Preventing Cardiovascular Disease and Diabetes

Excess body weight has become a major public health problem in the U.S., with nearly two-thirds of adults either overweight or obese.1 The steady gain in the prevalence of obesity over the last 25 years has affected our entire population—no racial or ethnic group, no region of the country, and no socioeconomic group has been spared.2 Perhaps most worrisome is the observation that the rise in the rate of obesity has been greatest in children and minorities, which suggests that future generations of Americans, and our fastest growing populations, may bear the ultimate burden of this condition.3Overweight or obesity results in a wide range of elevated risk factors and many fatal and nonfatal conditions.4 Paradoxically, although we have witnessed decades in which heart disease and stroke have steadily declined and cancer mortality has at worse remained stable,5 the prevalence of diabetes has soared.6 The increase in diabetes can largely be attributed to weight gain,7,8 and it threatens the enormous advances in disease prevention we have seen.3,9,10Among individuals with diabetes, cardiovascular disease (CVD) is the leading cause of morbidity and mortality9,11; adults with diabetes have a two- to fourfold higher risk of CVD compared with those without diabetes.12,13 Diabetes is also accompanied by a significantly increased prevalence of hypertension and dyslipidemia.14It is reasonable to postulate that in many individuals, excess weight gives rise to diabetes, hypertension, and dyslipidemia, thereby leading to frank CVD.15–17 This seemingly simple algorithm is undoubtedly more complex because (1) many studies …