Waistline Predicts Heart Disease
Remember when you were a kid and hefty Uncle Morty would always end every Thanksgiving dinner by pushing himself from the table, opening his belt buckle, and letting his growing belly roll him onto the Lazee-Boy? Remember how you promised yourself you'd never end up like that -- no matter what?
Statistics show that more than a few of us have broken that promise. According to the CDC, more than 60 percent of the population is either overweight or obese. And experts say that's bad news for heart health nationwide.
Overall, it's a constellation of risks that threaten our heart health most: a combination of high cholesterol, high blood pressure, and high blood sugar.
But simply being overweight - without any other risk factor -- can cause problems, says the American Heart Association.
The heavier you are -- period -- the higher your risk of heart disease, says Helene Glassberg, MD, director of the Preventive Cardiology and Lipid Center at Temple University School of Medicine in Philadelphia.
Moreover, excess weight often means higher-than-normal levels of both cholesterol and triglycerides, indications of how much fat may be also floating around in your blood.
"The higher your level of blood fats, the greater your risk of developing a clot significant enough to block blood flow to your heart," says Glassberg.
Indeed, even seemingly healthy hearts are affected by weight. In a study published in the journal Circulation, doctors found that lugging around those extra pounds appears to subtly weaken your heart's ability to pump blood -- one of the first steps leading to eventual heart failure.
But weight alone is not your only concern. If you have thin arms and legs but a bulging tummy, you may be at equally high -- or even higher -- risk than an overweight or obese person. Emerging research points to "central obesity" (or a big waistline) as a key culprit in bringing on heart disease.
Your Waistline Is a Key Predictor of Heart Disease
While for many years doctors weren't exactly sure of the link between weight and heart health, recent studies, including research published in the American Journal of Physiology in 2005, indicate fat cells may act like mini chemical factories, churning out a host of hormones and other inflammatory substances that increase our risk of heart disease. This, say experts, is particularly true if you carry your excess weight around a chubby midsection or "spare tire."
What's the connection here? Doctors say that fat around the midsection acts differently than fat on your thighs or on your bottom.
"We used to think that all adipose [fat] tissue was neutral -- but as it turns out, it's an active organ that makes all kinds of substances that we now know can cause, or at least stimulate the atherosclerotic process," says James Underberg, MD, Director of the Bellevue Hospital Lipid Clinic, in New York City.
In studies on more than 1,300 Finnish men published in the European Heart Journal, doctors learned that an central obesity is, on its own, a potent predictor of heart disease, with risks that go far beyond obesity alone.
National criteria propose that a 40-inch waist in men and 35-inch waist in women predicted an increased risk for heart disease.
Special Risks for Women
What may be even more important -- particularly for women -- is what doctors call "visceral" fat. This is the fat that lies beneath the muscle, and is frequently wrapped around internal organs. It is often found in people with large midsections.
In a study published in the Journal of Clinical Endocrinology and Metabolism, doctors found that middle aged women who carried more visceral fat in their tummy region were at higher risk for metabolic syndrome -- a constellation of conditions that include high blood pressure, high cholesterol, and insulin resistance, all leading to a higher risk of heart disease.
A Danish study published in the journal Circulation showed a woman was nearly five times more likely to die of heart disease if she had both a large waist and a high level of fat in her blood.
Losing a Little Gets You a Lot
The good news is that losing weight can make a huge difference: often it can dramatically reduce the risk factors associated with heart disease.
Even better news: Even a small weight loss can help.
"Even a minimal weight loss can make an enormous difference. Your blood pressure will drop, your lipid profile [cholesterol] will get better. It's remarkable how much good you can do for your body by just shedding a few pounds," says cardiologist Chuck McCauley, MD, director of the Marshfield Healthy Lifestyles Program in Marshfield, Wis.
Indeed, McCauley says drop just 10 or 15 pounds and watch your blood pressure drop 10 or 15 points. Cholesterol levels, he says, respond even better. "I've seen people drop their LDL [bad cholesterol] from 160 down to 90 or 100 just by losing 10 pounds," he says.
If, at the same time you can also whittle down your waistline and reduce your total BMI (body mass index) so much the better. "Every inch and every pound you lose can add years to your life," McCauley says.
But what are the ideal numbers? According to the National Institutes of Health, a BMI that falls between 18.5 and 24.9 is considered normal. For example, a man who is 5-feet-11-inches tall and weighs 170 pounds would be on the upper end of end of the scale -- with a BMI of near 24. A woman who is 5-feet-4-inches tall and weighs 110 pounds would be on the lower end of the scale with a BMI of about 19.
Likewise, a man or woman who is 5-feet-8-inches tall and weighs 230 pounds has a BMI of around 35 is considered obese.
When it comes to waistline goals, study results vary. Some indicate that for best health men should aim for a waistline of 34 inches or less; other research indicates that a waistline below 39 inches is OK. For women, studies indicate the safest waistline for heart health is below 29 inches, but some research has found that waistlines under 33 inches are OK.
Now if you think it's going to require six days of aerobics each week to accomplish this, you may be surprised to learn that one of the most passive forms of exercise is also the most effective for getting rid of that spare tire.
That exercise is yoga. In research published in the journal Alternative Therapies in Health and Medicine," doctors from the Fred Hutchinson Cancer Research Center found that just 30 minutes of yoga once a week could prevent middle-aged spread in normal weight folk. It also helped those who are overweight to lose those extra pounds.
The Benefits of Certain Foods
While losing weight clearly matters, experts say changing eating habits may also help your heart -- regardless of any weight loss.
Here's what McCauley says is the recipe for success.
Cut back on:
Then add more:
"If you change your eating habits ... you'll automatically see some drop in your cholesterol, and that, in and of itself, will help reduce some of your risks right away," says McCauley. This is also the dietary recommendation of the American Heart Association.
Nutritionist Samantha Heller, MS, RD tells WebMD we should also avoid tropical oils like palm, corn, and coconut oils. Instead go for olive, canola or grape seed oils. She also recommends avoiding foods high in hydrogenated oils or trans fats, which are found in many commercial baked goods lining the supermarket shelves.
"They increase your triglycerides, which can contribute to cholesterol and help increase the risk of clot formation," says Heller a senior clinical nutritionist with the Cardiac Rehabilitation and Prevention Center at NYU's Rusk Institute for Rehabilitation Medicine.
Also important: If you can't eat differently, at least eat less. Indeed, if you follow the logic of smaller portions, they say, you'll probably see some weight loss and you'll definitely see an improvement in your risk of heart disease.
"Controlling portion sizes is major. But unfortunately, most folks don't have a clue as to what a portion should look like," says Heller.
If you are at a loss as to how much to put on your plate, you can try one of two easy strategies. "You can simply buy a smaller plate -- and fill that up. Or, using the plates you already have, make sure there's enough space around your food to see the design and color of your dishware," says McCauley.
If that doesn't work, experts say be certain to leave at least a portion of every meal on your plate. "The goal is to get in touch with what it feels like to be 'full' and not 'stuffed.' When you can do that, you'll definitely be eating less," says Heller.
SOURCES:Helene Glassberg, MD, FACC, director, Preventive Cardiology and Lipid Center, Temple University School of Medicine in Philadelphia, Pa. James Underberg, MD, director, Bellevue Hospital Lipid Clinic, New York City. Chuck McCauley, MD, director, Marshfield Healthy Lifestyles Program, Marshfield, Wis. Samantha Heller, MS, RD, senior clinical nutritionist, Cardiac Rehabilitation and Prevention Center, NYU's Rusk Institute for Rehabilitation Medicine, New York City. You, T. American Journal of Physiology, April 2005; Lakka, H.M. European Heart Journal, May 2002; vol 23. Wahrenberg, H. British Medical Journal Online, April 14, 2005. Niklas, B. Journal of Clinical Endocrinology and Metabolism, November 2004. Rexrode, K. Journal of the American Medical Association, December 1998. Tanko, L. Circulation, April 19, 2005. Marwick, T. Circulation, November 2, 2004. Kristal, A. Alternative Therapies in Health and Medicine, July-August 2005. National Institutes of Health Clinical Guidelines on the Identification, Evaluation and Treatment of Overweight and Obesity in Adults.
By Colette Bouchez
Reviewed by Brunilda Nazario, MD
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