Overweight and Obesity – Risk Status. Assessment of a patient’s absolute risk status requires examination for the presence of:
Disease conditions: established coronary heart disease (CHD), other atherosclerotic diseases, type 2 diabetes, and sleep apnea; patients with these conditions are classified as being at very high risk for disease complications and mortality.
Other obesity-associated diseases: gynecological abnormalities, osteoarthritis, gallstones and their complications, and stress incontinence.
Cardiovascular risk factors: cigarette smoking, hypertension (systolic blood pressure ³ 140 mm Hg or diastolic blood pressure ³ 90 mm Hg, or the patient is taking antihypertensive agents), high-risk LDL-cholesterol (³ 160 mg/dL), low HDL-cholesterol (< 35 mg/dL), impaired fasting glucose (fasting plasma glucose of 110 to 125 mg/dL), family history of premature CHD (definite myocardial infarction or sudden death at or before 55 years of age in father or other male first-degree relative, or at or before 65 years of age in mother or other female first-degree relative), and age (men ³ 45 years and women ³ 55 years or postmenopausal). Patients can be classified as being at high absolute risk if they have three of the aforementioned risk factors. Patients at high absolute risk usually require clinical management of risk factors to reduce risk.
Patients who are overweight or obese often have other cardiovascular risk factors. Methods for estimating absolute risk status for
developing cardiovascular disease based on these risk factors are described in detail in the National Cholesterol Education Program’s Second Report of the Expert Panel on the Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (NCEP’s ATP II) and the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI). The intensity of intervention for cholesterol disorders or hypertension is adjusted according to the absolute risk status estimated from multiple risk correlates. These include both the risk factors listed above and evidence of end-organ damage present in hypertensive patients. Approaches to therapy for cholesterol disorders and hypertension are described in ATP II and JNC VI, respectively. In overweight patients, control of cardiovascular risk factors deserves equal emphasis as weight reduction therapy. Reduction of risk factors will reduce the risk for cardiovascular disease whether or not efforts at weight loss are successful.
Other risk factors: physical inactivity and high serum triglycerides (> 200 mg/dL). When these factors are present, patients can be considered to have incremental absolute risk above that estimated from the preceding risk factors. Quantitative risk contribution is not available for these risk factors, but their presence heightens the need for weight reduction in obese persons.