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Action levels for obesity treatment in 40 to 42-y-old men and women compared with action levels for prevention of coronary heart disease

International Journal of Obesity volume 25, pages 1698–1704 (2001)Cite this article

Abstract

BACKGROUND: Guidelines for treating overweight and obesity have been suggested by the World Health Organization and other expert groups. We asked whether most men and women targeted in obesity guidelines would already be included in existing clinical recommendations for the prevention of coronary heart disease (CHD) or whether a new group of patients would be added to current workloads.

SUBJECTS AND METHODS: In 1997 the Norwegian National Health Screening Service examined CHD risk factors in subjects aged 40–42 y living in three counties. We studied 6911 men and 7992 women who did not report treatment for diabetes, hypertension or the presence of cardiovascular disease. Estimated 10 y risk of CHD was calculated using the Framingham equation.

RESULTS: The prevalence of single risk factors (systolic blood pressure ≥160 mmHg, diastolic blood pressure ≥95 mmHg, total cholesterol level ≥7.8 mmol/l and nonfasting glucose ≥11.1 mmol/l) ranged between 0 and 11% among subjects with body mass index ≥25 kg/m2. Adding low HDL cholesterol (<1.0 mmol/l for men, <1.1 mmol/l for women) and 10 y risk CHD risk to the classical risk factors increased prevalence to 16–50% (one or more risk factors or 10 y risk ≥10%). Sensitivities and specificities of using body mass index (BMI) or BMI and waist circumference as a screen for elevated CHD risk ranged between 22 and 91%. Screening for 10 y CHD risk of ≥10% or one or more risk factors among men and screening for one or more risk factors among women gave positive predictive values of 19–50%; however, the positive predictive value of screening for 10 y CHD risk of ≥10% was only 1–2% among women. Compared with men with BMI<30 kg/m2 or waist circumference <102 cm, those with measurements equal to or above these levels had statistically significantly higher adjusted odds ratios of elevated CHD risk (1.49, 95% CI 1.24–1.79 and 1.48, 95% CI 1.22–1.80, respectively); these associations were not observed among women.

CONCLUSION: Using BMI and waist circumference to screen for CHD risk yields low positive prediction values, thus doubling the number of men and adding even more to the number of women seen by the practitioner for prevention of CHD.

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References

  1. Wickelgren I . Obesity: how big a problem? Science 1998 280: 1364–1367.

    Article  CAS  PubMed  Google Scholar 

  2. World Health Organization . Obesity: preventing and managing the global epidemic. World Health Organization: Geneva 1998

  3. National Council on Nutrition and Physical Activity . Body weight and health. National Council on Nutrition and Physical Activity: Oslo 2000

  4. Scottish Intercollegiate Guidelines Network . Obesity in Scotland: integrating prevention with weight management. A national clinical guideline recommended for use in Scotland. Royal College of Physicians: Edinburgh 1996

  5. Andersen T, Rissanen A, Røssner S (eds) . Fetma/fedme—en nordisk lœrebok. Studentlitterature: Lund 1998

  6. Executive summary of the clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults Arch Intern Med 1998 158: 1855–1867.

  7. Wood DA, De Backer G, Faergeman O, Graham I, Mancia G, Pyöräläa K . Prevention of coronary heart disease in clinical practice. Recommendations of the second joint task force of the European Society of Cardiology, European Atherosclerosis Society and European Society of Hypertension Eur Heart J 1998 19: 1434–1503.

    Article  Google Scholar 

  8. Troein M, Gardell B, Selander S, Råstam L . Guidelines and reported practice for the treatment of hypertension and hypercholesterolaemia J Intern Med 1997 242: 173–178.

    Article  CAS  PubMed  Google Scholar 

  9. Hetlevik I, Holmen J, Midthjell K . Treatment of diabetes mellitus—physicians' adherence to clinical guidelines in Norway Scand J Prim Health Care 1997 15: 193–197.

    Article  CAS  PubMed  Google Scholar 

  10. McBride P, Schrott HG, Plane MB, Underbakke G, Brown RL . Primary care practice adherence to National Cholesterol Education Program guidelines for patients with coronary heart disease Arch Intern Med 1998 158: 1238–1244.

    Article  CAS  PubMed  Google Scholar 

  11. Hetlevik I, Holmen J, Kruger O, Kristensen P, Iversen H . Implementing clinical guidelines in the treatment of hypertension in general practice Blood Pressure 1998 7: 270–276.

    Article  CAS  PubMed  Google Scholar 

  12. Bjartveit K, Foss PO, Gjervig T, Lund-Larsen PG . The cardiovascular disease study in Norwegian countries. Background and organization Acta Med Scand 1985 634 (Suppl): 1–70.

    Google Scholar 

  13. World Health Organization . Geographical variation in the major risk factors of coronary heart disease in men and women aged 35–64 y. The MONICA project World Health Stat Q 1988 41: 115–40.

    Google Scholar 

  14. Study group, European Atherosclerosis Society . The recognition and management of hyperlipidaemia in adults: a policy statement of the European Atherosclerosis Society Eur Heart J 1988 9: 571–600.

    Article  Google Scholar 

  15. The report of the expert committee on the diagnosis and classification of diabetes mellitus Diabetes Care 1997 20: 1183–1197.

  16. Han TS, van Leer EM, Seidell JC, Lean MEJ . Waist circumference action levels in the identification of cardiovascular risk factors: prevalence study in a random sample Br Med J 1995 311: 1401–1405.

    Article  CAS  Google Scholar 

  17. Anderson KM, Wilson PWF, Odell PM, Kannel WB . An updated coronary risk profile. A statement for health professionals Circulation 1991 83: 356–362.

    Article  CAS  PubMed  Google Scholar 

  18. Megnien JL, Denarie N, Cocaul M, Simon A, Levenson J . Predictive value of waist-to-hip ratio on cardiovascular risk events Int J Obes Relat Metab Disord 1999 23: 90–97.

    Article  CAS  PubMed  Google Scholar 

  19. The International Task Force for Prevention of Coronary Heart Disease . Coronary heart disease: reducing the risk Nutr Metab Cardiovasc Dis 1998 8: 205–271.

    Google Scholar 

  20. Wood D, Durrington P, McInnes G, Poulter N, Rees A, Wray R . Joint British recommendations on prevention of coronary heart disease in clinical practice Heart 1998 80 (Suppl 2): 1–29.

    Google Scholar 

  21. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults . Summary of the second report JAMA 1993 269: 3015–3023.

    Article  Google Scholar 

  22. Schulte H, Cullen P, Assmann G . Obesity, mortality and cardiovascular disease in the Münster Heart Study (PROCAM) Atherosclerosis 1999 144: 199–209.

    Article  CAS  PubMed  Google Scholar 

  23. Hubert HB, Feinleib M, McNamara PM, Castelli WB . Obesity as an independent risk factor for cardiovascular disease: a 26-y follow-up of participants in the Framingham Heart Study Circulation 1983 67: 968–977.

    Article  CAS  PubMed  Google Scholar 

  24. Manson JE, Willett WC, Stampfer MJ, Colditz GA, Hunter DJ, Hankinson SE, Hennekens CH, Speizer FE . Body weight and mortality among women New Engl J Med 1995 333: 677–685.

    Article  CAS  PubMed  Google Scholar 

  25. Jousilahti P, Tuomilehto J, Vartiainen E, Pekkanen J, Puska P . Body weight, cardiovascular risk factors, and coronary mortality Circulation 1996 93: 1372–1379.

    Article  CAS  PubMed  Google Scholar 

  26. Noakes M, Clifton PM . Weight loss and plasma lipids Curr Opin Lipidol 2000 11: 65–70.

    Article  CAS  PubMed  Google Scholar 

  27. Sjöström L . Obesity, diabetes and other cardiovascular risk factors: lessons from SOS Int J Obes Relat Metab Disord 2000 24 (Suppl 1): 7.

    Google Scholar 

  28. Andersson I, Rössner S . Weight development, drop-out pattern and changes in obesity-related risk factors after two years treatment of obese men Int J Obes Relat Metab Disord 1997 21: 211–216.

    Article  CAS  PubMed  Google Scholar 

  29. Green KL, Cameron R, Polivy J, Cooper K, Liu L, Leiter L, Heatherton T . Weight dissatisfaction and weight loss attempts among Canadian adults Can Med Assoc J 1997 157 (Suppl 1): 517–525.

    Google Scholar 

  30. Haq IU, Ramsay LE, Yeo WW, Jackson PR, Wallis EJ . Is the Framingham risk function valid for northern European populations? A comparison of methods for estimating total coronary risk in high risk men Heart 1999 81: 40–46.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Montaye M, De Bacquer D, De Backer G, Amouyel P on behalf of the EUROASPIRE investigators . Overweight and obesity: a major challenge for coronary heart disease secondary prevention in clinical practice in Europe Eur Heart J 2000 21: 808–813.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

We thank Per G Lund Larsen, Aage Tverdal and Randi Selmer of the National Health Screening Service for data collection, comments on the manuscript and statistical assistance.

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  1. Department of Medicine, Preventive Cardiology, Ullevål Hospital, Oslo, Norway

    S Tonstad

  2. National Health Screening Service, Oslo, Norway

    S Graff-Iversen

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Correspondence to S Tonstad.

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Tonstad, S., Graff-Iversen, S. Action levels for obesity treatment in 40 to 42-y-old men and women compared with action levels for prevention of coronary heart disease. Int J Obes 25, 1698–1704 (2001). https://doi.org/10.1038/sj.ijo.0801804

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