STUDY: Being Overweight A Risk

JOURNAL: JAMA 2003;289:1799-1804.

AUTHORS: Dr. Katherine Esposito

ABSTRACT: Vascular inflammation markers and insulin resistance improve in obese women after weight loss and lifestyle changes.

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COMMENTARY: Elevated levels of proinflammatory cytokines have been associated with indicators of elevated body fat and with cardiovascular disease risk factors.

Obesity itself is an independent risk factor for cardiovascular disease.

Dr. Katherine Esposito and associates from Second University of Naples, Italy measured markers of vascular inflammation and insulin resistance in 120 premenopausal obese women randomly assigned to a program of lifestyle changes designed to provide sustained weight loss.

Prior to the intervention, the obese women had higher levels of serum IL-6, IL-18, and C-reactive protein, as well as higher body-mass indices, insulin resistance, and free fatty acids, compared with nonobese women, the report indicates.

After 2 years of lifestyle change, the authors report, body weight, body-mass index, waist-hip ratio, insulin resistance, blood pressure, and free fatty acid levels had all declined to a greater extent than in the control group.

Serum levels of IL-1, IL-18, and C-reactive protein were significantly reduced in the intervention group compared with controls, the results indicate, while serum levels of adiponectin (a hormone that enhances insulin action) were significantly higher.

Cytokine and C-reactive protein declines correlated with the reduction in body-mass index, while free fatty acid, IL-6, and adiponectin were independent predictors of insulin resistance.

A multidisciplinary program aimed to reduce body weight in obese women through lifestyle changes, including a low-energy Mediterranean-type diet and increased exercise, is feasible and gives sustained results over 2 years, as indicated by the significant reduction of markers of inflammation and improved insulin sensitivity.

The effective prevention of many diseases, including obesity and type 2 diabetes, starts at table with a Mediterranean-type diet and continues with physical activity.

"Although not easy to implement, this strategy will allow us to enjoy the spectacular increase in life expectancy we have experienced in the last century. It is time to move towards a more integrated approach for a large-scale control of obesity, based on lifestyle changes."

"Since both obesity and diabetes are two major risk factors for cardiovascular disease, it is reasonable to hypothesize that any intervention aimed at reducing the prevalence of these two conditions in the population will lead to a decrease of the level of cardiovascular risk," Dr. Esposito concluded.