Long-term effects of non-surgical therapy for obesity on cardiovascular risk management: A weighted empirical review

Weight loss affects cardiovascular risk profiles in obese patients. Surgery is not a plausible or viable response to the public health problem of obesity, given that more than 30% of adults are obese in some countries. However, most studies investigating the effects of weight loss on the cardiovascular risk profile are focussed on weight loss and limited to short-term effects. Since newer data show a rebound of cardiovascular risks in studies that complete a short-term follow-up, the question arises whether, and to what extent, long-term treatments offer a more sustained cardiovascular benefit beside the extensive or less marked weight loss. Aims: The purpose of this article is to critically review existing data on the long-term cardiovascular effects of weight loss in obese and overweight patients treated with dietary interventions, physical activity programmes, behavioural therapy and pharmacological treatments and their combination. Method: Inclusion criteria were peer-reviewed, randomized controlled trials (RCT) in the English language which presented data on cardiovascular effects at a follow-up of at least 18 months during or after weight reduction interventions. The search was limited to adults and the publication years between 1990 and 2007. Studies of patients with diagnoses such as coronary heart disease and cancer, and medically treated diabetes and hypertension were excluded. Results: Twenty-three studies measured cardiovascular risk factors after 18 months or more. Mean BMI was 33.9 kg/m2 including 13,733 patients. Mean duration of the studies was 37 months with a dropout rate of 16.1% on average. Regardless of the absolute amount of weight loss a positive effect on cardiovascular risk factors such as blood pressure, lipids and glucose tolerance was found. © 2007 Springer-Verlag.