Obesity is a problem of epidemic proportions that is associated with adverse cardiovascular outcomes. The long-term efficacy of currently available treatments is limited, and therapeutic benefits might paradoxically be achieved only at the expense of other serious adverse cardiovascular consequences. Owing to these limitations, new paradigms in the management of obesity are being explored, including expanded surgical and pharmacologic therapies. Recent discoveries in the pathogenesis of obesity, including the discovery of leptin, might lead to new treatment options. Leptin dysregulation within the central nervous system or in peripheral adipose tissue has a putative role in the pathogenesis of obesity. Furthermore, important differences exist between men and women in regard to leptin levels; these discrepancies might ultimately impact the therapeutic approach in a gender-specific manner. The goals of obesity therapy and the appropriate therapeutic endpoints are being evaluated to maximize the efficacy of therapy and improve cardiovascular outcomes, while diminishing the risk of adverse cardiovascular complications.
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