Wake Up to Heart Risks: Overweight and Obesity Linked
Being overweight or obese in middle age, even if you do not have risk factors such as high blood pressure or high cholesterol, increases the odds that you will develop heart disease later in life, according to a report in the Journal of the American Medical Association (JAMA).
And if you are overweight or obese, or have other factors that put you at high risk for heart disease or stroke, chances are you are not getting the treatment you need, a second study in JAMA states.
The US Surgeon General has declared that overweight and obesity have reached epidemic proportions in this country. One in three US adults are overweight or obese and 16 percent of children between the ages of six and 19 are overweight.
Public health officials say physical inactivity and poor diet are catching up to tobacco as a significant threat to health. Currently, about 28 percent of men and 33 percent of women are considered seriously overweight.
Obesity is a serious, chronic disease that can inflict substantial harm to a person’s health.
"All this screaming about obesity, cholesterol, blood pressure, and tobacco that's been bombarding you really is truthful," says Dr. Stephen Siegel, a cardiologist at New York University Medical Center. "These are problems that can really impact your life."
Dr. Siegel adds, "The message for middle-aged people is that, just as you worry about saving for your retirement with 401ks and Keoghs, you also need to worry about your health retirement, and you need to invest in good health at this stage in order to be able to enjoy retirement."
The first study set out to settle the debate about whether excess weight by itself puts people at greater risk of heart disease. Or does being overweight lead to other heart disease risk factors, such as high cholesterol, diabetes, and high blood pressure?
The researchers examined data on 17,643 men and women between the ages of 31 and 64 who were included in the Chicago Heart Association Detection Project in Industry.
The researchers divided the study participants into five groups: low risk, moderate risk, intermediate risk, elevated risk, and highest risk for heart disease.
Those in the low-risk group did not smoke, and had normal blood pressure and cholesterol readings.
The moderate-risk group also did not smoke, but may have had either slightly elevated blood pressure or cholesterol.
Persons in the intermediate-risk group had one of the following risk factors: current smoking, high cholesterol, or high blood pressure. Those in the elevated-risk group had two of those risk factors, and the highest-risk group had all three.
The researchers also gathered information on the participants' body mass index (BMI), a ratio of weight to height. The average follow-up time was 32 years.
The risk of death from heart disease was 43 percent higher for obese people in the low-risk group compared to people of normal weight.
In the moderate-risk group, the risk of death from heart disease was 2.1 times higher for obese persons.
The risk of hospitalization was also higher for obese persons - in the low-risk group, obese people had a 4.2 times greater risk of hospitalization for heart disease.
"Our study is one more piece of evidence that overweight and obesity do increase health risks, whether or not you have other risk factors," says study author Lijing Yan, at the Northwestern University Feinberg School of Medicine in Chicago.
People need to pay attention and maintain a healthy body weight," he says.
The second study included information on nearly 70,000 people from 44 countries. All of the study participants had established arterial diseases, such as heart disease, stroke, or peripheral artery disease.
Many of these people were also overweight or obese, according to the researchers.
In these persons, who were already at high risk for additional problems, almost 70 percent were undertreated for high cholesterol, nearly 80 percent were undertreated with anti-clotting medications, and 50 percent had undertreated high blood pressure, the study found.
"We found a high rate of undertreatment in this population, most of whom already had a heart attack or stroke," says study author Dr. Deepak Bhatt, a cardiologist at the Cleveland Clinic.
"Risk factors weren't optimally controlled," he says. "There were far from optimal rates of antiplatelet therapy and statins, and people were still hypertensive at visits."
Both Drs. Bhatt and Siegel said patient reluctance to take medication may be one of the reasons for undertreatment.
Another reason, according to Dr. Bhatt, may be the cost of treating these risk factors. It may also be that primary-care physicians, the physicians who were treating most of the people in this study, may not be aware of current guidelines for each specialty.
Dr. Bhatt says an electronic system could help with some of these factors. For example, if a patient had high cholesterol, the system would flag that patient and provide the treating physician with the most current guidelines available.
The study also found that 16 percent of persons with symptoms of heart disease had other circulatory problems as well. That means that someone who had symptomatic heart disease had about a one in six chance of having another circulatory problem, such as stroke or peripheral artery disease, Bhatt said.
The bottom line, according to Dr. Bhatt, is that "physicians across specialties need to be aware of the cross risks their patients face.
"Cardiologists might not worry about stroke, and likewise, neurologists might not think that their mini-stroke patient is at risk of a heart attack," he says. "We need to approach vascular disease as a problem with circulation, period. The entire circulatory system is at risk."
Dr. Siegel agrees and said physicians and patients need to think of these circulatory diseases more as one disorder.
"It's an artery problem," he says. "We tend not to think of the arteries as an organ, but that's what's failing, and artery problems can affect the heart, the kidneys, the brain, and more."
Always consult your physician for more information.
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Overweight and obesity are not the same; rather, they are different points on a continuum of weight ranging from being underweight to being morbidly obese. The percentage of people who fit into these two categories, overweight and obese, is determined by body mass index (BMI).
BMI is a measure of weight proportionate to height. BMI is considered a useful measurement of the amount of body fat.
Occasionally, some very muscular people may have a BMI in the overweight range. However, these people are not considered overweight because muscle tissue weighs more than fat tissue. Generally, BMI can be considered an effective way to evaluate whether a person is overweight or obese.
According to the National Heart, Lung, and Blood Institute (NHLBI), a BMI from 18.5 to 24.9 is considered normal while a BMI of more than 25 is considered overweight.
A person is considered obese if the BMI is greater than 30 and morbidly obese if the BMI is 40 or greater.
In general, after the age of 50, a man’s weight stabilizes and even drops slightly between the ages of 60 and 74. However, a woman’s weight continues to increase until age 60 and then begins to drop.
Another measure of obesity is the waist-to-hip ratio (WHR). The WHR is a measurement tool that looks at the proportion of fat stored on the waist, and hips and buttocks. The waist circumference indicates abdominal fat. A waist circumference over 40 inches in men and over 35 inches in women may increase the risk for heart disease and other diseases associated with being overweight.
In many ways, obesity is a puzzling disease. How the body regulates weight and body fat is not well understood. On one hand, the cause appears to be simple in that if a person consumes more calories than he or she expends as energy, then he or she will gain weight.
However, the risk factors that determine obesity can be a complex combination of genetics, socioeconomic factors, metabolic factors, and lifestyle choices, as well as other factors.
Some endocrine disorders, diseases, and medications may also exert a powerful influence on an individual’s weight.
Factors which may influence the occurrence of obesity include, but are not limited to, the following:
genetics
Studies have shown that a predisposition toward obesity can be inherited. The chance of being overweight increases by 25 percent if one or both parents are obese. Where a person carries weight - the hips or around the middle - is also strongly influenced by heredity.
metabolic factors
How a particular person expends energy is different from how someone else’s body uses energy. Both metabolic and hormonal factors are not the same for everyone, but these factors play a role in determining weight gain.
Recent studies show that levels of ghrelin, a peptide hormone known to regulate appetite, and other peptides in the stomach, play a role in triggering hunger and producing a feeling of fullness (satiety).
socioeconomic factors
There is a strong relationship between economic status and obesity, especially among women. Women who are poor and of lower social status are six times more likely to be obese than women of higher socioeconomic status.
The occurrence of obesity is also highest among minority groups, especially among women. Seventy seven percent of African-American women 20 years old or older are overweight.
lifestyle choices
Overeating, along with a sedentary lifestyle, contributes to obesity. These are lifestyle choices that can be affected by behavior change.
Eating a diet in which a high percentage of calories come from sugary, high-fat, refined foods promotes weight gain. And, as more US families eat on the go, high-calorie foods and beverages are often selected.
Lack of regular exercise contributes to obesity in adults and makes it difficult to maintain weight loss. In children, inactivity, such as watching television or sitting at a computer, contributes to obesity.
Always consult your physician for more information.
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