Obesity and heart health go together like burgers and fries. That’s probably not a surprise. But are you ready for a shock? Enter your height and weight into an online body mass index, or BMI, calculator. At 30 or higher (180 pounds for a 5-foot-5 woman or 225 for a 6-foot man, for example) you are obese, and that extra weight is probably harming your heart. “A fair number of people seen in a clinical practice setting are surprised to learn based on these criteria that they are overweight or obese,” says Dr. Mehreen Qureshi, a noninvasive cardiologist with Harrisburg’s PinnacleHealth (www.pinnaclehealth.org).
What is there to do about it? Here are the answers to your top five questions:
1. HOW DOES OBESITY AFFECT THE HEART?
Fat deposits in the arteries cause high blood pressure, which strains the heart and causes heart failure. Blockages in the arteries can lead to heart attack and sudden death. Obesity can also cause sleep apnea, which strains the right side of the heart and triggers failure.
Obese people are predisposed to elevated blood sugar levels or diabetes, a “coronary artery disease risk equivalent” that puts them in the same heart-disease risk as people with known heart-attack histories, says Qureshi. They can also be prone to elevated lipids, such as cholesterol.
2. IF MY HEART’S SO BAD, IS IT SAFE TO EXERCISE?
It’s true. You should check with your doctor before starting an exercise program. Symptoms such as shortness of breath, palpitations and chest tightness can be warnings that exercise should be tailored to your condition.
Still, heart problems aren’t always apparent, especially among sedentary people who don’t tax their hearts enough to trigger symptoms, says Qureshi. Basic stress testing can provide guidance on safe exercising.
3. CAN WEIGHT LOSS REVERSE HEART DAMAGE?
Good news. The answer is yes. “If you have not had major damage to the heart, a lot of the changes affecting the heart including high blood pressure in the setting of obesity can be reversed through weight loss, consuming a diet rich in fruits, vegetables and fish, and through regular, structured exercise,” says Qureshi. It takes a loss of about 10 percent of weight to significantly improve health, says Dr. Ann Rogers, director of Penn State Hershey Surgical Weight Loss (www.pennstatehershey.org). “And it has to be durable,” she adds. “It doesn’t help to lose 35 pounds and gain it all back within six months, which frequently happens with conventional diets.” Gradual weight loss is best, because sudden weight loss just sends the body into “starvation mode,” creating cravings for more food, says Qureshi.
4. I CUT BACK ON CALORIES BUT STILL CAN’T LOSE WEIGHT. WHAT’S GOING ON?
“A calorie isn’t really a calorie,” says Dr. Christopher D. Wenger, cardiologist with Lancaster General Health (www.lancastergeneralhealth.org). “Five hundred calories of carrots are nothing compared to 500 calories of carrot cake.” The glut of fructose in our foods is a big culprit in the obesity epidemic, Wenger says. When we eat fructose, “the trans fat of the sugar family,” a domino effect happens that increases blood pressure and cholesterol production and makes the liver insulin-resistant.The Mediterranean diet loaded with fruits, vegetables, nuts, beans, olive oil, fish and seafood offers healthy fats, plus the kind of insoluble fiber that fills us up and counteracts the fructose found in nature. “God packaged the poison with the antidote,” says Wenger. “Fruit has a lot of fructose, but it also has a lot of fiber.”
5. WHICH IS BEST FOR LOSING WEIGHT: DIET AND EXERCISE OR SURGERY?
Any doctor will tell you to try diet and exercise first, “but there comes a time when you’re going to feel like you’ve tried everything, and the weight is just not staying off,” says Rogers. “Weight-loss surgery is the only effective and durable way of losing a significant amount of weight, so we know it will improve heart health.” Surgical candidates have a BMI of 35 with associated medical problems, such as high blood pressure, or a BMI of 40 without health problems. Gastric bypass and the newer, increasingly popular sleeve gastrectomy, which cuts down the size of the stomach, are very safe, Rogers says (see a video at www.pennstatehershey.org/web/surgicalweightloss). Newly slim patients still have to eat right and exercise, but through surgery, they lose enough weight to improve heart health, and the weight stays off. The medical problems accompanying obesity “start melting away,” says Rogers. “We have patients whose diabetes was cured while they were still in the hospital. It’s remarkable. This is the only known cure for diabetes.”
