Cognitive behavior therapy or collaborative care for patients with clinical depression after CABG can be beneficial to reduce depression (Class IIa; Level of Evidence B). Obesity and Metabolic Syndrome Obesity is a major risk factor for cardiovascular disease. Many epidemiological studies have shown a clear associa- tion between obesity and CAD.392 The association is mediated mostly through the effect of obesity-related cardiovascular risk factors such as hypertension, dyslipidemia, or diabetes melli- tus but also through a direct atherogenic effect by increased circulation of free fatty acids, by adrenergic stimulation, and through the effect of adipose tissue related hormones. Biologically, obesity is defined as increased body fat, but for simplicity purposes, the World Health Organization defines obesity on the basis of body weight in relation to height. The most widely accepted method to diagnose obesity is the body mass index (BMI), calculated by dividing the weight in kilo- grams by the height in meters squared. Recent studies have challenged the accuracy of BMI in detecting body adipos- ity, particularly in patients with established CAD.393,394 This new evidence suggests that the assessment of adiposity needs to go beyond total body adiposity and the measurement of With a focus on the distribution of adipose tissue, central obesity and greater amounts of visceral fat convey the highest mortality risk in patients with CAD.395 The assessment of body fat distribution can be performed in a simple manner by measuring the waist and hip circumference to calculate the waist-to-hip ratio. The metabolic syndrome is defined as the coexistence of several interrelated conditions, including central obesity, hyperglycemia, elevated systemic BP, hypertriglyceridemia, and decreased HDL. 