The expert panel recognized the need to address the cardiometabolic risk associated with obesity and reflected on the lack of agreement in the medical community as to the suitable approach to such risk. Current strategies to reduce cardiometabolic risks produce two different schools of thought.
The first tactic, and perhaps the most commonly used one, is to manage risk through recognized efficacious treatment of the patient for the risk components—dyslipidemia, hypertension, and hyperglycemia. Thus, patients can be given agents that will reduce their cholesterol levels, decrease their blood pressure, and lower their blood glucose levels. Of course, that means patients will often require more than one agent to treat them for a given condition and, if several diseases are present, many medications. With polypharmacy comes issues of drug interaction, medication management, and adherence, all of which are beyond the scope of this consensus statement.
The other option is to recognize and treat patients for the underlying disease; in this case, obesity. The benefits of treating patients for overweight and obesity have been enumerated
70 and include:
The treatment of patients for obesity itself remains an area of debate; however; this panel recognizes that effective management may demand more than lifestyle modification alone. As a disease, obesity merits attention as a target for medical intervention. What are our therapeutic options? According to joint guidelines from the National Institutes of Health (NIH), the National Heart, Lung, and Blood Institute (NHLBI), and NAASO: The Obesity Society,
77 three levels of treatment options should be recommended to patients based on BMI and the presence of comorbidities: lifestyle modification, pharmacotherapy, and surgery.