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Obesity & Heart Attack

Obesity & Heart attack

Dr G Sengottuvelu. MD., DM., DNB., FRCP (Glasgow),FSCAI (USA), FMMC, FCSI.Fellowship in Interventional Cardiology (France)Senior Consultant & Interventional Cardiologist,Apollo Hospitals, Chennai

Is obesity a problem in our country?
The US tops the list with 13 per cent of the obese people worldwide in 2013, while China and India together accounted for 15 per cent of the world's obese population, with 46 million and 30 million obese people, respectively. According to the study, number of overweight and obese people globally increased from 857 million in 1980 to 2.1 billion in 2013. This is one-third of the world's population.

How will you define Obesity?
You can tell if you are obese by the size of your waist, the ratio of your waist to your hips, and the relationship between your height and your weight.  This last measure is known as the Body Mass Index (BMI).  It is not a perfect way of checking your cardiovascular risk but as your BMI increases, so does your risk of heart disease and stroke.

How to Calculate BMI? 
BMI is calculated by dividing your weight in kilograms by the square of your height in meters (kg/m2).If you are of south Asian origin you may be considered overweight if your BMI is greater than 22.  If you are a woman, a BMI greater than 21 may adversely affect your heart’s health.  If your BMI is more than 30, you are obese and at serious risk of cardiovascular disease. If your BMI is below 18.5 you are probably underweight.

What is the Ideal Waist Measurement?
Excess body fat is never good for your health, but it is more harmful if it's up around the abdomen than if it is down in the hips and thighs. In other words, it is healthier to be shaped like a pear than an apple. A high waist circumference becomes an independent prediction of risk for developing certain diseases such as:Diabetes, Hypertension, Cardiovascular disease (heart disease), Dyslipidemia (high cholesterol, high triglycerides), Metabolic syndrome (overweight, high blood pressure, and high levels of cholesterol and blood sugar) Increased risk            Men (Asian) >= 90 cm; Women (Asian) >= 80 cm

What are the Health effects of obesity?
High blood pressure - Additional fat tissue in the body needs oxygen and nutrients in order to live, which requires the blood vessels to circulate more blood to the fat tissue. This increases the workload of the heart because it must pump more blood through additional blood vessels. More circulating blood also means more pressure on the artery walls. Higher pressure on the artery walls increases the blood pressure. In addition, extra weight can raise the heart rate and reduce the body's ability to transport blood through the vessels.
Diabetes - Obesity is the major cause of type 2 diabetes. This type of diabetes begins in adulthood. Obesity can cause resistance to insulin, the hormone that regulates blood sugar. When obesity causes insulin resistance, the blood sugar becomes elevated. Even moderate obesity dramatically increases the risk of diabetes.

Heart disease - Atherosclerosis (hardening of the arteries) is present 10 times more often in obese people compared to those who are not obese. Coronary artery disease is also more prevalent because fatty deposits build up in arteries that supply the heart. Narrowed arteries and reduced blood flow to the heart can cause chest pain (angina) or a heart attack. Blood clots can also form in narrowed arteries and cause a stroke. Heart failure, Atrial fibrillation, Sleep Apnoea are also associated with obesity.

Joint problems, including osteoarthritis - Obesity can affect the knees and hips because of the stress placed on the joints by extra weight. Joint replacement surgery, while commonly performed on damaged joints, may not be an advisable option for an obese person because the artificial joint has a higher risk of loosening and causing further damage.
Sleep apnea and respiratory problems - Sleep apnea, which causes people to stop breathing for brief periods, interrupts sleep throughout the night and causes sleepiness during the day. It also causes heavy snoring. Respiratory problems associated with obesity occur when added weight of the chest wall squeezes the lungs and causes restricted breathing. Sleep apnea is also associated with high blood pressure.
Cancer - In women, being overweight contributes to an increased risk for a variety of cancers including breast, colon, gallbladder and uterus. Men who are overweight have a higher risk of colon and prostate cancers.
Metabolic syndrome - The National Cholesterol Education Program has identified metabolic syndrome as a complex risk factor for cardiovascular disease. Metabolic syndrome consists of six major components: abdominal obesity, elevated blood cholesterol, and elevated blood pressure, insulin resistance with or without glucose intolerance, elevation of certain blood components that indicate inflammation, and elevation of certain clotting factors in the blood. Psychosocial effects - In a culture where often the ideal physical attractiveness is to be overly thin, people who are overweight or obese frequently suffer disadvantages. Overweight and obese individuals are often blamed for their condition and may be considered to be lazy or weak-willed. It is not uncommon for overweight or obese conditions to result in individuals having lower incomes or having fewer or no romantic relationships. Unsuccessful attempts at dieting to lose weight can also lead to depression, which in itself can increase the risk of heart disease.
What causes obesity?
In many ways, obesity is a puzzling disease. How the body regulates weight and body fat is not well understood. On one hand, the cause appears to be simple in that if a person consumes more calories than he or she expends as energy, then he or she will gain weight.Factors which may influence the occurrence of obesity include, but are not limited to:

Genetics - Studies have shown that a predisposition toward obesity can be inherited. The chance of being overweight increases by 25 percent if one or both parents are obese. Where a person carries weight - the hips or around the middle - is also strongly influenced by heredity.

Metabolic factors - How a particular person expends energy is different from how someone else's body uses energy. Both metabolic and hormonal factors are not the same for everyone, but these factors play a role in determining weight gain.

Socioeconomic factors - There is a strong relationship between economic status and obesity. Those who are poor and of lower social status are six times more likely to be obese than those of higher socioeconomic status. The occurrence of obesity is also highest among minority groups.

Lifestyle choices - Overeating, along with a sedentary lifestyle, contributes to obesity. These are lifestyle choices that can be affected by behavior change.Eating a diet in which a high percentage of calories come from high-fat, refined foods promotes weight gain. Lack of regular exercise contributes to obesity in adults and makes it difficult to maintain weight loss. In children, inactivity, such as watching television or sitting at a computer, contributes to obesity.

Healthy tips for maintaining your weight:
Remember - a calorie is a calorie. High-fat foods generally have more calories than foods that are high in carbohydrates or protein, but the truth is, the best way to lose weight is to eat fewer calories than you burn each day. While it is possible to eat a larger quantity of food that is low in fat as long as it is also low in calories, be sure to check labels or read educational materials to make sure.
Fruits, vegetables, and other foods that are low in fat and calories can also help reduce your risk of heart disease, stroke and cancer.Use "lite" or low-fat dairy products (i.e., milk, cheese, yogurt or sour cream).
Use in recipes and/or drink one-percent or skim milk. You will still get the nutrients and taste but not the fat.Use oils sparingly (try olive and canola oils). Bake chicken without the skin.
Substitute a potato for French fries.
Choose healthy, quick and easy-to-grab foods such as little bags or containers of ready-to-eat vegetables (i.e., celery sticks, cucumber wedges and cherry tomatoes). Or, make healthier choices for snacks that are store-bought, such as pretzels. Keep them with you in your briefcase, office, car and home.Substitute low-fat or fat-free baked goods, cookies and ice cream. They still taste great. Cut down on the portion size and how often you eat these items. Or, choose fruit. It tastes great, is filling, and provides energy.
Exercise is an important way to manage your weight. Aerobic exercises and strengthening exercises burn calories by increasing your heart rate. Physical activity need not be strenuous to achieve health benefits.
People of all ages benefit from a moderate amount of physical activity, preferably daily. The same moderate amount of activity can be obtained in longer sessions of moderately intense activities (such as 30 minutes of brisk walking) as in shorter sessions of more strenuous activities (such as 15 to 20 minutes of jogging).
Previously sedentary adults who begin physical activity programs should start with short intervals (5 to 10 minutes) of physical activity and gradually build up to the desired level of activity.
Those with chronic health problems, such as heart disease, diabetes, or obesity, or those who are at high risk for these conditions should first consult their physician before beginning a new program of physical activity.
Those over 50 who plan to begin a new program of vigorous physical activity should first consult their physician to be sure they do not have heart disease or other health problems.

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