EN 
ES Published in: Today Digital
Author: Dr. Lissi A. Sena, Cardiologist-echocardiographer, Cardiology Management, General Hospital of the Plaza de la Salud.
Obesity is a chronic disease of multifactorial origin, preventable, characterized by excessive accumulation of fat or general hypertrophy of adipose tissue in the body.
Excess weight is the most prevalent cardiovascular disease risk factor and certainly the least improvement factor in subjects with established cardiovascular disease. The association between obesity and cardiovascular disease is complex and is not limited to traditional mediating factors such as hypertension, dyslipidemia and type 2 diabetes mellitus.
In recent years, several studies have shown that obesity could cause cardiovascular disease through other mechanisms such as subclinical inflammation, endothelial dysfunction, increased sympathetic tone, atherogenic lipid profile, thrombogenic factors and obstructive sleep apnea.
Despite the large amount of data linking obesity with cardiovascular disease, several studies have shown a paradoxical association between obesity and prognosis in patients with established cardiovascular disease.
This has been attributed to the way in which obesity is currently defined. The evidence indicates that it would be more appropriate to measure total body fat and use markers of central obesity, instead of just using the body mass index. However, recent evidence has shown that the association between obesity and cardiovascular disease could include many other factors, such as subclinical inflammation, neurohormonal activation with increased sympathetic tone, high concentrations of leptin and insulin, and increased exchange of free fatty acids, and also due to the deposit of fat in specific areas of the body with direct function in the pathogenesis of coronary atherosclerosis, such as subepicardial fat.
The excess fat accumulated in the viscera, related to central obesity, is the metabolically more active adipose tissue that causes more insulin resistance, hypertriglyceridemia and changes in the particle size of low density lipoprotein (LDL) and low concentrations of high density lipoproteins (HDL).
Insulin resistance causes diabetes mellitus type 2, a condition that by itself can initiate or accelerate the atherogenic process by several additional mechanisms, such as hyperglycemia.
Resistance to leptin in obese humans is evidenced by the increase in serum leptin concentration. Leptin has multiple actions, including possible effects on increased sympathetic activity, which potentiates thrombosis and increases blood pressure and heart rate.
The increase in sympathetic activity may also be related to the accumulation of fat in the central region of the body, instead of the BMI per se, or with prolonged sedentary states or stress. Increased BMI and body fat content, particularly central obesity, have been associated with endothelial dysfunction that induces the chemotaxis of adhesion molecules. Endothelial dysfunction also promotes platelet aggregation and decreases the availability of nitric oxide, which promotes thrombosis. Inflammation has emerged as a powerful predictor, and perhaps etiological, of cardiovascular disease.
The elevated concentration of C-reactive protein (CRP) has been associated with an increased risk of myocardial infarction, cerebrovascular disease, peripheral arterial disease and death from ischemic heart disease in apparently healthy men and women.
Frequent questions:
1. How do I know if I am overweight?
For this we doctors use a scale called body mass index (BMI). Divide your weight (in kilos) between the square of your height (in meters). Now, you will only have to analyze the result. If you are between 25 and 30 you are overweight and you should watch your diet; If you are over 30, you suffer from obesity and you should consult with a specialist in endocrinology and nutrition as soon as possible.
2. What are the causes of obesity?
Obesity is usually the result of poor diet and lack of exercise, as this causes the body to take in more calories than it can burn, leading to an accumulation of fat. Sedentary can contribute to this problem. There are medical conditions that can also cause some people to be overweight or obese, such as hypothyroidism, polycystic ovarian syndrome and Cushing's syndrome. They also influence environmental factors and genetic predisposition.
3. Is obesity dangerous?
Obesity is considered a dangerous condition due to its ability to lead to a large number of very serious health problems, such as high cholesterol, cardiovascular diseases, type 2 diabetes and high blood pressure. Other problems that can arise as a result of obesity include depression, acne, gallstones, social anxiety and problems while walking or running.
Overweight, beyond an aesthetic issue, negatively affects the quality of life of people, they feel more tired, with less energy and less self-esteem.
4. Can obesity be cured?
The treatment is based on a hypocaloric diet plan designed by a professional in the area of nutrition.
