Obesity

Obesity has been described as “the great humbler” because so many investigators have anticipated finding an easy cure only to learn that it is stubbornly difficult to treat.1 With the exception of bariatric surgery, no major treatment breakthroughs have emerged despite decades of scientific inquiry. All this may change as a result of research that has begun to identify the humoral and behavioral forces that sustain body weight and limit the losses achievable with dietary modification.2,3 As these investigations unfold, there is reason to anticipate new therapies that safely modify appetite and eating behaviors and change how we manage obesity.As effective treatment become feasible, obesity may constitute an important frontier for neurologists and other clinicians caring for stroke patients. This highly prevalent risk factor for stroke afflicts a large proportion of adults4 and represents a logical target for both primary and secondary prevention. In this article, we provide a narrative review of salient research that supports the optimistic view that obesity treatment will substantially reduce the burden of stroke.The prevalence of obesity among adults in the United States (defined as a body mass index [BMI] ≥30 kg/m2) has increased from 13% to 34% over the past half-century.4 A similar trend has been observed in other countries although the absolute prevalence of obesity varies considerably.5,6 For example, compared with the United States, current obesity rates are lower in Canada (24%), Germany (23%), and China (4%).Over 40 published studies, between 1983 and 2011, have examined the association between obesity and cerebrovascular disease. Almost all measured obesity with the BMI; some also used measures of central obesity such as the waist-to-hip ratio or waist circumference. With few exceptions, each study reported at least one measure of adiposity to be significantly …