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Obesity as a cardiovascular disease: Time to take your BMI seriously

Obesity now has an official designation as a disease. Learn how the new obesity guidelines may affect your heart health.

It’s a well-accepted fact that excess body fat strains the heart, wreaks havoc on blood sugar, blood pressure, and cholesterol levels, and diminishes health and well-being on many other levels. Despite this knowledge, it has not always been clear how best to tackle the problem. However, two recent developments may help clarify the issue.

A new view of obesity

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Even modest weight loss can lower blood pressure and blood sugar levels, which will also lower your risk of heart disease.

The first is the official designation of obesity as a disease by the American Medical Association (AMA). “I think it’s a wake-up call,” says Dr. George Blackburn, professor of nutrition at Harvard-affiliated Beth Israel Deaconess Medical Center.” This highly respected medical organization has determined that obesity is a disease in line with other cardiovascular risks such as hypertension and diabetes. There are strategies for treating these diseases; now we’re adding obesity, with body mass index as the vital sign we use to guide treatment.”

Following on the heels of the AMA statement are first-ever treatment guidelines for obesity from the American Heart Association and American College of Cardiology. This evidence-based document outlines risk categories based on body mass index (BMI).

For most people, obesity is unhealthy. An analysis of several research studies shows that most obese people who appear to be free of metabolic abnormalities (such as high cholesterol, high blood pressure, and high blood sugar) still have a higher long-term risk of cardiovascular disease than people of normal weight.

What is BMI?

Body mass index is a formula that uses your weight and height to estimate the amount of body fat you have. (See www.health.harvard.edu/bmi for a BMI calculator.) A BMI in the range of 19 to 24 is considered normal and poses minimal risk for heart disease. A BMI of 25 to 29 is considered overweight (moderate risk), and a value of 30 or over is classified as obese (high risk).

A tiered approach

Once your BMI and heart risk are determined, the often-overlooked first action is to stop gaining weight. This includes making lifestyle changes such as choosing healthy, nutrient-rich foods, controlling portion sizes, and increasing your physical activity. After weight is stabilized, you can begin work on bringing down your BMI number. “Losing just 5 pounds will make you look better and feel better, and motivate you to do more,” says Dr. Blackburn. And, because even modest weight loss can lower blood pressure and blood sugar levels, you will be improving your cardiovascular risk profile on several fronts. An added advantage: You may be able to cut back on some of the medicines you had been taking to control your other cardiovascular risks.

A key challenge to long-term health is to view lowering your BMI as part of an ongoing strategy for better heart health, not a quick weight-loss fix to get into your favorite summer outfit. It is crucial to find a calorie-control and exercise regimen that works for you. Low-fat, low-carb, and other types of low-calorie diets have been shown to be successful. Also, many people benefit from getting individual nutrition counseling or participating in weight-loss and exercise support programs.

Medical treatments for obesity

Depending on the degree of obesity, lifestyle changes alone may not be sufficient to bring your BMI into a healthy range. You may need to add weight-loss medications to your treatment plan. “After years of no new medicines, we now have three new FDA-approved drugs that are safe and effective,” says Dr. Blackburn. These are lorcaserin (Belviq), phentermine plus topiramate (Qsymia), and orlistat (Xenical, Alli). For people who are severely obese—a BMI of 40 or higher or 75 pounds or more above a healthy weight—bariatric surgery may be a useful option. This treatment has also been proven safe and effective when performed by experienced surgeons.

Characterizing obesity as a serious disease rather than an awkward personal issue paves the way for meaningful conversations between individuals and their doctors about BMI. By tracking BMI at every health check-up, the provider can a spot a worrisome trend and suggest a remedy in the same objective manner he or she would use to address high blood pressure or high cholesterol in the office visit. Another positive effect of formal obesity treatment guidelines may be more leeway by insurers to pay for a wide variety of weight-loss treatments.?

Posted by: Dr.Health

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