by week 36 occurred in 46 to 75% of the participants who received orforglipron, as compared with 9% who received placebo. The use of orforglipron led to improvement in all prespecified weight-related and cardiometabolic measures. The most common adverse events reported with orforglipron were gastrointestinal events, which were mild to moderate, occurred primarily during dose escalation, and led to discontinuation of orforglipron in 10 to 17% of participants across dose cohorts. The safety profile of orforglipron was consistent with that of the GLP-1 receptor agonist class.
Daily oral orforglipron, a nonpeptide GLP-1 receptor agonist, was associated with weight reduction. Adverse events reported with orforglipron were similar to those with injectable GLP-1 receptor agonists. (Funded by Eli Lilly; GZGI ClinicalTrials.gov number, NCT05051579.).
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