As obesity rates skyrocket, scrutiny of health impact broadens
Increasing rates of obesity are a global crisis in the making.
Since 1990, the number of people worldwide estimated to be living with obesity has quadrupled — totaling more than 1 billion in 2022, figures from the World Heart Report 2025 show. If such trends continue, by 20250 nearly two-thirds of adults older than 25 might live with overweight or obesity.
A session Saturday — “Getting to the Heart of Metabolic Health: An Update on Cardiovascular Kidney Metabolic Syndrome” — will explore the obesity pandemic and how it is contributing to heart health issues worldwide.
“Since 1990, obesity rates have risen in almost every country. Obesity is responsible for 10% of cardiovascular disease deaths worldwide and is among the top five causes of cardiovascular disease deaths in almost all regions,” said Jagat Narula, MD, PhD, executive vice president and chief academic officer at UTHealth Houston.
“South Asia and sub-Saharan Africa were two regions that saw some of the largest increases in mortality due to high body mass index.”
Obesity is one factor associated with cardiovascular-kidney-metabolic (CKM) syndrome, a multisystemic condition that also involves connections among heart disease, kidney disease and diabetes. CKM syndrome is linked to kidney failure and a high incidence of cardiovascular disorders such as heart failure, heart attack and stroke, as well as cardiovascular death.
In 2023, the American Heart Association issued a presidential advisory calling for changes in how to approach CKM health. The changes included:
• More clarity on the definition of kidney metabolic syndrome.
• An approach to cardio-kidney-metabolic staging that promotes prevention across the life course.
• Prediction algorithms that include the exposures and outcomes most relevant to cardiovascular-kidney-metabolic health.
• Strategies for the prevention and management of cardiovascular disease in relation to cardiovascular-kidney-metabolic health that reflect harmonization across major subspecialty guidelines and emerging scientific evidence.
The advisory also calls for prioritizing weight loss among appropriate patients as a pillar of managing CKM syndrome and heading off the development of other risk factors. Even modest weight loss of 5% to 10% can have a positive impact, Narula said. On average, systolic blood pressure decreases by about 1 mm Hg and diastolic blood pressure by 0.5 mm Hg for each kilogram of weight lost.
“Weight reduction also lowers triglycerides, increases HDL cholesterol and shifts LDL particles to a less dangerous profile, reducing the risk of atherosclerosis,” he said. “Greater weight loss is associated with reduced incidence of myocardial infarction and stroke.”
Narula, a moderator for the session Saturday, pointed out obesity’s role in other health conditions such as metabolic dysfunction-associated steatotic liver disease (MASLD), also known as nonalcoholic fatty liver disease.
“NAFLD pathophysiology is complex but is often associated with obesity and metabolic dysfunction,” he said. “In such situations, excess accumulation of fat within the liver along with altered lipoprotein metabolism due to insulin resistance can lead to damage of the liver cells.”
Another condition where obesity is a factor is excess visceral fat around the pancreas. It can lead to insulin resistance and systemic inflammation.
Saturday’s session, which is a joint presentation with the European Society of Cardiology, the American College of Cardiology and the World Heart Federation, will include three additional presentations related to the obesity pandemic and its role in cardiovascular health. They are:
• Global Burden of Disease (George Mensah, MD, FACC, director of the Center for Translation Research and Implementation Science at NIH/National Heart, Lung, and Blood Institute in Bethesda, Maryland).
• Mechanistic Oversights (Thomas Lüscher, MD, FRCP, director of research, education and development and consultant of cardiology at Royal Brompton & Harefield Hospital, London, and director of the Center for Molecular Cardiology at University Zurich.
• Therapeutic Innovations (Amanda Vest, MBBS, MPH, FHFSA, FAHA, FACC, section head of Heart Failure and Transplantation Cardiology, in the Tomsich Family Department of Cardiovascular Medicine and Miller Family Heart, Vascular and Thoracic Institute at Cleveland Clinic in Ohio).
