The Interrelation between carotid, femoral and coronary artery disease.

obesity is not a health risk as long as traditional coronary atherosclerotic risk factors are normal. Two other points concerning obesity deserve mention. First, not all obesity confers the same degree of abnormality in coronary heart disease risk factors. The patient with abdominal obesity (the ‘apple’ form of obesity often associated with males) is linked to insulin resistance and hence significant risk for the development of atherosclerosis. Thigh and buttock obesity (the ‘pear’ form of obesity often associated with females) confers minimal coronary heart disease risk probably because fat in this zone is not as metabolically active as abdominal fat. Another point made by Ashton et al. that deserves repeating is that modest weight loss is capable of remarkable improvement in abnormal coronary heart disease risk factors. It has often been observed that modest ( 10% of body weight) loss of weight produces marked amelioration in elevated blood pressure, abnormal serum cholesterol, and hyperglycaemic tendency. I am in complete agreement with Ashton et al. when they advise moderate weight loss for obese patients. Demanding that the patient seek to reach their ideal body weight is often unrealistic and discourages compliance with the prescribed programme of diet and exercise. In the end, ‘the enemy of good is perfect’, that is, we should strive to enlist our patients in a programme that produces moderate, sustained weight loss rather than advising a draconian strategy that eventually fails to induce the patient to lose any weight at all. As recently pointed out by the National Task Force on the Prevention and Treatment of Obesity here in the U.S., the best strategy for weight loss would appear to be one of the moderate calorie restriction, increased activity (that is, regular exercise), and a supportive programme of behavioural modification to assist patients in remodelling their eating habits and style. J. S. ALPERT R. S. FLINN I. P. FLINN Department of Medicine, University of Arizona College of Medicine, Tucson, Arizona, U.S.A.