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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EObesity (body mass index =30 kg\/m2) is increasing globally and is now recognized as a major public health epidemic because of its association with precursors to cardiovascular complications, such as dyslipidemia, insulin resistance, and hypertension.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EObesity\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EPrevention \u0026amp; Screening\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EObesity (body mass index [BMI] \u226530 kg\/m\u003Csup\u003E2\u003C\/sup\u003E) is increasing globally and is now recognized as a major public health epidemic because of its association with precursors to cardiovascular (CV) complications, such as dyslipidemia, insulin resistance, and hypertension.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003ETwin and adoption studies have shown that \u226470% of the interindividual variance in fat mass is determined by genetic factors, said Professor Amaia Rodrigues Murueta-Goyena, PhD, Clinical Universida de Navarra, Madrid, Spain. Monogenic obesity, a single gene mutation, is extremely rare. Five genes that are linked to monogenic obesity have been associated with early onset obesity, as well as behavioral, developmental, and endocrine disorders. Thirteen genes that are linked to syndromic chromosomal disorders, also rare, have been associated with obesity, mental retardation, dysmorphic features, and organ-specific developmental abnormalities. More commonly, single nucleotide polymorphisms make an individual susceptible to environmental factors that promote energy consumption over energy expenditure. \u201cGenetic strategies can be useful tools to understand the complex molecular and physiologic mechanisms involved in the regulation of body weight,\u201d said Prof. Rodrigues Murueta-Goyena.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EProfessor Robert Ross, PhD, Queens University, Kingston, Ontario, Canada, discussed the relationship between waist circumference (WC) and BMI, noting that together they characterize a high-risk obesity phenotype for predicting cardiovascular disease (CVD) and diabetes. Although the measurement of BMI is well established, there is no clear measurement protocol for WC. World Health Organization and National Institutes of Health panels recommend protocols that use bony landmarks to guide measurement and that can be easily implemented by both the general public and primary care physicians. Prof. Ross concluded by saying, \u201cWe need to rethink our approach to CVD prevention\u201d The primary care physician needs to identify which patients are at high risk for developing CVD, and measuring WC and BMI is an important component in this process.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EProfessor Luc Van Gaal, MD, Antwerp University Hospital, Belgium, discussed the link between obesity and being overweight and other CVD risks, such as higher triglyceride and glucose levels and a higher incidence of the metabolic syndrome, noting that an association between excess abdominal fat and CV complications has been noted in diabetics.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EInsulin resistance, a core symptom of diabetes, is influenced by a number of bioactive mediators, such as leptin, resistin, and the cytokine TNF\u03b1, which are released by adipose tissue or body fat. Adipocytokines, derived from adipocytes, have a central role in the regulation of insulin resistance, as well as many aspects of inflammation and immunity. Recent research suggests that TNF\u03b1 may play a role in the development of insulin resistance, while high plasma levels of the adipocyte-specific secretory protein adiponectin have been associated with a lower risk of myocardial infarction in men.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EProfessor Nicholas Finer, MD, University College London, London, UK, presented data to counter the \u201cobesity paradox\u201d (ie, a higher BMI in people with established CVD is associated with a trend toward improved survival; \u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E), suggesting that studies that support the paradox may have been flawed, because body wasting, or cardiac cachexia, is a serious complication of congestive heart failure and may have contributed to involuntary weight loss. He said that there is no clear evidence that marked obesity (BMI \u0026gt;35 kg\/m\u003Csup\u003E2\u003C\/sup\u003E) has a protective effect and that BMI is a poor indicator of total body fat, because body weight is affected by fluid retention. Prof. Finer presented data that showed that weight reduction of as little as 5% improved CV risk, prevented type 2 diabetes, improved quality of life, and improved mechanical symptoms (eg, knee osteoarthritis) and that a \u0026gt;10% reduction in weight improved sleep apnea and lung function in patients with asthma and decreased mortality rate.\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/9\/4\/34\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Is There a Mortality Paradox?\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-42989133\u0022 data-figure-caption=\u0022Is There a Mortality Paradox?\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/9\/4\/34\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/9\/4\/34\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/9\/4\/34\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11404\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-8\u0022 class=\u0022first-child\u0022\u003EIs There a Mortality Paradox?\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EReproduced with permission by N. Finer.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-9\u0022\u003EEarly results from the SCOUT (Sibutramine Cardiovascular OUTcomes) trial active run-in period showed significant benefits (p\u0026lt;0.001) for antiobesity drugs in hypertensive patients. Not only were body weight and WC reduced but systolic blood pressure dropped by a mean of 3.0 mm Hg and diastolic fell by 1.0 mm Hg. Effective weight loss is also achievable with bariatric surgery. After surgery, long-term total mortality is significantly reduced, particularly deaths from diabetes, heart disease, and cancer.\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EProf. Finer concluded that active weight management should be a core component of CV management.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2009 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/9\/4\/34.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzmjhp\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzmjhp\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}