Exercise and Healthy Diet for Management of Abdominal Obesity

Toni Rizzo

doi:10.1177/155989771316013

Summary

This article discusses physical activity in the management of abdominal obesity, as well as the targeting cardiometabolic risk and biologic risk in cardiovascular disease.

Obesity
Prevention & Screening
Cardiometabolic Disorder

Obesity
Endocrinology
Diabetes & Metabolic Syndrome
Prevention & Screening
Cardiometabolic Disorder

PHYSICAL ACTIVITY IN THE MANAGEMENT OF ABDOMINAL OBESITY

Robert Ross, PhD, Queen's University, Kingston, Ontario, Canada, studied the effects of diet or exercise with or without weight loss on abdominal obesity and insulin resistance [Ross R et al. Ann Intern Med 2000; Ross R et al. Obes Res 2004]. Obese men and women who exercised and lost weight had the greatest reductions in abdominal and visceral fat. There was no difference in fat reduction between those who dieted with weight loss or exercised without weight loss; however, both groups had significant fat reduction compared with controls. More recently, modest reductions in waist circumference in abdominally obese men, but not in women, were observed in a randomized trial on behavioral, lifestyle-based intervention in clinical settings [Ross R et al. Arch Intern Med 2012].

Several studies provided insight into the comparative benefits of various types of exercise. A recent study showed that individuals who exercise without weight loss have decreased abdominal and visceral fat and waist circumference, increased skeletal muscle mass and cardiorespiratory fitness, and decreased blood pressure [Ross R, Bradshaw AI. Nature Rev Endocrinol 2009]. In a study comparing exercise modalities, aerobic exercise and combined aerobic and resistance exercise significantly improved insulin sensitivity but resistance exercise alone did not [Davidson LE et al. Arch Intern Med 2009]. Exercise that had both resistance and aerobic components was optimal (p<0.001 versus resistance exercise alone). A recent meta-analysis provided additional support for the benefits of aerobic exercise concluding that visceral fat was significantly reduced with aerobic but not resistance exercise (p<0.01) [Ismail I et al. Obes Rev 2012].

Individuals who exercise and lose weight gain the greatest benefits in terms of improved fitness and insulin sensitivity. Aerobic plus resistance exercise provides the greatest fat loss and skeletal muscle increases.

TARGETING CARDIOMETABOLIC RISK IN CLINICAL PRACTICE

According to lean-Pierre Després, PhD, Université Laval, Québec City, Québec, Canada, targeting health behaviors is at least as important as targeting biologic risk factors for CVD. Visceral adiposity and ectopic fat are key risk factors for the development of cardiovascular disease (CVD). Levesque, Després, and colleagues of Université Laval found that a 1-year lifestyle modification program in men undergoing coronary artery bypass graft surgery decreased visceral and intrathoracic adipose tissue volumes and improved glucose and insulin homeostasis, cardiorespiratory fitness, and cardiometabolic risk profile.

In another study conducted at the workplace, a total of 2399 employees participated in the Grand Défi Entreprise (GDE). The employees were challenged to eat better, stop smoking, and be more active. The key findings of this 3-month pilot intervention included reductions in mean waist circumference (−4.2 cm; p<0.0001), resting blood pressure (SBP, −6 mm Hg; DBP, −4 mm Hg), heart rate (−2 beats per minute; p<0.0001 for all), mean plasma lipid levels (p<0.0001) and increased mean estimated VO₂max (+1.4 mL/kg/minute; p<0.01). Carriers of hypertriglyceridemic waist (marker of visceral obesity) decreased by 34%. The proportion of employees with prediabetes decreased from 51.5% to 48.0% and healthy employees increased from 43.5% to 47.0%. HbAlC levels decreased in employees with prediabetes (−0.1%), untreated diabetes (−0.7%), and treated diabetes (−0.7%).

Prof. Després concluded that behaviors, rather than weight, should be targeted for the prevention and treatment of obesity, diabetes, and CVD. A lifestyle modification program with regular physical activity and healthy diet is key to reducing cardiometabolic risk. Achieving lifestyle therapeutic targets results in increased cardiorespiratory fitness and decreased visceral adipose tissue and ectopic fat depots, which improves the cardiometabolic risk profile and reduces CV risk.

The editors would like to thank the many members of the International Congress on Abdominal Obesity presenting faculty who generously gave their time to ensure the accuracy and quality of the articles in this publication.

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