BMI and/or waist circumference should be assessed at every visit, and the clinician should consistently encourage weight maintenance or reduction through an appropriate balance of lifestyle physical activity, structured exercise, caloric intake, and formal be- havioral programs when indicated to maintain or achieve a BMI between 18.5 and 24.9 kg/m2 and a waist circumference less than 102 cm (40 inches) in men and less than 88 cm (35 inches) in women (less for certain racial groups).257,449,635 642 (Level of Evidence: B) 2. The initial goal of weight loss therapy should be to reduce body weight by approximately 5% to 10% from baseline. With success, further weight loss can be attempted if indicated. (Level of Evidence: C) Population studies consistently have demonstrated an associ- ation of increased BMI with ischemic cardiac events. In a meta-analysis of 21 cohort studies including .300 000 persons, the risks for cardiovascular events in patients who ) and obese (BMI ) compared with those of normal weight were 32% and 81% higher, respectively, after adjustment for age, sex, physical activity, and smoking.635 Cardiovascular risk is increased particularly in patients with central obesity, which can be identified by a waist circumference .102 cm (40 inches) in men or .88 cm (35 inches) in women,643,644 and in those with extreme obesity, defined as a BMI .40 kg/m2 Obesity likely contributes to increased cardiovascular risk through multiple pathophysiological pathways. 