Cardiovascular and metabolic consequences of obesity

INTRODUCTION The alarming increase in the incidence and impact of obesity in Australia requires urgent national focus at all levels of government and the community. The reason for the call to action has been due to the realization of the enormity of the health issues of being overweight or obese. There is clearly increased risk of metabolic disease, cardiovascular complications and premature death. The predictions outlined in a Victorian Government report suggest increases in the prevalence of being overweight or obese of between 0.4 and 0.8%, respectively per year. From the levels in 1995 in which 65% of adult males and 50% of adult females were classified as overweight or obese, we now expect levels to increase to 83% of adult males and 75% of females by 2025 (Haby and Marwick, 2008). Thus, being overweight or obese will become very much the “norm” for Australians unless this issue is addressed with appropriate evidence based allocation of resources for prevention, reduction and mitigation. Importantly, we must clearly understand and act on the short term and long term impact on the health and well-being of the individual of being overweight or obese. The early consequences of obesity involve a range of metabolic changes that have been grouped together to define the “metabolic syndrome” (Cameron et al., 2009a). These include dyslipidaemia and changes to metabolic homeostasis including insulin resistance which is the primary feature of type 2 diabetes. The progression from obesity to metabolic dysfunction to diabetes ultimately occurs unless there are significant interventions. However, the real danger lies in the long term effect of obesity related metabolic disease on cardiovascular risk associated with greater rates of atherosclerosis, hypertension, vascular disease and cardiovascular mortality. There is also a considerable alteration in the quality of life related to public stigma, reduced mobility, higher levels of unemployment and psychological sequelae including depression. Thus, the purpose of the current review is to bring together the latest research on the health complications of obesity as it becomes the dominant driver for the health sector and a dominant financial burden for the community.