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Heart Disease and Obesity

People who are overweight or obese have a greater chance of developing high blood pressure, high blood cholesterol or other lipid disorders, type 2 diabetes, heart disease, stroke, and certain cancers. But there is also good news: even a small weight loss (just 10 percent of your current weight) will help to lower your risk of developing these diseases.

Is your weight placing your health at risk? Take these three steps to find out.

1. Determine your BMI score.

The BMI score means the following:

 

 BMI
Underweight
Below 18.5
Normal18.5 - 24.9
Overweight25.0 - 29.9
Obesity30.0 and Above

Recent studies have shown that the risks of nonfatal heart attack and coronary heard disease death increase with increasing levels of BMI.

* Low risk: BMI of 22 or lower

* Twice the risk: MMI of 29 or greater

Source: http://www.nhlbi.nih.gov/guidelines/obesity/e_txtbk/ratnl/2214.htm

2. Determine your waist circumference by placing a measuring tape snugly around your waist. It is a good indicator of your abdominal fat which is another predictor of your risk for developing risk factors for heart disease and other diseases. This risk increases with a waist measurement of over 40 inches in men and over 35 inches in women.

Use the chart below to determine the combined risk from the two above measures.

Classification of Overweight and Obesity by BMI, Waist Circumference, and Associated Disease Risks
    
    Disease Risk* Relative to Normal Weight and Waist Circumference
 BMI (kg/m 2)
Obesity Class

 Men 102 cm (40 in) or less

Women 88 cm (35 in) or less

 Men > 102 cm (40 in)

Women > 88 cm (35 in)

 Underweight < 18.5  - -
 Normal 18.5 - 24.9  --
 Overweight 25.0 - 29.9  Increased High
 Obesity 30.0 - 34.9 I High Very High
  35.0 - 39.9 II Very High Very High
 Extreme Obesity 40.0 + III Extremely High Extremely High

 

*    Disease risk for type 2 diabetes, hypertension, and CVD.

+    Increased waist circumference can also be a marker for increased risk even in persons of normal weight.

Chart source:

http://www.nhlbi.nih.gov/health/public/heart/obesity/lose_wt/bmi_dis.htm

3. Do you have any of the risk factors noted below?

  • high blood pressure (hypertension)
  • high LDL-cholesterol ("bad" cholesterol)
  • low HDL-cholesterol ("good" cholesterol)
  • high triglycerides
  • high blood glucose (sugar)
  • family history of premature heart disease
  • cigarette smoking
  • physical inactivity

For your health’s sake, you need to lose weight if:

  • Your BMI is 25 or higher, and
  • You have two or more risk factors.

You need to prevent further weight gain if:

  • Your BMI is 25 – 29.9 (not obese), and
  • You do not have a high waist measurement, and
  • You have zero or only one of the above risk factors.

Recommended Weight Loss Goals

The first weight loss goal should be a 10% weight loss over a 6-month period. The rate of weight loss should be 1 to 2 pounds a week. Faster weight loss does not improve the long-term results.

After the first 6 months, additional weight management goals can be discussed with the healthcare provider. Sometimes more weight loss is needed. Others may be ready to maintain their weight loss.

Recommended Weight Loss Planning Includes:

  • Dietary therapy . NIH recommends the following general dietary guidelines. · A diet with 1,000 to 1,200 calories a day is appropriate for most women. · A diet with 1,600 calories a day is appropriate for most men. · A diet with 1,600 calories a day may be appropriate for women who exercise regularly or weigh over 165 pounds. · A 1,200-calorie diet may be recommended for a person who is not losing weight on a 1,600-calorie diet. · If a person is hungry, the healthcare provider may recommend adding 100 to 200 calories a day. · Specific dietary recommendations should be given to be sure the person gets enough essential nutrients.
  • Behavior therapy . Behavior therapy provides ways to overcome barriers to dietary therapy or physical activity. A good behavior therapy plan has the following characteristics: · incorporates the person's attitudes, beliefs, and history · includes a partnership with the healthcare provider · sets reasonable goals · includes self-monitoring, with appropriate rewards · focuses on what matters · includes frequent contact with the healthcare provider
  • Regular physical activity . To begin treatment of obesity, NIH recommends moderate levels of physical activity 30 to 45 minutes a day, 3 to 5 days a week. The activity should be started slowly and gradually increased in intensity. Some moderate physical activities are as follows: · bicycling 5 miles in 30 minutes · gardening for 30 to 45 minutes · raking leaves for 30 minutes · walking 2 miles in 30 minutes · water aerobics for 30 minutes
  • The plan may also include medicines or surgery . The Food and Drug Administration, or FDA, has approved only two medications for long-term use for weight loss. They are orlistat, or Xenical, and sibutramine, or Meridia. These medicines may be prescribed for people with a BMI of 27 to 29.9 with comorbidities. NIH also includes them as a consideration for people with a BMI of 30 or higher. Surgery, which changes the way food is absorbed, is sometimes used to treat obesity. NIH includes surgery as an option for people with a BMI or 30 or higher and comorbidities.

Caution: NIH states that these groups of people should be excluded from weight loss treatment: · women who are pregnant or breastfeeding · people with a serious uncontrolled psychiatric illness, such as major depression · individuals with serious illnesses that might be worsened by calorie restriction

Safe Practices for Weight Loss

Weight loss should not exceed one to two pounds per week. This is the rate of weight loss that can be maintained. One pound of fat contains 3,500 calories. Therefore, a negative caloric balance of 500 to 1000 calories per day through dietary changes and increase in physical activity should allow one to lose one to two pounds per week. Any greater weight loss will be extremely hard to continue over a period of time. In addition, restricting calorie intake to less than 1,200 calories a day may cause serious health problems. For adolescents, calorie restriction may impair normal growth.

Aerobic exercise combined with healthful eating helps people lose fat rather than muscle. Dieting without exercise is seldom successful, because it leads to the loss of muscle mass. Maintaining muscle mass requires more energy than maintaining fat, so losing muscle mass will ultimately slow down weight-loss efforts.

Aerobic exercise should be done at least three days per week for 20 minutes each session at a low to moderate intensity. Aerobic exercise is any continuous, rhythmic activities that incorporate large muscle groups. Research has shown that exercising aerobically for 20 minutes at least three days a week increases caloric expenditure and results in fat loss.

The foods you choose should be based on the Dietary Guidelines. People who choose foods they like that comply with the dietary guidelines are more likely to be successful at maintaining a healthy weight.

Modifying behavior may help correct eating habits that are not healthy. Identifying behaviors that lead to unhealthy eating habits may help control excessive calorie intake. Behaviors such as eating when nervous or eating when angry can contribute unneeded calories. Identifying and changing problem behaviors helps people maintain a healthy weight. In addition, behavior modification can lead to a more permanent lifestyle change, increasing the possibility of long-term weight management.

Source:  Based on recommendations from the American College of Sports Medicine.

Did you know?

Storing extra fat around the abdomen has been associated with higher risks for heart disease, coronary artery disease, high blood pressure, high cholesterol, diabetes, obesity and other conditions, even if a person's actual weight or body mass index is in a healthy range. Waist-to-hip ratios help determine excess abdominal fat.

These three body types, pear, squash and apple, describe different waist to hip ratios. The pear shape has the lowest waist to hip ratio and is not associated with increased health risks. The squash shape suggests a moderate amount of intra-abdominal fat in relation to hip size and presents some increased health risks. Of the three, the apple shape has the highest intra-abdominal fat in relation to hip size and indicates significantly increased health risks.