Obesity
11
5. Obesity
➤ 5.1 In individuals who have obesity, we advise assessment of components
of the metabolic syndrome (MetS) and body fat distribution to accurately
determine the level of CVD risk. (UGPS)
Technical Remarks:
▶ Diagnosis of MetS requires the presence of three of the following criteria:
> Elevated TG ≥150 mg/dL (1.7 mmol/L) or on TG-lowering medication
> Reduced HDL-C <50 mg/dL (1.3 mmol/L) in women and <40 mg/dL (1.0
mmol/L) in men.
> Systolic blood pressure ≥ 130 mm Hg or diastolic blood pressure ≥85 mm Hg or on
blood pressure medication.
> Elevated waist circumference (men ≥40 in [102 cm] and women ≥35 in [88 cm]),
except for East and South Asian men ≥35 in (90 cm) and women ≥31.5 in (80
cm).
> Hyperglycemia (but not yet with T2D) is defined by cutoffs for prediabetes
according to fasting blood glucose, oral glucose tolerance and/or HbA1c.
▶ Body fat distribution can be assessed in clinical practice by measuring the waist size or
the waist/hip ratio.
▶ Waist size measurement in people with body mass index greater than 35 kg/m
2
has
potential limitations.
➤ 5.2 In individuals who have obesity, we suggest lifestyle measures as
first-line treatment to reduce plasma TG to lower CV and pancreatitis risk.
(2|⊕
)
Technical Remarks:
▶ Reductions in LDL-C and increases in HDL-C are modest compared to the decrease
in TG with lifestyle measures that produce weight loss.
▶ Lifestyle therapy-induced changes in the lipid profile in obesity have not been shown
to reduce CVD events.
➤ 5.3 In individuals who have obesity, we recommend assessment of 10-year
risk for ASCVD to guide the use of lipid-lowering therapy. (1|⊕⊕⊕
)
Technical Remarks:
▶ Calculation of 10-year risk for ASCVD may be done using the Pooled Cohort
Equations.
▶ Elevated LDL-C is predictive of CV risk.
