A 9-month lifestyle intervention reduced the proportion of clinical obesity from 71% to 57% and clinical obesity increased risk of incident cardiovascular disease (HR 2.78) and type 2 diabetes (HR 7.88) in US adults with confirmed obesity.
Cohort (n=5,265)
Yes
Does clinical obesity increase the risk of incident cardiovascular disease and type 2 diabetes, and does a lifestyle intervention reduce the proportion of clinical obesity in adults?
Most adults with BMI-defined obesity meet criteria for clinical obesity, which carries a significantly higher risk for cardiovascular disease and type 2 diabetes, though lifestyle interventions can induce remission of clinical obesity.
Effect estimate: HR for incident CVD in clinical obesity 2.78; HR for incident T2D in clinical obesity 7.88; HR for incident T2D in preclinical obesity 4.32 (95% CI CVD HR 2.78 (1.78-4.34); T2D HR 7.88 (5.56-11.2); T2D preclinical HR 4.32 (1.77-10.5))
Absolute Event Rate: 57% vs 71%
p-value: p=<0.0001 for decrease in clinical obesity proportion after intervention
Abstract An expert commission (The Lancet Diabetes & Endocrinology Commission on Clinical Obesity) proposed novel diagnostic criteria distinguishing between preclinical and clinical obesity and suggesting treatment indications for the latter. However, the proportional assignment to preclinical and clinical obesity in adults with BMI-defined obesity, the associated disease risks, as well as the response to lifestyle interventions are not well known. Here we show that among those with BMI-based obesity, 100% are confirmed to have obesity by at least one other anthropometric measure in NHANES 2017-2018 and the prospective EPIC-Potsdam cohort. More than 80% of adults with confirmed obesity meet the criteria for clinical obesity and have 2.8-fold increased risk of incident cardiovascular disease and 7.9-fold increased risk for type 2 diabetes compared to adults without obesity and not fulfilling clinical criteria. Adults with preclinical obesity have no elevated cardiovascular disease risk, but type 2 diabetes risk is markedly increased. A 9-months lifestyle intervention (Tübingen Lifestyle Intervention Programme) decreases the proportion of clinical obesity from 71% to 57%, and that of prediabetes from 52% to 29%.
Schiborn et al. (Thu,) conducted a cohort in Adults aged ≥20 years in the United States with BMI-based obesity confirmed by at least one additional anthropometric measure and classified as preclinical or clinical obesity (n=5,265). Lifestyle intervention consisting of diet modification and increased physical activity (TULIP study) vs. No lifestyle intervention group (observational) was evaluated on Prevalence of clinical obesity and incident cardiovascular disease (CVD) and type 2 diabetes (T2D) (HR for incident CVD in clinical obesity 2.78; HR for incident T2D in clinical obesity 7.88; HR for incident T2D in preclinical obesity 4.32, 95% CI CVD HR 2.78 (1.78-4.34); T2D HR 7.88 (5.56-11.2); T2D preclinical HR 4.32 (1.77-10.5), p=<0.0001 for decrease in clinical obesity proportion after intervention). A 9-month lifestyle intervention reduced the proportion of clinical obesity from 71% to 57% and clinical obesity increased risk of incident cardiovascular disease (HR 2.78) and type 2 diabetes (HR 7.88) in US adults with confirmed obesity.