ESC 2024: New Guidelines on Managing Obesity and Reducing Risk

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ESC 2024: New Guidelines on Managing Obesity and Reducing Risk

ESC 2024: New Guidelines on Managing Obesity and Reducing Risk

The Risk of Obesity-Related Deaths Increases by 100%! New Consensus Outlines 3 Major Weight Loss Methods and 6 Weight Loss Drugs.

In the past 40 years, the global obesity rate has doubled, now affecting nearly 1 billion people—roughly 1 in 8 individuals. The latest European Society of Cardiology (ESC) Clinical Consensus Statement on Obesity and Cardiovascular Diseases (referred to as the “Consensus”) highlights that compared to people of normal weight, obese individuals have a 50% to 100% increased risk of all-cause mortality, with 67.5% of the increased risk attributed to cardiovascular diseases (CVD). Obesity is recognized as a disease that not only reduces quality of life but also shortens life expectancy.

Released at the ESC 2024 conference, the Consensus summarizes current clinical evidence on the epidemiology and etiology of obesity, the interaction between obesity, cardiovascular risk factors, and heart disease, and clinical management and weight loss strategies for patients with obesity and heart disease. The content is simultaneously published in the European Heart Journal and the European Journal of Preventive Cardiology.

ESC 2024: New Guidelines on Managing Obesity and Reducing Risk

The Definition and Causes of Obesity

Overweight/obesity is defined as abnormal or excessive fat accumulation that may impair health. The World Health Organization (WHO) defines obesity based on BMI (Body Mass Index). For the Chinese population, a BMI of 24-28 kg/m² is considered overweight, and a BMI ≥28 kg/m² is considered obese.

Overweight: BMI 25-29.99 kg/m²
Obesity Class 1: BMI 30-34.99 kg/m²
Obesity Class 2: BMI 35-39.99 kg/m²
Obesity Class 3: BMI ≥40 kg/m²

Obesity is broadly caused by excessive energy intake and insufficient energy expenditure, with contributions from neurobiological factors, genetics, and psychological factors. Sedentary behavior is a particular concern, as it reduces energy expenditure, leading to weight gain and increasing the risk of cardiovascular disease, creating a vicious cycle. Research has shown that people with sedentary lifestyles have higher mortality rates, but 60-75 minutes of moderate-intensity physical activity per day can reduce this risk.

Four Key Management Recommendations for Overweight/Obese Individuals

Diabetes: There is a strong link between obesity and diabetes, with about 80%-85% of type 2 diabetes patients also being overweight or obese. Compared to individuals with normal weight, the risk of developing diabetes in overweight/obese individuals is nearly three times higher. It is recommended that high-risk individuals (including those who are overweight/obese) undergo regular diabetes screenings, especially after age 45. For diagnosed type 2 diabetes patients, weight loss can be beneficial in managing blood sugar levels.

ESC Guidelines on Managing Overweight/Obese Patients with Type 2 Diabetes:

Set goals for weight loss and increased physical activity to improve metabolic control and overall cardiovascular risk (Recommendation Class I; Evidence Level A).

Hypertension: As BMI increases, the incidence of hypertension also rises linearly. Studies, like the Framingham study, indicate that overweight/obese individuals are more likely to develop hypertension. Even modest weight loss can achieve significant long-term reductions in blood pressure.

ESC Guidelines on Managing Hypertension in Obese Individuals:

Aim for a stable and healthy BMI (20-25 kg/m²) and waist circumference (men <94 cm, women <80 cm) to reduce blood pressure and cardiovascular risk (Recommendation Class I; Evidence Level A).

Dyslipidemia: Low-density lipoprotein cholesterol (LDL-C) is a key factor in atherosclerosis, with a U-shaped relationship between BMI and LDL-C. Obesity is associated with a lipid profile that promotes atherosclerosis. Weight loss can reduce atherogenic lipid levels.

ESC Guidelines on Lipid Measurement:

Consider ApoB-related risk assessments in certain subgroups (including those with obesity) as a substitute for LDL-C and for the screening, diagnosis, and management of dyslipidemia (Recommendation Class I; Evidence Level C).

Obstructive Sleep Apnea (OSA): For patients with OSA, a 10% reduction in body weight can decrease the apnea-hypopnea index (AHI) by 26%-32%, while a 10% weight gain can increase AHI by 32%. Weight loss combined with continuous positive airway pressure (CPAP) can also reduce other cardiovascular risk factors like insulin resistance and blood pressure.

ESC Guidelines on Sleep Disorders in Obese Individuals:

Regularly screen obese patients for non-restorative sleep, such as asking about difficulties in falling asleep, staying asleep, or sleeping too long (Recommendation Class I; Evidence Level C).

Obesity Treatment Strategies

Obesity treatment can be broadly categorized into lifestyle interventions, pharmacological interventions, and surgical interventions.

Lifestyle Interventions: Dietary interventions aim to reduce energy intake by 500-750 kcal/day. The goal is to create a sustainable eating pattern through portion control, reduced intake of ultra-processed foods, limited alcohol consumption, and increased consumption of fruits and vegetables.

Physical activity combined with dietary intervention is considered the first-line treatment for obesity. The current ESC cardiovascular disease prevention guidelines recommend at least 150-300 minutes of moderate-intensity physical activity per week, or 75-150 minutes of vigorous activity, to reduce all-cause mortality and cardiovascular morbidity and mortality.

Pharmacological Treatment: When lifestyle interventions alone are insufficient, weight loss medications may be considered, especially for individuals with a BMI ≥30 kg/m² or a BMI ≥27 kg/m² with at least one weight-related comorbidity. Six medications are currently approved by the European Medicines Agency (EMA) and the U.S. FDA for long-term weight management: Orlistat, Naltrexone/Bupropion, Liraglutide, Semaglutide, Tirzepatide, and Setmelanotide.

ESC Guidelines on GLP-1 Receptor Agonists:

Consider using weight-reducing antidiabetic medications, such as GLP-1 receptor agonists, in overweight/obese patients with type 2 diabetes to promote weight loss (Recommendation Class IIa; Evidence Level B).

Surgical Treatment: Bariatric surgery, including laparoscopic sleeve gastrectomy (LSG) and Roux-en-Y gastric bypass (RYGB), is a critical tool for weight loss but comes with strict indications.

ESC Guidelines on Bariatric Surgery:

For high-risk obese individuals, when lifestyle interventions fail to maintain weight loss, bariatric surgery should be considered (Recommendation Class IIa; Evidence Level B).

In conclusion, obesity management remains a critical public health issue, with lifestyle interventions as the cornerstone of treatment.

In some cases, pharmacological or surgical interventions may be necessary, but long-term adherence to a healthy lifestyle is essential to sustain weight loss and reduce cardiovascular risk.