Obesity management interventions delivered in primary care for patients with hypertension or cardiovascular disease : a review of clinical effectiveness

Because weight loss interventions can be associated with reduced intake of essential nutrients as well as loss of muscle and bone mass, it is important to evaluate strategies for ability to induce desired changes without detrimental impact on vitamins and bone metabolism, and to determine the suitab...

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Corporate Author: Canadian Agency for Drugs and Technologies in Health
Format: eBook
Language:English
Published: Ottawa (ON) Canadian Agency for Drugs and Technologies in Health 2014, 2014
Series:Rapid response report: summary with critical appraisal
Subjects:
Online Access:
Collection: National Center for Biotechnology Information - Collection details see MPG.ReNa
Summary:Because weight loss interventions can be associated with reduced intake of essential nutrients as well as loss of muscle and bone mass, it is important to evaluate strategies for ability to induce desired changes without detrimental impact on vitamins and bone metabolism, and to determine the suitability of available options to targeted patients. The aim of this report is to provide current evidence on the clinical effectiveness of various obesity management interventions that could be used in primary care settings to halt or slow the progression of hypertension or CVD.
The first-line strategy for the treatment of obesity and prevention of cardiometabolic disease is achieving weight loss. Lifestyle measures, which consist of reductions in caloric intake by between 500 to 1000 calories per day, together with increases in physical activity and changes in health behaviors, are the cornerstone of prevention and treatment of obesity. However, maintenance of behavioral changes associated with weight loss can be challenging and short-term improvements commonly fail to be translated into long-term behavioral maintenance. Therefore, adding anti-obesity drugs in obese patients who do not achieve sufficient weight loss or who find it difficult to maintain initial weight loss after lifestyle modifications may be a good strategy for patients who can safely use them.
Though weight loss associated with PA may be minimal compared with interventions that combine reduced caloric intake with exercises, PA has demonstrated favorable changes in body composition, and increased PA is recommended for weight loss maintenance. In view of the abundance of evidence supporting health benefits associated with weight loss, The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC 7) recommends that lifestyle modifications such as weight loss and regular aerobic exercise as part of the initial treatment strategy for lowering high blood pressure. In this respect, the Dietary Approaches to Stop Hypertension (DASH) diet, which is rich in fiber, fruits, vegetables and low-fat dairy products, and low in fat has been recommended by JNC.
It has been shown in hypertension treatment trials that weight loss, whether alone or in combination with antihypertensive drugs, has a beneficial effect on blood pressure control and heart rate and may therefore have a role in the management of hypertension in overweight and obese patients. Weight loss has also been found to ameliorate several other modifiable cardiovascular disease (CVD) risk factors such as improving glycemic control, reducing total cholesterol, LDL cholesterol and triglycerides, and increasing HDL cholesterol. In addition, increased physical activity (PA), reduces the risk for atherosclerotic disease, acute cardiovascular events, stroke, and type 2 diabetes mellitus. Greater weight loss typically confers larger improvements in cardiometabolic risk factors, but even modest weight loss of 5 to 10% has been shown to produce beneficial effects. A reduction in triglycerides and an increase in HDL-cholesterol levels have been reported with 5% and 10% weight reduction.
Item Description:Title from PDF caption. - "9 July 2014."
Physical Description:1 PDF file (28 pages) illustrations