Current Epidemiology Reports

, Volume 5, Issue 3, pp 243–251 | Cite as

Trends in Obesity and Risk of Cardiovascular Disease

  • Ryan Lahey
  • Sadiya S. KhanEmail author
Cardiovascular Disease (R Foraker, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Cardiovascular Disease


Purpose of Review

The obesity epidemic is a global health crisis of staggering proportion. Excess body weight is a major risk factor for the development of cardiovascular disease (CVD). We review temporal trends in obesity rates, pertinent pathophysiology to understand mechanisms of disease, and treatment strategies in the context of reducing cardiovascular risk.

Recent Findings

The prevalence of obesity is increasing in recent decades and is driven by a complex interplay of economic, environmental, and biological factors. In developed countries, changes in food intake, such as increased consumption of energy-dense and added sugar, have contributed significantly to weight gain. Single nucleotide variations in genes and alterations in the gut microbiome have been associated with the obese phenotype. The description of an obesity paradox in patients with CVD may have several explanations, including limitations of body mass index (BMI) to assess adiposity, selection bias, and lead-time bias with earlier onset of disease. Evidence-based treatments for weight loss include lifestyle intervention, pharmacotherapy, and bariatric surgery. Data on the long-term effects of these therapies on cardiovascular risk are limited.


Overweight and obesity are associated with increased cardiovascular morbidity and mortality over the lifespan. Despite our increasing understanding of biological and environmental drivers of obesity, more work is needed in developing effective prevention strategies and implementation of evidence-based treatments to promote cardiovascular health and reduce cardiovascular risk. Ultimately, efforts to prevent and postpone cardiovascular morbidity should include focus on maintenance of normal BMI (primordial prevention) for a longer and healthier life, free of CVD.


Overweight Obesity Cardiovascular disease risk 


Compliance with Ethical Standards

Conflict of Interest

Ryan Lahey declares no conflicts of interest and Sadiya S. Khan reports grants from NIH/NHBLI, during the conduct of the study.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.
    Ogden CL, Carroll MD, Fryar CD, Flegal KM. Prevalence of obesity among adults and youth: United States, 2011–2014. NCHS Data Brief. 2015;219:1–8.Google Scholar
  2. 2.
    Finkelstein EA, Khavjou OA, Thompson H, Trogdon JG, Pan L, Sherry B, et al. Obesity and severe obesity forecasts through 2030. Am J Prev Med. 2012;42(6):563–70.CrossRefPubMedGoogle Scholar
  3. 3.
    • Ogden CL, Carroll MD, Lawman HG, Fryar CD, Kruszon-Moran D, Kit BK, et al. Trends in obesity prevalence among children and adolescents in the United States, 1988–1994 through 2013–2014. JAMA. 2016;315(21):2292–9. Report on increasing obesity prevalence in recent decades among the US pediatric population. CrossRefPubMedGoogle Scholar
  4. 4.
    • Heymsfield SB, Wadden TA. Mechanisms, pathophysiology, and management of obesity. N Engl J Med. 2017;376(15):1492. A review with emphasis on management which may be of special interest to clinicians. PubMedGoogle Scholar
  5. 5.
    Lavie CJ, Milani RV, Ventura HO. Obesity and cardiovascular disease. J Am Coll Cardiol. 2009;52(21):1925–32.CrossRefGoogle Scholar
  6. 6.
    • Khan SS, Ning H, Wilkins JT, Allen N, Carnethon M, Berry JD, et al. Association of body mass index with lifetime risk of cardiovascular disease and compression of morbidity. JAMA Cardiol. 2018;3(4):280–7. A large-scale population-based study demonstrating increased CVD morbidity and mortality associated with overweight and obesity. CrossRefPubMedGoogle Scholar
  7. 7.
    Ford ES, Ajani UA, Croft JB, Critchley JA, Labarthe DR, Kottke TE, et al. Explaining the decrease in U.S. deaths from coronary disease, 1980–2000. N Engl J Med. 2007;356(23):2388–98.CrossRefPubMedGoogle Scholar
  8. 8.
    Roth GA, Dwyer-Lindgren L, Bertozzi-Villa A, Stubbs RW, Morozoff C, Naghavi M, et al. Trends and patterns of geographic variation in cardiovascular mortality among US counties, 1980–2014. JAMA. 2017;317(19):1976–92.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Lloyd-Jones DM, Hong Y, Labarthe D, Mozaffarian D, Appel LJ, Van Horn L, et al. Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association’s strategic impact goal through 2020 and beyond. Circulation. 2010;121(4):586–613.CrossRefPubMedGoogle Scholar
  10. 10.
    Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, et al. Heart disease and stroke statistics—2017 update: a report from the American Heart Association. Circulation. 2017;135(10):e146–603.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of obesity among adults and youth: United States, 2015–2016. NCHS Data Brief. 2017;288:1–8.Google Scholar
  12. 12.
    Zobel EH, Hansen TW, Rossing P, von Scholten BJ. Global changes in food supply and the obesity epidemic. Curr Obes Rep. 2016;5(4):449–55.CrossRefPubMedGoogle Scholar
  13. 13.
    Swinburn B, Sacks G, Ravussin E. Increased food energy supply is more than sufficient to explain the US epidemic of obesity. Am J Clin Nutr. 2009;90(6):1453–6.CrossRefPubMedGoogle Scholar
  14. 14.
    USDA Economic Research Service. Food calories and macronutrients per capita per day. United States Department of Agriculture: Center for Nutrition Policy and Promotion. 2014. Accessed 25 May 2018.
  15. 15.
    Bowman SA, Vinyard BT. Fast food consumption of U.S. adults: impact on energy and nutrient intakes and overweight status. J Am Col Nutr. 2004;23(2):163–8.CrossRefGoogle Scholar
  16. 16.
    Sturm R, An R. Obesity and economic environments. CA Cancer J Clin. 2014;64(5):337–50.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    GBD 2015 Obesity Collaborators. Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med. 2017;377(1):13–27.CrossRefGoogle Scholar
  18. 18.
    Carnell S, Gibson C, Benson L, Ochner CN, Geliebter A. Neuroimaging and obesity: current knowledge and future directions. Obes Rev. 2012;13(1):43–56.CrossRefPubMedGoogle Scholar
  19. 19.
    Zhang Y, Liu J, Yao J, Ji G, Qian L, Wang J, et al. Obesity: pathophysiology and intervention. Nutrients. 2014;6(11):5153–83.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Farooqi IS, Bullmore E, Keogh J, Gillard J, O'Rahilly S, Fletcher PC. Leptin regulates striatal regions and human eating behavior. Science. 2007;317(5843):1355.CrossRefPubMedGoogle Scholar
  21. 21.
    Wang B, Chandrasekera PC, Pippin JJ. Leptin- and leptin receptor-deficient rodent models: relevance for human type 2 diabetes. Curr Diabetes Rev. 2014;10(2):131–45.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Farooqi IS, O'Rahilly S. Recent advances in the genetics of severe childhood obesity. Arch Dis Child. 2000;83(1):31–4.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Yang R, Barouch LA. Leptin signaling and obesity: cardiovascular consequences. Circ Res. 2007;101(6):545–59.CrossRefPubMedGoogle Scholar
  24. 24.
    Hukshorn CJ, van Dielen FM, Buurman WA, Westerterp-Plantenga MS, Campfield LA, Saris WH. The effect of pegylated recombinant human leptin (PEG-OB) on weight loss and inflammatory status in obese subjects. Int J Obes Relat Metab Disord. 2002;26(4):504–9.CrossRefPubMedGoogle Scholar
  25. 25.
    Maffeis C, Manfredi R, Trombetta M, Sordelli S, Storti M, Benuzzi T, et al. Insulin sensitivity is correlated with subcutaneous but not visceral body fat in overweight and obese prepubertal children. J Clin Endocrinol Metab. 2008;93(6):2122–8.CrossRefPubMedGoogle Scholar
  26. 26.
    Björntorp P. Obesity, atherosclerosis and diabetes mellitus. Verh Dtsch Ges Inn Med. 1987;93:443–8.PubMedGoogle Scholar
  27. 27.
    Tiedemann LJ, Schmid SM, Hettel J, Giesen K, Francke P, Büchel C, et al. Central insulin modulates food valuation via mesolimbic pathways. Nat Commun. 2017;8:16052.CrossRefPubMedPubMedCentralGoogle Scholar
  28. 28.
    Nauck MA, Meier JJ. Incretin hormones: their role in health and disease. Diabetes Obes Metab. 2018;20(Suppl 1):5–21.CrossRefPubMedGoogle Scholar
  29. 29.
    Turnbaugh PJ, Ley RE, Mahowald MA, Magrini V, Mardis ER, Gordon JI. An obesity-associated gut microbiome with increased capacity for energy harvest. Nature. 2006;44(7122):1027–31.CrossRefGoogle Scholar
  30. 30.
    Ridaura VK, Faith JJ, Rey FE, Cheng J, Duncan AE, Kau AL, et al. Gut microbiota from twins discordant for obesity modulate metabolism in mice. Science. 2013;341(6150):1241214.CrossRefPubMedGoogle Scholar
  31. 31.
    Rajpal DK, Klein JL, Mayhew D, Boucheron J, Spivak AT, Kumar V, et al. Selective spectrum antibiotic modulation of the gut microbiome in obesity and diabetes rodent models. PLoS One. 2015;10(12):e0145499.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Rastelli M, Knauf C, Cani PD. Gut microbes and health: a focus on the mechanisms linking microbes, obesity, and related disorders. Obesity (Silver Spring). 2018;26(5):792–800.CrossRefGoogle Scholar
  33. 33.
    Herrera BM, Lindgren CM. The genetics of obesity. Curr Diab Rep. 2010;10(6):498–505.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    • Loos RJ. The genetics of adiposity. Curr Opin Genet Dev. 2018;50:86–95. A review of the current knowledge regarding the genetic determinants of overweight and obesity. CrossRefPubMedGoogle Scholar
  35. 35.
    Locke AE, Kahali B, Berndt SI, Justice AE, Pers TH, Day FR, et al. Genetic studies of body mass index yield new insights for obesity biology. Nature. 2015;518(7538):197–206.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    • Shungin D, Winkler TW, Croteau-Chonka DC, Ferreira T, Locke AE, Mägi R, et al. New genetic loci link adipose and insulin biology to body fat distribution. Nature. 2015;518(7538):187–96. Through GWASs, identified numerous novel loci associated with visceral adiposity shedding new light on underlying pathophysiological mechanisms. CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    James WP. The epidemiology of obesity: the size of the problem. J Intern Med. 2008;263(4):336–52.CrossRefPubMedGoogle Scholar
  38. 38.
    Chen C. Overview of obesity in Mainland China. Obes Rev. 2008;9(Suppl 1):14–21.CrossRefPubMedGoogle Scholar
  39. 39.
    Pradeepa R, Anjana RM, Joshi SR, Bhansali A, Deepa M, Joshi PP, et al. Prevalence of generalized & abdominal obesity in urban & rural India—the ICMR-INDIAB study (phase-I) [ICMR- NDIAB-3]. Indian J Med Res. 2015;142(2):139–50.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Levine JA. Poverty and obesity in the U.S. Diabetes. 2011;60(11):2667–8.CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Story M, Kaphingst KM, Robinson-O'Brien R, Glanz K. Creating healthy food and eating environments: policy and environmental approaches. Annu Rev Public Health. 2008;29:253–72.CrossRefPubMedGoogle Scholar
  42. 42.
    Cooksey-Stowers K, Schwartz MB, Brownell KD. Food swamps predict obesity rates better than food deserts in the United States. Int J Environ Res Public Health. 2017;14(11):E1366.CrossRefPubMedGoogle Scholar
  43. 43.
    • Twig G, Yaniv G, Levine H, Leiba A, Goldberger N, Derazne E, et al. Body-mass index in 2.3 million adolescents and cardiovascular death in adulthood. N Engl J Med. 2016;374(25):2430–40. A population-based study which found an association between elevated BMI in adolescence and cardiovascular mortality later in adulthood. CrossRefPubMedGoogle Scholar
  44. 44.
    Flegal KM, Graubard BI, Williamson DF, Gail MH. Excess deaths associated with underweight, overweight, and obesity. JAMA. 2005;293(15):1861–7.CrossRefPubMedGoogle Scholar
  45. 45.
    Berrington de Gonzalez A, Hartge P, Cerhan JR, Flint AJ, Hannan L, RJ MI, et al. Body-mass index and mortality among 1.46 million white adults. N Engl J Med. 2010;363(23):2211–9.CrossRefPubMedGoogle Scholar
  46. 46.
    Iliodromiti S, Celis-Morales CA, Lyall DM, Anderson J, Gray SR, Mackay DF, et al. The impact of confounding on the associations of different adiposity measures with the incidence of cardiovascular disease: a cohort study of 296,535 adults of white European descent. Eur Heart J. 2018;39(17):1514–20.CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Umer A, Kelley GA, Cottrell LE, Giacobbi P Jr, Innes KE, Lilly CL. Childhood obesity and adult cardiovascular disease risk factors: a systematic review with meta-analysis. BMC Public Health. 2017;17(1):683.CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Yu E, Ley SH, Manson JE, Willett W, Satija A, Hu FB, et al. Weight history and all-cause and cause-specific mortality in three prospective cohort studies. Ann Intern Med. 2017;166(9):613–20.CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Sam S. Differential effect of subcutaneous abdominal and visceral adipose tissue on cardiometabolic risk. Horm Mol Biol Clin Investig. 2018;33
  50. 50.
    Heymsfield SB, Peterson CM, Thomas DM, Heo M, Schuna JM Jr. Why are there race/ethnic differences in adult body mass index-adiposity relationships? A quantitative critical review. Obes Rev. 2016;17(3):262–75.CrossRefPubMedGoogle Scholar
  51. 51.
    Razak F, Anand SS, Shannon H, Vuksan V, Davis B, Jacobs R, et al. Defining obesity cut points in a multiethnic population. Circulation. 2007;115(16):2111–8.CrossRefPubMedGoogle Scholar
  52. 52.
    Andreoli A, Garaci F, Cafarelli FP, Guglielmi G. Body composition and clinical practice. Eur J Radiol. 2016;85(8):1461–8.CrossRefPubMedGoogle Scholar
  53. 53.
    Vasan SK, Osmond C, Canoy D, Christodoulides C, Neville MJ, Di Gravio C, et al. Comparison of regional fat measurements by dual-energy X-ray absorptiometry and conventional anthropometry and their association with markers of diabetes and cardiovascular disease risk. Int J Obesity (Lond). 2018;42(4):850–7.CrossRefGoogle Scholar
  54. 54.
    Baum T, Cordes C, Dieckmeyer M, Ruschke S, Franz D, Hauner H, et al. MR-based assessment of body fat distribution and characteristics. Eur J Radiol. 2016;85(5):1512–8.CrossRefPubMedGoogle Scholar
  55. 55.
    Olson C. Achieving a healthy weight gain during pregnancy. Annu Rev Nutr. 2008;28:411–23.CrossRefPubMedGoogle Scholar
  56. 56.
    Oken E, Rifas-Shiman SL, Field AE, Frazier AL, Gillman MW. Maternal gestational weight gain and offspring weight in adolescence. Obstet Gynecol. 2008;112(5):999–1006.CrossRefPubMedPubMedCentralGoogle Scholar
  57. 57.
    Williams CB, Mackenzie KC, Gahagan S. The effect of maternal obesity on the offspring. Clin Obstet Gynecol. 2014;57(3):508–15.CrossRefPubMedPubMedCentralGoogle Scholar
  58. 58.
    Owen CG, Martin RM, Whincup PH, Smith GD, Cook DG. Effect of infant feeding on the risk of obesity across the life course: a quantitative review of published evidence. Pediatrics. 2005;115(5):1367–77.CrossRefPubMedGoogle Scholar
  59. 59.
    • Seidell JC, Halberstadt J. The global burden of obesity and the challenges of prevention. Ann Nutr Metab. 2015;66(Suppl 2):7–12. Provides insight into obesity trends in various countries. CrossRefPubMedGoogle Scholar
  60. 60.
    111th Congress (2009–2010). H.R.3590: Patient Protection and Affordable Care Act. Accessed 25 May 2018.
  61. 61.
    Wang Y, Wu Y, Wilson RF, Bleich S, Cheskin L, Weston C, et al. Childhood obesity prevention programs: comparative effectiveness review and meta-analysis. Rockville: AHRQ Comparative Effectiveness Reviews; 2013.Google Scholar
  62. 62.
    Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG, Donato KA, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association task force on practice guidelines and the obesity society. J Am Coll Cardiol. 2014;63(25 Pt B):2985–3023.CrossRefPubMedGoogle Scholar
  63. 63.
    Elfhag K, Rössner S. Who succeeds in maintaining weight loss? A conceptual review of factors associated with weight loss maintenance and weight regain. Obes Rev. 2005;6(1):67–85.CrossRefPubMedGoogle Scholar
  64. 64.
    • Bray GA, Frühbeck G, Ryan DH, Wilding JP. Management of obesity. Lancet. 2016;387(10031):1947–56. A review of current clinical management of overweight and obesity, including lifestyle modification, pharmacotherapy, and surgery. CrossRefPubMedGoogle Scholar
  65. 65.
    Look AHEAD Research Group. Eight-year weight losses with an intensive lifestyle intervention: the look AHEAD study. Obesity (Silver Spring). 2014;22(1):5–13.CrossRefGoogle Scholar
  66. 66.
    LeFevre ML. US preventive services task force. Behavioral counseling to promote a healthful diet and physical activity for cardiovascular disease prevention in adults with cardiovascular risk factors: U.S. preventive services task force recommendation statement. Ann Intern Med. 2014;161(8):587–93.CrossRefPubMedGoogle Scholar
  67. 67.
    Wing RR, Bolin P, Brancati FL, Bray GA, Clark JM, Coday M, et al. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med. 2013;369(2):145–54.CrossRefPubMedGoogle Scholar
  68. 68.
    Dunkley AJ, Charles K, Gray LJ, Camosso-Stefinovic J, Davies MJ, Khunti K. Effectiveness of interventions for reducing diabetes and cardiovascular disease risk in people with metabolic syndrome: systematic review and mixed treatment comparison meta-analysis. Diabetes Obes Metab. 2012;14(7):616–25.CrossRefPubMedGoogle Scholar
  69. 69.
    • Bersoux S, Byun TH, Chaliki SS, Poole KG. Pharmacotherapy for obesity: what you need to know. Cleve Clin J Med. 2017;84(12):951–8. An overview of the current FDA-approved pharmacotherapies for weight loss. CrossRefPubMedGoogle Scholar
  70. 70.
    Khera R, Pandey A, Chandar AK, Murad MH, Prokop LJ, Neeland IJ, et al. Effects of weight-loss medications on cardiometabolic risk profiles: a systematic review and network meta-analysis. Gastroenterology. 2018;154(5):1309–19.CrossRefPubMedGoogle Scholar
  71. 71.
    Marso SP, Daniels GH, Brown-Frandsen K, Kristensen P, Mann JF, Nauck MA, et al. Liraglutide and cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2016;375(4):311–22.CrossRefPubMedPubMedCentralGoogle Scholar
  72. 72.
    Mechanick JI, Youdim A, Jones DB, Timothy Garvey W, Hurley DL, Molly McMahon M, et al. Clinical practice guidelines for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient-2013 update: cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery. Surg Obes Relat Dis. 2013;9(2):159–91.CrossRefPubMedGoogle Scholar
  73. 73.
    American Society for Metabolic and Bariatric Surgery. Estimate of Bariatric Surgery Numbers, 2011–2016. Accessed 25 May 2018.
  74. 74.
    • Sjöström L, Peltonen M, Jacobson P, Sjöström CD, Karason K, Wedel H, et al. Bariatric surgery and long-term cardiovascular events. JAMA. 2012;307(1):56–65. The first study to demonstrate cardiovascular benefit of bariatric surgery, conducted in a small Swedish population. CrossRefPubMedGoogle Scholar
  75. 75.
    Sjöström L. Review of the key results from the Swedish obese subjects (SOS) trial—a prospective controlled intervention study of bariatric surgery. J Intern Med. 2013;273(3):219–34.CrossRefPubMedGoogle Scholar
  76. 76.
    Sjöström L, Peltonen M, Jacobson P, Ahlin S, Andersson-Assarsson J, Anveden Å. Association of bariatric surgery with long-term remission of type 2 diabetes and with microvascular and macrovascular complications. JAMA. 2014;311(22):2297–304.CrossRefPubMedGoogle Scholar
  77. 77.
    Frühbeck G. Bariatric and metabolic surgery: a shift in eligibility and success criteria. Nat Rev Endocrinol. 2015;11(8):465–77.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Department of MedicineNorthwestern University Feinberg School of MedicineChicagoUSA
  2. 2.Division of Cardiology, Department of MedicineNorthwestern University Feinberg School of MedicineChicagoUSA
  3. 3.Department of Preventive MedicineNorthwestern University Feinberg School of MedicineChicagoUSA

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