Visceral adiposity and cardiometabolic risks: epidemic of abdominal obesity in North America

Correspondence: Sunil J Wimalawansa Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, 1 Robert Wood Johnson Place, New Brunswick, NJ 08903, USA Tel +1 73 2235 9584 Fax +1 73 2235 8892 Email wimalawansa1@hotmail.com Abstract: Over the past 40 years, the prevalence of obesity has more than doubled in the United States. Approximately 67% of American adults older than 20 years of age are either obese or overweight. Obesity has now become a critically important issue facing more than 40% of Americans and has become a major burden on the American health care system. Today, obesity cannot be considered a simple lifestyle issue; it is a disease with major public health and economic consequences that requires serious attention by all stakeholders. Each individual has different causes and risk factors that lead to obesity and its associated complications. In addition to preventing becoming overweight, focusing on identifying the causes of obesity and then individualizing care and treatment plans to targeting weight loss, particularly intra-abdominal fat, could potentially generate huge cost savings. Excess intra-abdominal fat (visceral adiposity) is linked to excess morbidity and mortality, and positively correlates with the risks of insulin resistance, type 2 diabetes, cardiovascular diseases, certain cancers, and premature death. Therefore, overweight and obese patients should be offered healthy lifestyle changes including education about causes leading to excess weight, weight-reducing diets, physical activity regimens, and monitoring for progress. Medications and bariatric surgery are effective but are the last options and should be complementary to lifestyle and behavioral changes. The costs associated with managing obesity-related disorders and their complications are astounding; unless we intervene now, these are likely to triple over the next 2 decades. Thus, policymakers must pay serious attention to this progressive, insidious epidemic and determine the right paths for tackling obesity, which requires a paradigm shift in thinking and combined approaches. The increasing prevalence of obesity is a major health hazard in all health sectors, in both low and high income societies and countries. Thus, comprehensive programs are needed to minimize the effects of the epidemic.