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Review
. 2008 Sep;24 Suppl D(Suppl D):25D-31D.
doi: 10.1016/s0828-282x(08)71046-8.

Is weight loss the optimal target for obesity-related cardiovascular disease risk reduction?

Robert Ross  1 , Peter M Janiszewski
Affiliations
Review

Is weight loss the optimal target for obesity-related cardiovascular disease risk reduction?

Robert Ross et al. Can J Cardiol. 2008 Sep.

Abstract
in English, French

In the present review, it is argued that while weight loss is associated with substantial reduction in obesity-related cardiovascular disease risk and remains a desired outcome of relevant treatment strategies, increasing physical activity is associated with marked reduction in waist circumference, visceral fat and cardiometabolic risk factors, concurrent with an increase in cardiorespiratory fitness despite minimal or no change in body weight. Failure to recognize the benefits of exercise independent of weight loss masks opportunities to counsel and educate patients whose sole criteria for gauging obesity reduction success is the bathroom scale.

Dans la présente analyse, on postule que même si la perte de poids s’associe à une importante réduction du risque de maladie cardiovasculaire reliée à l’obésité et qu’elle demeure une issue souhaitée des stratégies de traitement pertinentes, l’accroissement de l’activité physique s’associe à une diminution marquée du tour de taille, de la graisse viscérale et des facteurs de risque cardiométaboliques, conjointement avec une augmentation de la capacité aérobique, malgré une perte de poids minime ou même l’absence de perte de poids. Le fait de ne pas reconnaître les bienfaits de l’exercice qui n’entraîne pas de perte de poids enlève la possibilité de conseiller et d’éduquer les patients qui se fient seulement au pèse-personne pour évaluer la réussite de leur réduction d’obésité.

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Figures

Figure 1)
Figure 1)
Relationship between changes in body weight and waist circumference (WC). A Data are taken from prior publications (14,15,71,72) and illustrate the relationship between change in weight (kg) and change in WC (cm) in a sample of 105 men and women combined. B Based on the same subjects in Panel A, the data were separated into tertiles of weight reduction (<6.1 kg, 6.2 kg to 9.8 kg, and 9.9 kg to 20.7 kg). Each tertile of weight and WC reduction was significantly different from the other two tertiles (P<0.05)
Figure 2)
Figure 2)
Disassociation between changes in body weight, body composition and health risk. Individual body composition change data are shown for a sample of 20 obese men who participated in studies designed to reduce obesity by increasing exercise without changing caloric intake (14). AT Adipose tissue; CRF Cardiorespiratory fitness; LT Lean tissue; WC Waist circumference; WL Weight loss
Figure 3)
Figure 3)
Favourable effects of physical activity on obesity-related health risk: three possible scenarios. The scenarios presented represent three possible outcomes when increasing physical activity combined with a balanced (healthful) diet for the purpose of reducing obesity and related comorbid conditions. BMI Body mass index; CRF Cardiorespiratory fitness; WC Waist circumference
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