People concerned about heart disease rightfully fret about their cholesterol, blood pressure and blood sugar levels, but there's another overarching problem that could eclipse all those risk factors.
The nation's obesity epidemic has put more and more people at risk for developing heart disease, both on its own and by exacerbating other risk factors, experts say.
"Obesity plays a role in almost all the coronary risk factors," said Dr Vincent Bufalino, president and chief executive of Midwest Heart Specialists, medical director of Edward Heart Hospital in Naperville, Ill., and a spokesman for the American Heart Association.
Obesity can boost your levels of bad cholesterol, raise your blood pressure and increase your chances of acquiring diabetes, Bufalino said. In other words, obesity ties directly into the three biggest risk factors for heart disease.
Rising obesity rates also threaten to undermine progress that has been made in controlling those risk factors.
A study presented at the American Heart Association's annual meeting reported that blood pressure and blood sugar levels continue to rise in adults, mainly fueled by increases in obesity. Those increases are such that they overwhelm improving heart-health trends, such as a drop in "bad" cholesterol levels and lower smoking rates.
And given the rise in childhood obesity, experts believe that things will only get worse. One of every three children and teens in the United States is now obese, according to the US Centres for Disease Control and Prevention. Those children are more likely to develop heart disease later in life.
"The problem exists that the world is getting more and more obese," said Dr. Gerald Fletcher, a cardiovascular physician with the Mayo Clinic in Jacksonville, Fla. "Obesity is a major risk factor for heart disease, cancer and many other acquired diseases."
The definition of obesity and overweight depends on body mass index, or BMI, an estimate of a person's body fat. People with a BMI of 30 to 39.9 are considered obese, according to the US National Institutes of Health, and those with a BMI of 25 to 29.9 are considered overweight. A BMI of 40 or more indicates morbid obesity.
Doctors know that obesity plays a role in the three big risk factors, based on extensive research, but Bufalino said there's common-sense proof available, too. People who lose weight and keep it off, he points out, always see across-the-board improvements in those risk factors.
Sustained weight-loss best
"In all three categories - cholesterol, blood pressure and blood glucose - sustained weight loss will improve those numbers," Bufalino said.
People who lose weight experience a decrease in their high blood pressure, and their levels of "bad" cholesterol (LDL, or low-density lipoprotein) drop, according to the American Heart Association. They also tend to experience an increase in "good" cholesterol (HDL, or high-density lipoprotein), which lowers risk for heart disease and stroke by helping clear the blood vessels of bad cholesterol.
Losing weight also is considered one of the best ways to bring diabetes under control, or to avoid it altogether if a person has high blood sugar levels that indicate pre-diabetes.
People become obese by taking in more calories than they can burn off over the course of a day, according to the American Heart Association. They compound the problem by eating foods rich in fat, which contain more than twice the calories gram-for-gram of either protein or carbohydrates, and by eating foods loaded with sugar, which provides "empty" calories that have no nutritional value but drastically affect the body's blood glucose levels.
"People take care of their cars: They change the oil, they buy new tires," Fletcher said. "But there's only one body, and if we don't take care of it, we can't expect the health-care system to do it for us. You can buy another car, but you can't buy another body."
The answer, then, is a simple one: To reduce the chances that you'll develop heart disease, you need to control your kilojoule intake and exercise regularly.
A healthy diet involves watching everything you eat and counting the calories, Bufalino and Fletcher said. General tips include:
Eat more vegetables and fruits.
Select leaner cuts of meat, and try to eat fish more often.
Choose whole-grain breads and pastas over those made with white flour. The same goes for brown rice over white rice.
Cut out sugary soft drinks and fruit juices. Instead, drink water or diet beverages.
Dieting can help you lose weight, but you also need to exercise. "Reducing your kilojoule intake is what gets it started, and exercise provides the maintenance that keeps the weight off," Bufalino said.
NIH experts recommend that people who are out of shape start off slowly, performing moderate exercise - walking for a half-hour three times a week, for instance - and then build up from there.
Healthy weight loss is gradual, Bufalino said he encourages people to lose 10 pounds in six months, which is an attainable goal that keeps them from becoming frustrated. They then can build on their success.
"If you can get a 10% weight loss, that's a successful effort to control your weight problem," he said. For example, someone who is 220 pounds should try to ultimately lose 22 pounds if they want to see their heart-healthy numbers improve. (July 2010)
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