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. 2001 Mar 24;322(7288):716-20.
doi: 10.1136/bmj.322.7288.716.

Treatment of obesity: need to focus on high risk abdominally obese patients

J P Després  1 , I Lemieux, D Prud'homme
Affiliations

Treatment of obesity: need to focus on high risk abdominally obese patients

J P Després et al. BMJ. .
No abstract available

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Figures

Figure 1
Figure 1
Assessment of accumulation of abdominal fat by measurement of waist at mid-distance between bottom of rib cage and iliac crest. Amount of visceral adipose tissue that can be assessed by computed tomography can be estimated by waist measurement (adapted from Pouliot et al9)
Figure 2
Figure 2
Misleading information provided by follow up of changes in waist:hip ratio in woman followed over 20 years. Simultaneous increase in waist and hip measurements means ratio is stable over time despite considerable accumulation of visceral adipose tissue, which would have been predicted from 20 cm increase in waist observed over time. Thus, waist circumference provides crude index of absolute amount of abdominal adipose tissue whereas waist:hip ratio provides index of relative accumulation of abdominal fat
Figure 3
Figure 3
Schematic example of how “normal” concentration of low density lipoprotein cholesterol could mislead assessment of risk of coronary heart disease in abdominally obese patients. Even when concentrations of low density lipoprotein cholesterol are the same, abdominally obese patients have increased proportions of smaller low density lipoprotein particles that are relatively depleted in cholesterol (esterified cholesterol). However, as there is one apolipoprotein B (apo B) molecule per low density lipoprotein particle, increased concentration of these atherogenic lipoproteins can be detected by measuring apolipoprotein B, which is about 25% higher among abdominally obese people. Presence of increased concentration of these small low density lipoprotein particles predicts substantially increased risk of coronary heart disease in middle aged men
Figure 4
Figure 4
Potential benefits of moderate (5-10%) weight loss in high risk patients with cluster of atherothrombotic, pro-inflammatory metabolic abnormalities associated with hypertriglyceridaemic waist. Weight loss in abdominally obese patients is associated with selective mobilisation of diabetogenic and atherogenic visceral adipose tissue, even 5-10% weight loss is associated with preferential mobilisation of visceral adipose tissue, leading to simultaneous improvement in all metabolic markers of coronary heart disease risk. Thus simultaneous metabolic improvements associated with mobilisation of visceral adipose tissue may contribute substantially to reduced risk of acute coronary event in high risk patients
Figure 5
Figure 5
Contribution of abdominal obesity (increased waist measurement) as therapeutic target for better management of risk of coronary heart disease
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