Obesity, diabetes, and associated risk factors.

The prevalence of obesity has increased in the past 10 years. Recent studies have associated obesity with other cardiovascular risk factors, and an increased risk of diabetes and cardiovascular death. Patients with obesity should undergo a global evaluation cardiovascular risk, including measurement of abdominal waist circumference, assessment of standard cardiovascular risk factors, screening for dyslipidemia, abnormal glucose metabolism, and hypertension. Recommendations for dietary modification should be tailored to the patient's associated medical conditions, such as diabetes, dyslipidemia, and hypertension, and all patients should be instructed on the importance of monitoring caloric intake. For patients who can engage in regular physical activity, we recommend a minimum regimen of 150 min/wk of moderate intensity exercise, such as brisk walking. Use of pharmacotherapy for obesity can be considered when efforts at therapeutic lifestyle modification have been ineffective, but patients must be carefully screened because many agents have potential side effects. Surgical approaches for obesity have also been demonstrated to be effective in achieving and sustaining weight loss and improving markers of cardiovascular risk and should be considered in patients who are refractory to therapeutic lifestyle modification. All diabetic patients should be treated comprehensively to reduce other comorbid conditions, including hypertension and dyslipidemia. Hypoglycemic therapy should be initiated when efforts to reduce hyperglycemia to target thresholds fail.