A lifestyle weight loss intervention among severely obese patients and its impact on structural and functional subclinical CVD
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Obesity is a major health concern plaguing our society today and additional lifestyle solutions are required before any major strides are made in decreasing the effects of this deadly disease. Data from several longitudinal studies - including Framingham and the Nurses' Health Study show that obesity is an independent risk factor for cardiovascular disease mortality, even after adjusting for obesity related risk factors. Primary prevention trials for cardiovascular disease that target lifestyle changes in the obese and morbidly obese have not been described extensively in the literature. Those that have been published are limited by small sample size, short timelines and populations with existing cardiovascular disease. While morbidly obese individuals represent 8% of the obese population, current trends in obesity prevalence suggest that this population will increase, affecting both hard and soft cardiovascular endpoints. Early detection of cardiovascular disease is necessary in order to intervene in a timely fashion and possibly reverse the effects of obesity. Both carotid intima-media thickness (CIMT) and brachial artery reactivity (BAR) have been established in the literature as markers of structural and functional early atherosclerosis, respectively. Their utility in measuring subclinical cardiovascular disease is insightful in the context of a lifestyle intervention targeting morbidly obese populations. The Health Improvement Project (HIP) is a lifestyle intervention program in which morbidly obese individuals were randomized into a low-calorie diet, physical activity and behavioral therapy or a very low-calorie diet, physical activity and behavioral therapy. CIMT and BAR were measured over time in order to determine whether either intervention affected these structural and functional markers. The major aim of this thesis is to examine the effects of caloric restriction on changes in the carotid intima media thickness (CIMT) and brachial artery reactivity (BAR) in a group of participants with class III obesity. For this thesis analysis, 121 participants who came in to the ultrasound lab at the University at Buffalo for a baseline and three month scan for a carotid and brachial ultrasound test will be included.