Abdominal adiposity: Early intervention and therapeutic options

Abdominal obesity, especially visceral adipose tissue (VAT), increases the incidence of a cluster of metabolic disturbances (the so-called metabolic syndrome), type 2 diabetes, and associated cardiovascular risk. Not only is abdominal obesity a marker of a dysmetabolic profile, but VAT also appears to be a causal factor for morbidity and premature mortality, both by classic mechanisms (ie, dyslipidemia, hypertension, and glucose dysmetabolism), as well as less conventional mechanisms (ie, low adiponectin levels and high proinflammatory cytokine levels that promote insulin resistance and endothelial dysfunction). Because abdominal obesity is increasingly seen in young people, early intervention is mandatory to stop the cycle that leads to cardiometabolic risk. Obesity should be considered a chronic disease of multifactorial etiology,and treatment must be maintained for life —first with lifestyle interventions (energy-reduced diet and increased physical activity) and then with pharmacologic approaches (eg, orlistat, sibutramine, or rimonabant), when necessary. Beneficial metabolic effects may result from even moderate weight loss and are attributed primarily to a predominant reduction in VAT. Finally, special attention should be paid to possible additional positive effects beyond weight reduction, as especially demonstrated with the CB1 antagonist rimonabant.