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Lynchburg Journal of Medical Science

Lynchburg Journal of Medical Science

Specialty

Family Medicine

Advisor

Elyse Watkins

Abstract

This review focuses on the most effective treatment modalities for reducing cardiovascular risk factors in adults with severe obesity. Comprehensive lifestyle interventions, which include dietary and exercise modifications, remain a mainstay method for obesity management. However, in recent decades, bariatric surgery has become more prevalent in the treatment of severely obese patients who fail conservative therapy. Studies comparing the outcomes of intensive lifestyle intervention versus bariatric surgery on cardiovascular risk reduction have an overall mixed review. Bariatric surgery was found to be more efficient at achieving significant and optimal weight reduction compared to lifestyle intervention alone. Patients who underwent bariatric surgery experienced higher resolution of major cardiovascular risk factors, such as type 2 diabetes (T2DM), dyslipidemia, and hypertension (HTN).

Furthermore, weight loss achieved following surgery was more sustainable on a long-term basis. Although the short-term effects of cardiovascular risk reduction are well established for bariatric patients, the long-term risk reduction for cardiovascular morbidity and mortality is not well understood. Adults with severe obesity who chose intensive lifestyle interventions also experienced a notable reduction in cardiovascular risk factors achieved with significant weight loss. However, these reductions were, to a lesser degree, in comparison to patients who underwent bariatric surgery. Given the high risk for gastrointestinal complications and vitamin deficiencies, bariatric surgery should not be the default choice of treatment since the long-term reductions in cardiovascular morbidity and mortality are uncertain. Instead, shared decision making should be deployed to assess the risks, benefits, and goals of bariatric surgery compared to intensive lifestyle interventions, so outcomes and objectives are optimized.

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