Health Network》Don’t wait for three highs before prescribing medicines Research: Treat obesity first

[Health Channel/Comprehensive Report] Many people think that men with a medium-to-large figure, or women with an avocado figure, are just a little fatter and can wait until complications occur before treatment. On the contrary, foreign research emphasizes that "obesity should be actively treated before complications occur." Liu Chengen, the director of Anxin Nanzi Internal Medicine Clinic and a nephrologist, said in Threads "Liu Chengen" that at the end of October 2026, the authoritative American Obesity Medicine Association (OMA) published the latest clinical practice statement in the journal "Obesity Pillars", issuing a strong appeal to the global medical community and the public: We must completely reverse the old thinking of "waiting for the occurrence of three high complications before prescribing drugs" and adopt a source defense strategy of "Treat obesity first"!

This bombshell statement points out that obesity does not damage blood vessels through only one way, but through two routes: "physical oppression of fat weight (Fat Mass Disease)" and "chemical poisoning of sick fat (Sick Fat Disease)" that jointly attack our hearts and kidneys! Today, Dr. Cheng En, who is a specialist in internal medicine and nephrology, will take everyone to understand the behind-the-scenes of these two sad and painful kidney diseases!

The first path: "Fat weight disease" not only crushes the knees, but also the heart and kidneys are "strangled" by fat!

When the body carries too much fat weight, in addition to the well-known wear and tear of knee joints, our internal organs are actually subjected to huge "physical compression and overload" every day.

Heart overwork and physical constraints: Excessive weight forces the heart to increase blood output, leading to long-term left ventricular hypertrophy and impaired diastolic function. In addition, pericardial fat directly "tightens" the heart, which can easily lead to normal systolic fraction heart failure (HFpEF).

The kidneys are "choked" by visceral fat and increase high blood pressure: The fat accumulated in the abdominal cavity and around the kidneys will directly physically compress the kidneys, forcibly activating the "renin-angiotensin-aldosterone system (RAAS)" in the body, keeping blood pressure and nephroglomerular pressure high!

Compression of the respiratory tract and lower limb veins: Fat accumulation in the neck can induce sleep apnea (OSA) and arrhythmia; compression of the veins in the lower body and reduced mobility will increase venous blood retention and the risk of thrombosis.

The second path: "Sickly toxic fat" - the oil wrapped around the heart can actually corrode blood vessels "from the outside in"!

Many people don’t know that when fat cells are overcrowded and necrotic due to lack of oxygen, they are no longer just warehouses for storing heat, but will mutate into an “inflammation arsenal” that continuously releases toxic gases (medically known as Adiposopathy):

Systemic metabolic inflammation storm: Inflamed fat cells will release large amounts of free fatty acids and inflammatory factors, causing severe insulin resistance and "lipotoxicity", directly leading to type 2 diabetes, hypertension, hyperlipidemia and thrombosis-prone constitution.

Terrifying "outside-in" heart attack: In the past, we thought that vascular sclerosis was caused by the "inside-out" deposition of cholesterol in the blood; however, the "epicardial morbid fat" directly attached to the surface of the myocardium and coronary arteries will directly inject inflammatory toxins from the outside of the blood vessels, accelerating coronary arteriosclerosis, myocardial fibrosis and atrial fibrillation!

Three major international clinical evidences: the new generation of enterocrine not only reduces weight, but can also directly "save the heart and prevent failure"!

Since "physical weight" and "inflammation poisonous oil" are twin storms occurring at the same time, treatment must be two-pronged! The statement specifically reviewed three major clinical trials that have rewritten the history of cardiac medicine in recent years, proving that new weight loss drugs can bring about organ protection that goes beyond simple weight loss:

SELECT trial (Preventing Stroke and Myocardial Infarction): In overweight or obese adults without diabetes but with cardiovascular disease, weekly administration of semaglutide significantly reduced the risk of major adverse cardiovascular events by 20%.

STEP-HFpEF trial (Improving Heart Failure Symptoms): For obese heart failure patients, Semaglutide led to an average weight loss of 13.3%, and significantly improved the patients' symptoms of walking breathlessness, edema and weakness, and inflammation indicators in the body.

SUMMIT trial (Reducing Worsening of Heart Failure and Death): The dual-acting incretin Tirzepatide significantly reduced the combined risk of cardiovascular death or worsening of heart failure in 731 obese patients with heart failure.

Reduce the burden of atrial fibrillation: Although enterocrine will slightly increase the heartbeat by 2 to 3 beats per minute, through weight loss, anti-inflammation and improvement of atrial structure, it can significantly reduce dangerous "atrial fibrillation" episodes!

Liu Chengen said that if you want to dismantle the fat bomb wrapped around the heart and kidneys, please keep in mind the following three action guidelines:

Don’t just look at BMI, but also measure “waist circumference and body composition”: Asians are particularly prone to accumulation of visceral fat (thin limbs, big belly). Even if the BMI does not reach severe obesity, as long as the waist circumference exceeds the standard, early intervention should be performed.

Break the old thinking of "waiting for illness before taking medicine": implement the principle of "treat obesity first" and remove morbid fat from the source before it turns into diabetes, kidney failure or stroke.

Make good use of the precise weapon that protects the heart and kidneys: combine diet, exercise and a new generation of enterocrine with cardiovascular evidence to simultaneously achieve the dual goals of "reduce fat weight" and "fight fat inflammation".