Rational approaches to the treatment of patients with overweight and obesity: a cardiologist’s view

The objective is to evaluate various interventions for obesity in terms of their impact on life expectancy and the development of cardiovascular complications. When determining the degree of cardiovascular risk in patients suffering from obesity, one should rely not only on body mass index (BMI), but also on other data, namely, the presence of visceral obesity, metabolic disorders and/or cardiovascular diseases, type 2 diabetes mellitus. The review assesses drug and non-drug treatments for obesity, as well as bariatric surgery. GLP-1 agonist drugs and bariatric surgery, despite a significant reduction in body weight, showed the least impact on life expectancy and the development of cardiovascular diseases and complications. Moreover, they are expensive to use and have side effects. Indications for bariatric surgery should be significantly limited. Bariatric surgery is most indicated for people with type 2 diabetes and/or cardiovascular diseases when they cannot be corrected with medication and non-medicinal means. Based on the available data, the Mediterranean diet, brisk walking, and metformin, despite a slower and more moderate weight loss, have the best effect on the prognosis in patients suffering from obesity. Metformin therapy should be added to the treatment of patients suffering from obesity in combination with metabolic disorders and cardiovascular diseases. In this case, one should not remain on the initial doses, but individually select doses depending on the patient’s BMI.