A Vicious Cycle Doctors Say Obesity Has a Direct Relationship to Cardiovascular Disease

It’s easy to put on a few pounds — and then keep gaining more and more. In fact, that’s exactly what a growing number of Americans have done over the past 20 years. Statistics show that obesity in adults has reached record highs, while the incidence among children and adolescents is growing faster than they are.

The Centers for Disease Control and Prevention reports that, in 2010, every state in the nation had an obesity rate of at least 20{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5}, and in some states it was as high as 30{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5}. In addition, obesity affects 17{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of all children and adolescents in the U.S., which is triple the rate from a generation ago.

The results can be catastrophic and lead to a variety of health problems. “In recent years and especially the past decade, obesity has been at the forefront of health when it comes to cardiovascular disease,” said Dr. Amir Lotfi, interim director of the Cardiac Intensive Care Unit at Baystate Medical Center. “It puts people at increased risk for high blood pressure, diabetes, and high cholesterol, which are known risk factors for heart disease. The longer a person is obese, the greater the probability is that they will have symptoms of cardiovascular disease.”

Young people who are obese are expected to pay a high price in the future. “The fear is that this new generation will have an increase in coronary disease,” Lotfi said, also noting that diabetes in children and adolescents is becoming epidemic. “Diabetes and high blood pressure are both systemic and take time to show up in the organs, so people with these conditions may not feel it until it becomes too late.”

Dr. James Kirchhoffer of Northampton Cardiology agrees. “The incidence of cardiovascular disease is increasing at younger and younger ages due to obesity,” he said, commenting that it’s a modifiable risk factor which often results from a sedentary lifestyle. “I wouldn’t be surprised to see 30-year-olds having heart attacks in the next 10 to 20 years. Right now, if someone has a heart attack before age 50, it’s usually because they smoke or have diabetes. But the fatter people get, the more likely they are to have diabetes, which is a cardiovascular disease. If someone has diabetes, their doctor should assume they have narrowed blood vessels, even if they aren’t showing symptoms yet.”

The solution is simple, Kirchhoffer said, adding that his advice to patients can be summed up in four words that he repeats over and over again. “Eat less, move more. It’s simple, but it’s not easy,” he said, adding that our ancestors were cavemen and hunter-gatherers, and, other than Fred Flintstone, they were not overweight due to their high activity level and the food they had access to.

Vicious Cycle

Weight gain is insidious, and often happens without people realizing it.

“It sneaks up on you. You start buying bigger clothes to be comfortable, and then your doctor tells you are borderline diabetic and have high cholesterol and high blood pressure,” Lotfi said. “All you need is 10 extra calories a day, which is the equivalent of two Tic Tacs, and you will gain one pound a year. That’s why in 10 years people become 10 pounds overweight and don’t notice it.”

The problem is exacerbated by the fact that the body loses lean muscle mass as it ages and metabolism slows down. “As people grow older, they are usually not as active, and their metabolism slows, so they don’t even have to eat any extra to gain weight,” Lotfi said. “It’s the reason why insight is so important. People need to recognize what is going on in their bodies. I tell my patients, ’you see me for a half-hour, but you are with yourself 100{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of the time.”

However, changing the way one eats is an unrealistic goal unless everyone in a household makes a commitment to do so. “The whole family needs to get involved,” Lotfi said.

It may take some coaxing, especially when children are involved, but the foods they are served at home will affect their choices and health in the future. “If a child is obese, he or she is less active and gets used to bad eating habits. It’s a domino effect, because bad eating leads to lack of exercise. And as these children grow and get older, their joints may begin to bother them,” Lotfi said. “If you are [age] 15 and carry 20 to 50 extra pounds for 20 years and don’t exercise, you may get arthritis at an earlier age.”

Obesity can also contribute to obstructive sleep apnea, which causes fatigue and makes people less inclined to exercise. “They wake up tired no matter how much sleep they get,” Lotfi said. “It’s all interconnected.”

Obesity is measured by a person’s body mass index, or BMI. “Once it gets over 25, several things start to happen,” Kirchhoffer said. “Blood pressure and blood sugar go up, and the liklihood of the blood vessels closing increases, and then the risk of heart attack and stroke goes up.”

If a heart attack or stroke does occur, he added, the heart muscle is damaged, scar tissue forms, and the heart is weakened. “It’s a vicious cycle, because when that happens, people can’t breathe well, so they do less.”

The narrowing of blood vessels to the brain can cause a stroke, while the narrowing of vessels to the legs leads to pain when walking. “If they narrow enough, it can lead to gangrene and amputation, which is especially true in people who also develop diabetes,” he continued.

Although genetics and lifestyle play a role in the equation, Kirchhoffer continued, “the fatter you get, the more likely it is to happen. There are people who are fat, but fit; however, they are an exception. And there is always an exception.”

The good news is that weight loss and changes in lifestyle can not only improve diabetes, but also lower cholesterol and blood pressure levels and decrease the risk of heart attack and stroke.

But obesity remains a problem, and people often turn to unhealthy foods when they are upset. “The recent trend in increased weight in the U.S. can be traced to a perception that relates to food and comfort,” Kirchhoffer said. “People think many things they eat are healthy foods because they feel better when they eat them. But like it or not, ice cream is not a health food.”

Lotfi concurs. “When people aren’t happy, they may turn to food for pleasure,” he said. “This is where the vicious cycle comes in. They eat, don’t exercise, gain weight, and become more depressed because they aren’t happy with their bodies. Then they turn to food again for more comfort because it is the only thing they know how to do. They can’t get out of the fat track and suddenly need to start taking multiple medications.”

At that point, changes in lifestyle and weight loss can seem overwhelming. “People may want to lose weight, but feel they will have to climb a mountain to do so,” Lofti said.

Kirchhoffer says people should consider whether what they are eating is actually food or a “food-like substance.” Healthy foods are found on the outside of the grocery aisles and include lean meats along the back wall. “The inner sanctum of the store is the place that contains food-like substances such as potato chips. Don’t grab items that are processed,” he advised.

Lofti said people should not think of losing weight as a static event. “They shouldn’t set a goal of losing 20 pounds. Instead, they should think about leading a healthy lifestyle, and weight loss will come with it. If you eat well, exercise, refrain from smoking, and know your blood pressure and cholesterol levels, it will empower you, and you will become an advocate for your own health.”

But to make lasting changes, people may need to consult a nutritionist as well as their primary care physician, who can tell them how to begin an exercise program in a way that won’t cause further harm. “You need to have an open-ended conversation with your primary care physician and tell him or her that you are aware you are obese, but need help moving forward,” Lotfi said.

Kirchhoffer agreed. “Change is very challenging, and most people will need some type of coaching,” he said. “If they have been sedentary and gotten heavy, they shouldn’t start a vigorous exercise program without conferring with their doctor, because it could cause a heart attack.”

Changing Tactics

Kirchhoffer says some people think the solution to their health issues is as simple as popping an extra cholesterol pill after they consume a lot of fatty food.

“We all know what is good for us and what is bad for us. But people can rationalize just about anything,” he said. “So I tell people to adopt a Mediterranean diet, then tell them they are allergic to beef, butter, ice cream, and fried anything.” He added that the American Heart Assoc. recommends no more than three to five eggs a week and four ounces of beef twice a week.

Young Hee Kim, clinical nutrition manager for Mercy Medical Center, says fat around the middle poses a higher risk of cardiovascular disease than fat on the thighs. “Statistics show that, if a woman’s waist circumference is greater than 31 inches and a man’s is 35 inches or more, it poses some risk. But if their waists are 35 inches or greater [for women] or 37 to 40 inches [for men], it presents a significant risk. So people need to be active as they can.”

Kim says most Americans consume too much salt, which poses a cardiovascular risk. But it can be tricky to spot on a nutrition label. “There are many sources because sodium can be used as a leavening agent. For example, a muffin contains a significant amount of sodium because of the baking soda in it, which is sodium bicarbonate,” Kim said, adding that consumers need to read labels carefully and pay attention to the number of servings and the portion size the manufacturer considers to be one serving.

“People’s diets should contain a lot of plant sources. And they should eat more legumes such as lentils and dried beans and use them as a protein source rather than animal proteins such as beef or pork,” Kim said.

This doesn’t mean canned baked beans, which she says contain “a lot of sugar and things like bacon. I suggest using beans in soups and salads.”

The biggest problem, she said, is that people are not willing to invest time and effort into what they eat.

“You can’t just decide one day that you are going to eat healthy,” Kim said. “There are no quick fixes. Cooking methods such as baking, broiling, and roasting are better than frying, and it’s important to eat lots of fruits and vegetables. But people also need to think about what they are going to cook for the week and what ingredients they have in their house, then go to the grocery store and actually use what they purchase.”

Cold-water fish, such as mackerel, salmon, and herring, is a healthy choice, as it contains omega 3 fatty acids. “It can be frozen, but don’t buy breaded fish or anything that needs to be fried,” Kim said.

A common mistake is buying baked goods that are labeled low-fat. “The fat has to be replaced by something else to give it texture,” Kim explained. “It may be a comfort food, but it is not something the body really needs. And a lot of people follow fad diets, but they are just that.”

The problem with diets is that most people think of them as punitive. “People have it in their heads that they are being deprived. They need to think instead that they are making a lifestyle change that will stay with them the rest of their lives,” Kim said.

Weight loss can be slow, but that shouldn’t cause depression. “The ideal is to lose one to two pounds a week. Any diet plan that offers a 10-pound loss in a week means the person is probably going to lose a lot of water or lean muscle mass. It takes a long time to gain weight, and it will take a long time to lose it,” she said.

It’s also important to eat slowly, because the practice allows the brain time to assimilate the information. “We inhale our food, but it takes a good 20 minutes for our stomach to translate to the brain that it has fuel, so we go back for seconds before we realize we are full,” Kim said. “Even if something looks really good, exercise a little self-discipline.”

She also advises filling half of a lunch and dinner plate with vegetables and cooking enough healthy food on the weekend to last all week.

Tipping the Scale

Children learn from their parents and eat what is served to them. And if they are served a wide variety of foods, they are more likely to adopt healthy eating habits as they grow into adults.

“Small changes every day turn in big overall lifestyle changes and eating habits over time,” Kim said.

So the way to begin is slowly, even if you have a mountain of weight to lose. “Don’t get down on yourself, and don’t get depressed,” Lotfi said. “It’s not a sprint, it’s a marathon.”