The rising prevalence of obesity in the United States has been linked to an increased risk of cardiovascular disease as well as poor outcomes in obese patients. Central obesity — defined as a waist circumference of 40 inches (102 centimeters) or more in men and 35 inches (88 centimeters) or more in women — in particular has been associated with increased cardiovascular risk.
Most patients are unable to lose weight and successfully maintain weight loss. A recent study by cardiologists at Mayo Clinic in Rochester, Minn., and published in the November 2010 issue of the American Heart Journal revealed that physician diagnosis of obesity was a significant predictor of both attempts and success at weight loss.
In a review of National Health and Nutrition Examination Survey data compiled between 1999 and 2004, demographic, motivational and clinical factors were examined using multivariable logistic regression. "Most of these patients were aware of the fact that they were overweight and wanted to lose weight," says Francisco Lopez-Jimenez, M.D., a cardiologist and one of the study's authors. "Identification of weight loss as a specific treatment goal by the patient's physician was the most important predictor of successful weight loss."
The study also found that there was poor documentation of implementation of an obesity management plan in obese cardiovascular patients. "The recognized role of obesity in the development of hypertension, diabetes mellitus and hyperlipidemia makes it imperative for obese patients to lose weight, especially if they already have established coronary artery disease," notes Dr. Lopez-Jimenez.
Clinicians' understanding of the cultural, genetic and personal motivational factors in play in the development of obesity and their role in successful weight loss is incomplete. This study, however, underscores the important role of the physician in helping patients identify and achieve weight-loss goals.