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Watch your weight and your waist: Extra pounds may mean heart disease

When the scale starts creeping up, here’s what you should do, and why. Beware: belly fat is particularly dangerous.

Starting at around age 30, it’s common to begin putting on weight. It may not be much—a couple of pounds a year—but it adds up over time. Those extra pounds—particularly in the belly—increase the risk of heart disease.

By age 70, many seniors have put on a significant number of pounds. Their doctor may recommend that they take steps to stop the upward trend, but many seniors don’t want to bother. Some have given up after failing at many diets. Others are convinced that weight doesn’t matter at their age. But Dr. George Blackburn, associate director of the division of nutrition at Harvard Medical School, says this reasoning is faulty.

“Your weight matters at any age. Thinking it doesn’t may be a fatal error, because obesity kills,” he says. “The ideal healthy body weight is a BMI of 18.5 to 24.9. Any weight above or below that range will increase the risk of death.”

Are you overweight?

There are two ways to determine if you are overweight, and if so, by how much:
body mass index (BMI) and waist size.

  1. BMI is a measure of body fat. To calculate your BMI, multiply your weight in pounds by 703. Divide that number by your height in inches. Then divide again by your height in inches. Or you can look it up at www.health.harvard.edu/bmi. Rate your score as follows:

  • less than 18.5 = underweight

  • 18.5 to 24.9 = healthy weight

  • 25 to 29.9 = overweight

  • 30 and above = obese.

  1. Waist circumference is easy to measure with a tape measure. Your health risk is substantially increased if:

  • you’re a woman with a waist of 35 inches or more

  • you’re a man with a waist of 40 inches or more.

Fat location matters

Not all body fat is created equal. Visceral fat—the type that accumulates around the organs deep in your belly and chest—is particularly dangerous. People with belly fat often have high triglyceride levels, low levels of beneficial HDL cholesterol, high blood pressure, and high blood sugar. These factors add up to a condition called metabolic syndrome, which increases the chance of developing diabetes, heart disease, and stroke.

“Being seriously obese puts you at high risk, but having a normal weight with belly fat also increases the risk of developing a chronic disease,” says Dr. Frank Hu, a professor of nutrition and epidemiology at Harvard School of Public Health. “You need to watch your waist, not only your weight.”

Another big concern in overweight seniors is sarcopenia, which is loss of muscle and bone. Sarcopenia creates a vicious cycle: overweight people who do not exercise lose strength and mobility, which makes movement even more difficult. They become sedentary, lose more muscle and bone, and move even less. This increases the likelihood of becoming frail, losing mobility and independence, and falling.

Harvard doctors say extra weight is unhealthy. Period.

In January, a large study in The Journal of the American Medical Association suggested that carrying some extra pounds might actually be beneficial. The study found that people who were slightly overweight or “mildly obese” were 5% to 6% less likely to die than people of a healthy weight.

The benefit stopped when weight reached a certain point, however. People who were very-to-extremely obese were found to have a much higher risk of death than people who maintained a healthy weight.

This implies that it’s safe—even desirable—to carry a few extra pounds, so long as your weight doesn’t get out of hand? But Harvard experts disagree.

“Being overweight is a strong and independent risk factor for diabetes and heart disease. It would not make sense that excess weight increases the risk of chronic diseases, but reduces the risk of death,” says Dr. Hu.

Underweight can be unhealthy, too

Thin may be “in,” but carrying too few pounds may not be good for you as you age. Many older people are thin because they are malnourished or have a chronic disease. “We don’t see many thin but robust seniors,” says Dr. Hu.

In addition, people with heart failure, cancer, and other serious illness may suffer dramatic weight loss, even if they have a good appetite and eat well. This body-wasting syndrome in heart failure is called cardiac cachexia (pronounced kah-KEK-see-uh), and it increases the risk of death. People with cachexia lose muscle, bone, lean tissue, and fat all over the body. They are alsoat risk for developing fragile bones, suffering profound fatigue, and becoming extremely frail.

Why opinions differ

According to Dr. Hu, the study reached its controversial conclusion because overweight individuals were compared with a mixed bag of normal-weight individuals. Some were lean and active, but others were thin because they were heavy smokers or had a chronic disease. This caused the risk of death in the overweight and obese group to be underestimated, and gave a false impression that heavier people live longer than normal-weight people.

“Weight gain is a slippery slope—it can easily get out of hand. And the risk of being overweight is a continuum: the more excess weight you carry, the higher your risk of developing a chronic disease that can affect the length and quality of your life,” says Dr. Hu.

Nine-step action plan for overweight seniors

So if you are over 70 and carrying extra pounds, how can you normalize your weight? We asked Dr. Blackburn and Kathy McManus, the director of nutrition services at Harvard-af liated Brigham and Women’s Hospital, for advice. Their recommendations were simple:

Get moving. Buy a pedo-meter and start walking. Note how far you can walk in five minutes, and increase your walking speed and distance as you build stamina. You should strive to be able to walk a mile in 17 minutes.
Lift weights. This will strengthen your muscles. Do this even if you have a disease like arthritis that prevents you from walking.
Stretch your muscles. This will increase your flexibility.
Improve your balance. Stand on one foot for as long as possible, then switch feet. Good balance will aid your ability to walk and decrease the likelihood of falling.
Do sit-ups. Work toward doing five sit-ups in one minute.
Eat protein at every meal. You should have protein three times a day to build muscle.
Practice portion control. Cut back on the amount of food you eat. Do not eliminate any food group.
Be gentle with salt. Use herbs, garlic, lemon, and other strong flavors instead of salt to season your foods. Watch out for hidden sodium in prepared foods and
restaurant foods.
Make every bite count. Eat quality calories: fish at least twice a week, poultry, lean red meat no more than once a week, whole-grain breads and cereals, vegetables (fresh or frozen), seasonal fruits, nuts, olive and canola oils, and low-fat dairy.

Posted by: Dr.Health

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