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Published on February 19, 2018

It’s impossible to be overweight and heart healthy

As waistlines have grown in the U.S., there have been attempts to normalize being overweight and ignore the health consequences.

Researchers at Simon Fraser University in Canada have now found that when people viewed images of larger models as socially acceptable, it resulted in increased consumption of unhealthy food and decreased motivation to engage in a healthy lifestyle. They concluded that using healthy looking models who were neither underweight nor overweight is the best practice.

For several years there has been some controversy over whether it’s possible to be “healthy obese.” The term applies to people who are overweight, but do not have symptoms of metabolic syndrome.

Metabolic syndrome includes obesity, glucose intolerance or insulin resistance, elevated cholesterol and elevated blood pressure, according to cardiologist Lawrence McAuliffe, MD, of Cape Cod Healthcare Cardiovascular Center in Hyannis.

“We already know those are risk factors and that is what America is trending towards,” he said.

A study published in the European Heart Journal in August put to rest any notion that you can be obese and heart healthy. The study showed what cardiologists already intuitively know, but it can be a helpful tool when talking to patients, Dr. McAuliffe said. It’s not uncommon to have a patient who is overweight but points out that his blood pressure and lipids are pretty good and his blood sugar isn’t astronomical.

“This study helps to confidently identify for those patients that statistically, even though you are able to control those things, if we match you up with a gender and age cohort with controlled blood pressure, cholesterol and blood sugar, being overweight confers its own independent risk of developing cardiovascular disease, heart attacks, stroke and death,” he said.

In an analysis of the study on PubMed Health, those who were obese and considered metabolically healthy still had a 28 percent greater chance of heart disease than counterparts who were of normal weight and metabolically healthy. People who were of a normal weight but metabolically unhealthy fared the worst. They had more than double the risk of heart disease.

“It’s only those people who have no indicators or who have them treated and are at target weight, who have the lowest instances of cardiac events,” Dr. McAuliffe said. “You can be lean and fit, which is the goal. You can be fat and fit which increases risk. You can be lean and not be metabolically fit and be at risk. Or you can be like a lot of the people in the U.S. and be fat and unfit and that’s when you get into trouble.”

Lifestyle Changes Can Help

But don’t think you’re off the hook if you’re at your ideal weight.

The study showed that being thin was no guarantee of good health on its own. People with symptoms of metabolic disease like high blood pressure, high cholesterol and high blood sugar were also at risk, even if they were not considered overweight.

Americans are growing bigger at an alarming rate. In October the Centers for Disease Control and Prevention released a report that obesity is at an all-time high in the United States with close to 40 percent of all adults and 18.5 percent of youths falling in that category. This represents a 30 percent increase among adults and a 33 percent increase among youth since 1999.

The good news is that lifestyle changes can prevent heart disease, starting with losing weight. To figure out your Body Mass Index (BMI), plug your height and weight into the Centers for Disease Control and Prevention’s BMI calculator.

Dr. McAuliffe said the general BMI guidelines are:

  • Less than 25 is normal
  • 25 to 30 is overweight
  • 30 to 40 is obese
  • Greater than 40 is extreme obesity

Anyone who is overweight or obese should discuss a healthy diet and exercise program with their physician. When it comes to diet, the best approach is to eat healthy whole fruits, vegetables and small amounts of lean meats. Processed food isn’t heart healthy, Dr. McAuliffe said. It also helps to have a family unit that dines together, rather than everyone grabbing food on the go.

“We’re too busy, we’re too fast and delayed gratification is not one of our features anymore,” he said. “We want something quick and that’s generally not healthy.”

The American Heart Association recommends 150 minutes of moderate exercise or 75 minutes of vigorous exercise or a combination of both every week. That is only 30 minutes a day, five days a week. Even two to three segments of 10 to 15 minutes of exercise per day offers benefits.

Those with a normal BMI are not excluded. They should have a yearly physical to ensure that blood pressure, cholesterol and blood sugar are all normal. The AMA recommends that those with high blood pressure or high cholesterol get 40 minutes of moderate to vigorous intensity aerobic exercise three to four times a week, regardless of their weight. They should also discuss medications that might help lower those numbers with their physician.

Other heart healthy behaviors include refraining from smoking, drinking alcohol only occasionally and always in moderation and limiting salt intake, Dr. McAuliffe said.

”Fat, but fit is a myth,” he said. “It really doesn’t work.”