RE: Obesity in adults: a clinical practice guideline
References
Sean Wharton, David C.W. Lau, Michael Vallis, et al. Obesity in adults: a clinical practice guideline. CMAJ 2020;192:E875-E891.
1. Iturria-Medina Y, Sotero RC, Toussaint PJ, et al. Early role of vascular dysregulation on late-onset Alzheimer's disease based on multifatorial data-driven analysis. Nat Commun 7,11934 (2016)
2. Amen DG, Wu J, Noble G, Newberg A. Patterns of regional cerebral blood flow as a function of obesity in adults. J Alzheimer's Disease 2020; DOI 10.3233.
3. Hakim A. Small vessel disease. Front. Neurol. 10:1020. doi:10.3389/fneur.2019.01020
4.Antoine Hakim. Save Your Mind. Seven Rules to Avoid Dementia. Barlow Books. 2017
I am grateful for this publication which aims to shift the focus of obesity management from weight reduction toward improving patient-centered health outcomes. Having said that, I deeply regret the omission of dementia from the list of potential complications of obesity listed in this article. In a major study by Iturria-Medina et al (1) it was revealed that the first abnormal physiological event in the brain of individuals who will develop dementia is a reduction in cerebral blood flow, which occurs when they are still cognitively normal. Since then, multiple publications have confirmed that obesity results in a reduction of cerebral blood flow in many of the brain regions essential for cognitive activity, most recently confirmed by Amen and colleagues (2). The most likely reason for the association of obesity with brain hypo-perfusion is the inflammatory environment it promotes, which results in small vessel disease(3). It is therefore my contention that while dementia is not treatable, it is preventable (4), and emphasizing to patients the negative impact obesity has on cognitive function may provide them with a strong impetus to listen to the care provider's advice on how to manage obesity and follow it.