ReviewThe Obesity Epidemic and Its Impact on Hypertension
Section snippets
The Global Epidemic and Burden of Obesity
Globally the prevalence of obesity has been steadily increasing over the past several decades. Data from over 9 million adults in 199 countries have indicated that the BMI increased by 0.4-0.5 per decade worldwide between 1980 and 2008.9 The dramatic rise in obesity rates globally is fueled by the increased availability of energy-dense diets, increasingly sedentary physical activity behaviours and, importantly, mass urbanization in emerging nations. The proportion of the world's population
Causal Link Between Obesity and Hypertension
Hypertension is the most common cardiovascular risk factor predisposing to CAD, stroke, and structural end organ damage.2 The link between obesity and hypertension has been documented in many large population and epidemiological studies in adults and the burden of hypertension attributable to obesity is very high in both men and women.7, 8 Population-based studies consistently demonstrate an increased risk in the development of hypertension among overweight and obese people. Compared with
Health Behaviour Management of Obesity-Related Hypertension in Adults
The cornerstone treatment of obesity-related hypertension is weight loss through health behavioural changes and reduced sodium intake in the diet. Weight loss diminishes both the augmented renin-angiotensin-aldosterone axis activity and the activation of the sympathetic nervous system. Reduction in body fat, especially from the visceral depot, improves insulin resistance and also promotes natriuresis. The general principle of weight loss is the achievement of a net negative energy balance. This
Pharmacotherapy for Obesity
Pharmacotherapy for obesity is considered as an adjunct when health behavioural changes fail to achieve the goal targets in BP and/or other metabolic comorbidities.1 Currently, orlistat is the only drug approved as a long-term weight loss medication. Orlistat is a gastrointestinal lipase inhibitor that reduces dietary fat absorption and fat calorie intake by approximately 30%.45 As expected, the common side effects include bloating, fecal incontinence, and abdominal cramps. After 4 years,
Bariatric Surgery
At present bariatric surgery is considered for individuals with class III obesity (BMI > 40) or class II obesity (BMI > 35) with comorbid conditions such as hypertension and type 2 diabetes.1 Bariatric surgery procedures can be classified as restrictive, malabsorptive, or combination of both restrictive and malabsorptive. Four types of bariatric procedures are now available in Canada.
Firstly, adjustable gastric banding is a restrictive procedure that involves the placement of an adjustable
Management of Obesity-Related Hypertension in Overweight and Obese Adolescents
Health behaviour modification remains the cornerstone for the treatment of overweight and obese adolescents with hypertension and related metabolic comorbidities. However, no consistent protocols are available on such interventions and few published randomized trials report on BP lowering. With a 1-year training program of physical activity, nutrition, and behaviour therapy, SBP and DBP were lowered by 7 and 2 mm Hg respectively.60 A shorter term study reported greater BP reduction by 14 and 9
Proposed Approaches to Tackle the Obesity Epidemic and Its Impact on Hypertension
The global pandemic of obesity can only be effectively reversed by dismantling the principal determinants of the obesogenic environment. Obesity is a serious public health concern and is a consequence of people responding normally to the obesogenic environment where more processed, energy-dense, affordable, and effectively marketed food are in abundant supply, in association with increasingly sedentary physical activity behaviours promoted by the built environment and urbanization. Undeniably
Disclosures
D.C.W.L. has received research funding, honoraria/consulting fees from Alberta Innovates-Health Solutions, Canadian Diabetes Association, Canadian Institutes of Health Research, Boehringer-Ingelheim, Bristol-Myers Squibb, Dainippon, Eli Lilly, Novo Nordisk, Pfizer, and Sanofi; honoraria/consulting fees from Abbott, Allergan, Amgen, Bayer, Merck, and Novartis; and peer-reviewed funding from Alberta Innovates-Health Solutions, Canadian Diabetes Association, and Canadian Institutes of Health
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