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Background: Cardiovascular diseases are the leading cause of death in Germany. The knowledge of causal risk factors and their distribution is of utmost importance to design screening programs., Probands and Methods: In this cross-sectional study design we used STROBE criteria to achieve the highest comparability possible. Anthropometric measures (height and weight), total cholesterol, glucose level, and blood pressure were measured. Probands' history was collected by using a standardized questionnaire. The data was age- and gender-adjusted for the working population 16 to 70 years of age, derived from the micro census, the 1 %-sample census of the German statistical office. For each study year weight factors were calculated. Logistic regression analysis was conducted regarding the cardiovascular risk factors: smoking, arterial hypertension, diabetes, hypercholesterolemia, and obesity., Results: Between 2006 and 2015 a total of 28,293 employees took part in the ongoing company screenings. The mean age was 42.3 years for both sexes (median: 43 years). The mean body mass index (BMI) was 25.6 kg/m 2 (men: 26.5 kg/m 2 , women: 24.7 kg/m 2 ). A history of hypertension was present in 16 % of the employees (men: 17.8 %, women: 13.8 %). Of the respondents 2 % suffered from diabetes (men: 2.4 %, women: 1.6 %). Lipid-lowering drugs were taken by 2.8 % of all employees (3.6 % men and 1.9 % women). 23.3 % of the men and women indicated to be active smokers. In the regression analysis obesity was associated with a four times higher risk of hypertension and a three times higher risk of elevated glucose levels, thus manifesting as main contributor for vascular diseases. Meanwhile the risk for obesity was 140 % higher in probands who are former smokers., Conclusions: We regard obesity as the number one cardiovascular risk which should be assessed by various medical, legislative, and socio-economic actions to limit future mortality and health-care costs in Germany.

Background: While a cause and effect relationship is traditionally thought to exist between thigh surgery and postoperative lymphedema, the link between obesity-related lymphatic and/or venous disease and post-body contouring lower extremity edema has not been investigated. We hypothesize that patients who experience prolonged lower extremity edema following thigh surgery are predisposed to developing this complication due to unrecognized preoperative lymphovascular disease., Methods: Fifty-five patients who had undergone body contouring surgery were identified from our prospective registry. Twenty-eight patients completed the Venous Clinical Severity Score (VCSS), a validated outcome measure of venous disease. Three time points were assessed: pre-weight loss (T1), post-weight loss but pre-body contouring (T2), and post-body contouring (T3). Based on T3 VCSS, patients were divided into 2 groups-a T3 VCSS ≤3 (group 1; N = 13) and a T3 VCSS ≥4 (group 2; N = 15)., Results: VCSS for group 1 at T1, T2, and T3 were 3.31 ± 0.55, 1.85 ± 0.27, and 1.54 ± 0.35 (mean ± SEM), respectively, versus 6.3 ± 1.10, 4.33 ± 0.8, and 6.8 ± 0.63 for group 2 (P < 0.05, P < 0.05, and P < 0.0001). Pain scores at T1 was 0.46 ± 0.21 for group 1 versus 1.1 ± 0.24 for group 2 (P < 0.05). Edema scores for group 1 at T1, T2, and T3 were 0.69 ± 0.29, 0.08 ± 0.08, and 0.15 ± 0.10 versus 1.87 ± 0.35, 1.13 ± 0.31, and 2.13 ± 0.24 for group 2 (P < 0.05, P < 0.001, and P < 0.0001, respectively)., Conclusions: Using VCSS, post-bariatric patients with prolonged lower extremity edema experienced clinically identifiable signs of disease prior to weight loss and body contouring surgery. Thus, careful preoperative evaluation may help identify at-risk patients and aid in managing postoperative expectations.

Background: Gastroesophageal reflux disease (GERD) affects two thirds of the American population. Obesity is also a disease that affects two thirds of the population. The pathophysiology of reflux disease is reasonably understood, however, the degree to which obesity affects this disease remains poorly defined. Therefore the approach to GERD in the obese patient requires special attention and its own algorithm.Methods: A literature search was conducted to consolidate the current available literature on GERD and its management in the obese. In addition, the authors reviewed the literature and present expert opinion on controversial topics.Results: It is well established that GERD is increased in obesity and the pathophysiology is reviewed. Management options for GERD are discussed, with a focus on the obese population. Management strategies including fundoplication and gastric bypass are discussed. In addition, bariatric surgery in the setting of GERD is also reviewed.Conclusions: Currently this is an extremely controversial topic and this white paper presents a strong review of the literature to help guide the management of this challenging disease in this population. Expert recommendations are given throughout the paper based upon the current available data. [ABSTRACT FROM AUTHOR]