Weight loss through lifestyle changes: Impact in the primary prevention of cardiovascular diseases

Obesity, a chronic disease that develops from an interaction between genotype and environment, has already reached global epidemic proportions. From 1980 to 2015, the prevalence of overweight globally increased almost 50% (from 26.5% to 39.0%) and that of obesity around 80% (from 7% to 12.5%).1 The American and the European regions have the highest rates, but increasing prevalence has been reported across all regions, in both sexes and at all ages.1 Having a higher than a healthy body weight is associated with increased mortality and morbidity.2 3 Most chronic conditions and diseases, such as cancer, kidney disease, osteoarthritis, sleep apnoea, diabetes, non-alcoholic fatty liver disease, hypertension and cardiovascular disease (CVD), have been directly related to obesity. For years, the CVD risk associated with obesity had been attributed to the high positive correlation between obesity and several metabolic risk factors, like blood pressure, triglycerides, low-density lipoprotein cholesterol (LDL-C), glucose and insulin levels. During the past decades, an independent impact of obesity on CVD risk has been recognised. It has been suggested that for every 1% above healthy body mass index (BMI) values the risk for CVD increases by approximately 4% in both men and women.4 However, obesity is not always accompanied with metabolic abnormalities, but there is a lot of debate on the prognostic value of this ‘metabolically healthy obesity’ and whether it is a transient condition before the establishment of unhealthy cardiometabolic factors.5 6