The Obesity–Cardiometabolic Link: Root Causes, Screening, and Primary Care's Role

Cardiometabolic diseases—including cardiovascular disease, hypertension, and type 2 diabetes—often present as distinct conditions. But according to Monu Khanna, MD, a board-certified internist and obesity medicine specialist, they frequently share a common driver: obesity. In this conversation with Patient Care editors, Dr Khanna discusses how insulin resistance, inflammation, and poor metabolic health fuel these chronic conditions, and how a root-cause approach to weight management can improve outcomes across the board. She also emphasizes the central role of primary care in early screening, prevention, and management. Watch the video above for the full discussion.

The following transcript has been edited for clarity, flow, and style.

Patient Care: Can you explain the relationship between obesity and cardiometabolic diseases such as cardiovascular disease, hypertension, and type 2 diabetes?

Monu Khanna, MD: It’s a great question. Traditionally in Western medicine, we thought of obesity, high blood pressure, and diabetes as separate issues. But what we’ve learned is that the root cause of these chronic diseases is often the same. The same disease pathways create all of them. If we focus on the root causes—like insulin resistance and inflammation—we can see improvements across the board. Inflammation can cause diabetes, increase cancer risk, and contribute to atherosclerosis and heart disease.

We need a shift in how we think and treat these conditions. Rather than putting a bandage on high blood pressure, we should ask: Why is the patient hypertensive? Are there toxic exposures? Hormonal imbalances? Fixing those has a broader impact on weight, cardiovascular disease risk, and other chronic conditions.

Patient Care: Can you discuss the importance of early detection and screening for cardiometabolic risk in patients with obesity?

Khanna: Obesity and cardiometabolic risk go hand in hand. Data show that 93% of U.S. adults have suboptimal cardiometabolic health. That means only 7% are metabolically healthy. Risk factors include abdominal obesity, hypertension, high cholesterol, and elevated blood glucose.

One in five deaths is related to cardiovascular disease. Prevention is always better than treatment. Awareness and education should start early, even in schools—teaching children about healthy food choices and movement.

Some populations have higher risk based on ethnicity. The more we talk about this, the more strategies we can develop. As we age, our risk increases, so education should start early.

Patient Care: How can physicians—especially primary care—address prevention and management?

Khanna: Primary care providers are the heart and soul of our healthcare system. It’s a tough job, but also very impactful. You get to know your patients—their background, their lifestyle, what gives them purpose.

If you know a patient doesn’t have access to a gym but loves gardening, encourage that. Activities like weeding and mulching offer movement and joy. That connection is something only primary care can offer.

PCPs also have first access to labs and preventive screenings. You see the lipid panels, the A1c creeping up. You’re in a position of trust and influence. Teaching PCPs how to identify these patterns and intervene can have a huge impact.

Patient Care: What are some recommendations you would give to physicians regarding prevention and management?

Khanna: Obesity is a chronic disease—it needs to be acknowledged and documented. If we don’t label it, we don’t address it.

Unhealthy weight is often the root of hypertension, diabetes, and cardiovascular disease. Treating obesity can improve many chronic conditions.

Start with a non-stigmatizing, inclusive conversation. Let patients know weight isn’t taboo, and there are tools—teams, medications, strategies—to help them. Set realistic expectations.

For example, weight gain might occur after back-to-back pregnancies or during menopause. As men retire and move less, they may gain weight while maintaining the same eating habits. These are natural life stages, and we need to prepare patients for them.

Screen appropriately, document honestly, and understand that like diabetes or cancer, obesity is a disease with evidence-based treatments.

Patient Care: What are three key takeaways for our primary care physician audience?

Khanna: First, obesity is often the root of cardiovascular disease. While not every person with cardiovascular disease has obesity, it’s a major driver.

Second, build rapport so patients feel comfortable discussing weight. Much of the stigma around obesity occurs in healthcare settings.

Third, obesity medicine is advancing rapidly. We have many new tools, including highly effective medications that also lower cardiovascular risk. Get educated. Join professional associations. Stay updated, because we now have better ways than ever to help our patients.