The effects of stroke risk and weight reduction have not been studied extensively. A Swedish study that followed 4000 patients over 10 to 20 years, comparing individuals with weight loss through bariatric surgery and obese subjects receiving usual care, showed significant reductions in diabetes mellitus, MI, and Thirty-six thousand Swedish subjects followed for >13 years again showed a significant decrease in stroke incidence when more than 3 healthy lifestyle goals, including normal weight, were met.279 The Sibutramine Cardiovascular Outcomes (SCOUT) trial followed up 10000 patients with CVD or type 2 diabetes mellitus and found that even modest weight loss reduced cardiovascular mortality in the following 4 to 5 years.280 Reduction in body weight improves control of hypertension.A meta-analysis of 25 trials showed mean SBP and DBP reductions of 4.4 and 3.6 mmHg, respectively, with a 5.1-kg weight loss.281 The US Preventive Services Task Force currently recom- mends that all adults be screened for obesity and that patients with a BMI of 30 kg/m2 be referred for intensive multicom- ponent behavioral interventions for weight loss.282 Obesity and Body Fat Distribution: Summary and Gaps Although there is ample evidence that increased weight is associ- ated with an increased incidence of stroke, with stronger associa- tions for ischemic events, many questions remain unanswered. There is no clear and compelling evidence that weight loss in isolation reduces the risk of stroke because of the difficulty in isolating the effects of weight loss as a single contributing fac- tor rather than as a component contributing to better control of hypertension, diabetes mellitus, metabolic syndrome, and other stroke risk factors. It remains to be determined whether the dis- parities among studies stem from choosing BMI, waist-to-hip ratio, or waist circumference as the measure of obesity. 