Obesity management in cardiovascular disease – a view from primary care

Overweight and obesity affect around half of the UK population, and are a serious public health problem. Obesity is associated with hypertension, dyslipidaemia, type 2 diabetes and a sedentary lifestyle, and has been shown to be an independent risk factor for development of cardiovascular disease. There are characteristic structural changes of the heart and vasculature in obesity. There is strong evidence that even modest weight reduction lowers cardiovascular risk. Dietary intervention, lifestyle advice and increased exercise are the initial strategy, but selected patients will require adjunctive treatment with anti-obesity drugs. In the absence of contraindications, orlistat is appropriate to use in obese patients with established cardiovascular disease, though sibutramine use is contraindicated in this population. Surgical intervention, such as gastric restrictive procedures, may be needed in severe obesity but there is a high complication rate among the morbidly obese and particularly in those who are also diabetic.