OBESITY AND THE RISK OF HEART DISEASE

Many studies suggest that obesity is a key factor in developing heart disease, which can lead to heart attack. In addition, obesity accounts for numerous other health-related problems.

An estimated 300,000 deaths per year may be attributable to obesity, and the risk of death rises with increasing weight. Even moderate weight excess (10 – 20 pounds for a person of average height) increases the risk of death, particularly among adults age 30 - 64 years. Individuals who are obese have a 50 – 100% increased risk of premature death from all causes, compared to individuals with a healthy weight.

So what is obese and what is healthy? Doctors generally agree that men with more than 25% body fat and women with more than 30% body fat are obese. But body fat is hard to accurately measure without visiting a laboratory and being weighed in water in a carefully controlled environment. Instead, we can define obesity through the Body Mass Index (BMI). The BMI is a calculation of a persons weight in kilograms divided by their height in meters squared. According to the American Obesity Association, a BMI of 25 – 29.9 is considered overweight; a BMI of 30 or greater is considered obese.

The incidence of heart disease (heart attack, congestive heart failure, sudden cardiac death, angina or chest pain, and abnormal heart rhythm) is increased in persons who are overweight or obese. High blood pressure is twice as common in adults who are obese than in those who are at a healthy weight. Obesity is associated with elevated triglycerides (“blood fat”) and decreased HDL cholesterol (“good cholesterol”).

Patients who are obese are also at risk of diabetes. A weight gain of 11 – 18 pounds increases a persons risk of developing type 2 diabetes to twice that of individuals who haven’t gained weight. Over 80% of people with diabetes are overweight or obese.

Obesity has also been linked to other health-related problems, including cancer, breathing problems, arthritis, depression, and gall bladder disease. Obesity appears to be a growing epidemic, and has prompted the Surgeon General of the United States to publish a “call to action” guideline educating the public about obesity. In the U.S. in 1999, sixty-one percent of adults, thirteen percent of children 6 – 11 years, and 14% of adolescents 12 – 19 years were overweight or obese. These increases cut across all ages, races, ethnic groups, and both genders. The prevalence for adolescents being overweight has nearly tripled in the past two decades

What about obesity and heart disease? According to the American Heart Association, the major risk factors for heart disease are “age (65 years or older), male gender, heredity, smoking, high blood cholesterol levels, high blood pressure, physical inactivity, obesity, and diabetes.”

Obviously, some of these risk factors, such as age, gender, heredity, or diabetes cannot be changed. However, it is possible to make lifestyle modifications which may decrease the risk factors of smoking, elevated blood cholesterol, elevated blood pressure, physical inactivity or obesity.

In reality, the benefits of weight loss are dramatic. A weight loss as modest as 5 – 15% of total body weight in a person who is overweight or obese reduces the risk factors for some diseases, particularly heart disease. Weight loss can result in lower blood pressure, lower blood sugar, and improved cholesterol levels – all of which contribute to heart disease.

So what can one do to start losing weight? Regular physical activity is extremely helpful for the prevention of overweight and obesity and for maintaining weight loss. You don’t need special skills or training to be physically active; something as simple as walking is a great way to begin increasing physical activity. You should initiate your new program slowly, and intensity should be increased gradually. Start with a 10-minute walk three times a week and work your way up to 30 minutes of brisk walking or other form of moderate activity five times a week. The key to maintaining any exercise program is to select activities you enjoy and that fit into your daily life. You should also consult your doctor before beginning any new exercise program.

Successful weight loss requires a long-term weight management program that is realistic. To lose weight and/or maintain a healthy weight, consider the following:

Set realistic goals—don’t focus on the actual weight loss, but look at dietary and exercise changes that will keep weight off.

Set short-term goals that will lead to long-term goals—short-term goals are small steps that are easier to achieve and will help position you toward attaining your long-term goals.

Reward yourself—effective rewards are those that are timely, contingent on your goal achievement, and somewhat valuable to you. They do not include food.

Monitor yourself—Keep track of your progress by keeping a record of what you eat, how often you exercise, and how much you weigh. Avoid situations that cause you to overeat.

Eat slower—eating slower gives your body time to recognize that you have been fed. Also, schedule your meals at regular times so that you won't skip or delay a meal and overeat later to compensate.

By altering the “energy balance” between the intake calories from food and the output calories used during physical activity, you will be able to lose weight and, most importantly, decrease the risk of heart disease.

Dr. Raye Bellinger, MD, FACC, MBA is affiliated with the Sacramento Heart Center. For more information about the Sacramento Heart Center, call (916) 830-2080 and request information be mailed to you. Please address your cardiology-related questions to “Ask the Cardiologist”, 500 University Avenue, Sacramento, CA 95825. Selected questions will be answered in future articles.