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Severe Obesity and Left Ventricular Geometry

Obesity is a condition encompassing a broad range of clinical presentations from a nearly normal status to a life-threatening disease. In the absence of a permeating campaign raising the level of attention to the problem of obesity, many obese individuals see their doctors only for esthetic reasons. A large number of subjects, in fact, seem to live quite well even with moderate or severe obesity. Others, albeit feeling healthy, look for dietary interventions not only to improve their body build but also to increase the level of their self-esteem. Some others, a minority, usually those in class III,1 progressively develop symptoms and clinical signs that raise their level of attention and force them to see doctors. The latter type of obese subjects is usually more motivated and, therefore, tends to be more compliant with physicians’ suggestions and indications. There is a proportion of these individuals who are considered to be at higher risk, and when their motivations are strong enough, they are sent to bariatric surgery. When examining those obese subjects, doctors and researchers need to be aware that they represent the tip of the iceberg, far away from the reality of obesity in general and from the real cardiovascular risk attributable to obesity in population. Because of the a priori selection, hypertension, diabetes, joint pain, and whatever comorbidity is limiting quality of life are very frequent in those patients. Their cardiovascular risk is higher than in obese patients without prevalent comorbidities, and, unsurprisingly, they also show high levels of left ventricular (LV) mass partly related to coexisting abnormalities consistent with findings in the setting of the metabolic syndrome.2,3 Abnormalities of LV geometry get worse as the severity of morbid obesity increases. In this issue of the journal, Avelar et al 4 add another