Introduction: Obesity or body mass index (BMI) ≥ 30 is a risk factor for atherosclerosis. The 2011 AHA/ACCF secondary prevention guidelines recommend weight measurement at every visit and targeting BMI in normal range in management of patients with atherosclerotic diseases like peripheral arterial disease (PAD). However, no studies have prospectively examine obesity management in a vascular specialty setting and whether patients with PAD successfully address this risk factor are lacking.
Methods: Participants from the 16-center PORTRAIT registry presenting with new or worsening PAD symptoms to a vascular clinic were included in this analysis. BMIs were calculated for all patients (kg/m2) and categorized as normal (18.4 -24.9), overweight (25 -29.9), and obese (≥ 30). Referral rates for weight/diet counseling during the initial PAD visit were assessed and site variability for weight/diet counseling rates among obese/overweight participants was estimated using median odds ratios (MOR).Weight information was collected at 1 year through interviews and rates of successful weight loss ≥5 were calculated. A hierarchical multivariable logistic regression with a random effect for site was used to assess predictors of ≥5 % weight loss at 1 year.
Results: Among 1275 enrollees, we excluded 273 participants without documented BMI. The prevalence of obesity among those with documented BMI was 37% (n=370). Obese participants were more likely to have sleep apnea, hypertension, coronary disease and diabetes but less likely to be active smokers compared to those with normal weight. The prevalence of weight/diet counselling among normal, overweight and obese participants were 8.7%, 12.0%, 20.5% (p-value < 0.001) respectively. Weight loss of ≥ 5% occurred in 93(30.2%) of obese participants. Predictors of ≥ 5% weight loss at 12 months included male, coronary disease, diabetes, and country. There was significant variability in the utilization of weight/diet counselling across participating sites (MOR =2.8 (1.8 - 6.0), Fig).
Conclusion: Only 1 in 5 obese patients were offered weight/diet counseling and 30% achieved weight loss of ≥ 5%. There was marked site variability in the use of weight management in these patients. This suggests an opportunity for improvement in addressing this important cardiovascular risk factor.