International Task Force for Prevention of
Coronary Heart Disease

CORONARY HEART DISEASE: REDUCING THE RISK

3.2 Management of overweight and obesity

Overweight and obesity (see section 2.2.1, Body weight) and their body distribution strongly increase the risk of cardiovascular disease, and also increase the incidence and severity of such cardiovascular risk factors as lipid and lipoprotein disorders, hypertension and diabetes mellitus. Recognition of obesity and its distribution identifies a therapeutic opportunity, in that reduction of overweight is an important means of controlling these risk factors.

Central obesity is of paramount importance. An excessive waist:hip ratio is important even if body weight is normal, as defined in Table 1. To assist compliance, the patient is involved from the outset in deciding on the goals of treatment. She/he should have realistic expectations. For example the expected weight loss will average 0.5 kg/week, or at most 1 kg/week; a partial but achievable target weight loss is better than an unrealistic aim of normal body weight. The rate of weight loss is likely to vary from week to week.
The most critical component of a weight-reducing regimen is energy (caloric) restriction.
Waist:hip ratios exceeding 1.0 in men and 0.85 in women are taken as criteria for the presence of central obesity. Another criterion, regarded by some as the best index of the quantity of intra-abdominal adipose tissue, is the trunk circumference, but this has been less fully investigated as yet.

The physician and allied health professionals have an ongoing role in generating and sustaining motivation. The physician should be encouraging, patient and enthusiastic. She or he advises a combination of an exercise programme and a diet, and emphasizies from the start that some elements of this change in lifestyle need to be life-long in order to avoid relapse. He/she should be encouraging, patient and enthusiastic. However, it needs to be recognised that obesity is a highly stubborn condition which does not easily yield to treatment at the individual level. Advice on physical exercise is discussed in Section 3.3 (Physical exercise) and should aim at long duration of exercise rather than high intensity. An example of a weight reducing diet is given in Section 3.4.4 (Calorie-restricted lipid-lowering diet).

The physician and allied health professionals have an ongoing role in aiding motivation, and should underline the developing health benefits and subjective improvement during weight loss.

The benefits of weight reduction are spelled out:
short-term

• improved ability to engage in physical activity,
• improved appearance and self esteem.

• longer life span,
• lower cholesterol and triglyceride,
• higher HDL-cholesterol (after completion of weight loss),
• lower blood pressure,
• lower risk of diabetes, better glucose tolerance,
• lower risk of certain cancers, of accidents, of chronic lung disease,
• possible reduction in osteoarthritis of the knee.

The reducing diet includes a considerably-restricted intake of

• alcohol (in the first place), due to its high caloric value, and its effects in increasing appetite and in decreasing self control,
• all fats and oils,
• and sugar.

Green vegetables are eaten freely and and a moderate intake of fresh fruit is allowed. By ensuring a high intake of foods of very low energy content, the patient's satiety is maintained - examples are consommé, grapefruit, leafy vegetables, tomatoes, peppers (capsicum), carrots, celery, broccoli, oranges and apples.