Managing Obesity and Cardiovascular Risk in Primary Care Across Resource Settings

Dr. Mohan T. Shenoy, Consultant Endocrinologist at GG Hospital, Trivandrum,

“Global obesity is rising, driving type 2 diabetes, hypertension, and cardiovascular disease, with BMI and WHtR similarly identifying risk. Combating this crisis requires combining public health measures, affordable pharmacotherapy, and research into adipose biology for equitable global impact.”

Global projections indicate that by 2050, 50% of people will be overweight, and 16% will be classified as obese. Adiposity has serious health consequences, contributing not only to type 2 diabetes but also significantly increasing the risk of developing hypertension.

A recent analysis by the NCD Risk Factor Collaboration compared body mass index (BMI) and waist-to-height ratio (WHtR) in 7.5 million adults worldwide to determine which measure better identified individuals with hypertension. Despite long-standing debate that abdominal adiposity may better reflect cardiometabolic risk, BMI and WHtR showed nearly identical ability to discriminate hypertension across all regions and sexes.

Assessing obesity in low-resource primary care settings is important, even though major cardiovascular risk tools, like the SCORE2 models, do not include measures such as BMI or waist circumference. These models estimate the 10-year risk of cardiovascular disease using factors like age, sex, blood pressure, lipids, and smoking, based on extensive cohort studies. Previous research indicated that adding adiposity measures did not significantly enhance risk predictions, as seen with the Framingham Risk Score. Nonetheless, obesity assessment in primary care is crucial, particularly where non-laboratory-based indicators are necessary for adequate patient care.

New pharmacotherapies, especially GLP-1 receptor agonists such as semaglutide and emerging dual agonists like tirzepatide, offer powerful weight-loss effects and cardiometabolic benefits. However, high costs limit access in many low- and middle-income countries, despite their higher metabolic risk.

Tackling the obesity crisis requires combining pharmacotherapy with public health measures, lowering GLP-1 costs, improving manufacturing, and finding ways to convert fat into brown adipose tissue through different research..

(Source: Schutte AE. Addressing obesity and subsequent cardiovascular risk in primary care: the relevance of high- and low-resource settings. Cardiovasc Res. 2025;121(8):1135-1137. doi:10.1093/cvr/cvaf094.; https://academic.oup.com/cardiovascres/article/121/8/1135/8161606)