Obesity and Heart Disease: Understanding the Connection

It’s a known fact that obesity can take a toll on your heart health, and there’s an abundance of research to back it up. A scientific statement from the American Heart Association warns that obesity leads to the development of cardiovascular disease as well as other cardiovascular risk factors such as type 2 diabetes, high blood pressure, and sleep disorders.

Being overweight is defined as having a body mass index (BMI) between 25 and 29.9, and obesity is defined as a BMI of 30 or higher. The number of cardiovascular deaths related to obesity is on the rise in recent decades: One study found that the number of these deaths tripled between 1999 and 2020.

The link between heart disease and obesity is multifaceted. For one thing, obesity increases your risk of developing many other risk factors for heart disease. It also triggers inflammatory processes that can harm your cardiovascular system, and it can lead to structural or functional changes in the heart itself.

Carrying too much weight on your frame can have a detrimental impact on your cardiovascular health in many different ways.

It Increases Your Risk of Developing Diseases That Harm the Heart

The list of health conditions that can harm your ticker include hypertension, cholesterol abnormalities, and type 2 diabetes, notes Nieca Goldberg, MD, a cardiologist and clinical associate professor of medicine at the NYU Grossman School of Medicine in New York City. Being overweight also increases your risk of metabolic syndrome, a cluster of heart-disease risk factors, including high blood pressure, low levels of HDL (“good”) cholesterol, high triglyceride levels, high blood sugar levels, and a large waist circumference (35 inches or more for women, 40 inches or more for men).

Making matters worse, high blood pressure that’s brought on by obesity irritates plaque in the arteries and predisposes it to rupturing, which is what triggers a heart attack, adds Tracy Stevens, MD, a cardiologist and the medical director of the Saint Luke’s Muriel I. Kauffman Women’s Heart Center in Kansas City, Missouri.

It Ups Your Odds of Developing Sleep Apnea

Obstructive sleep apnea is unpleasant enough by itself, given that it makes for a fragmented night’s sleep. But it’s also a risk factor for developing high blood pressure, type 2 diabetes, and heart disease. In fact, a study found that people with overweight and mild sleep apnea were more likely to have metabolic syndrome, hypertension, prediabetes, and cholesterol abnormalities (especially high triglycerides).

It Can Cause Chronic Low-Grade Inflammation

Ongoing inflammation, which can be caused by obesity, can damage healthy cells, tissues and organs, leading to serious illness — including heart disease. This invisible inflammation and the inflammatory factors it releases increase your risk of developing atherosclerosis and the buildup of plaque in the walls of the arteries.

“Obesity also releases substances in the blood that can make plaque rupture, which is what leads to heart attacks,” Dr. Stevens explains. “Obesity is like broken glass to our arteries.”

It Can Cause an Irregular Heartbeat

Research shows that obesity can raise your risk of developing atrial fibrillation, an irregular heartbeat (arrhythmia) of the upper chambers (atria) of the heart that can promote the formation of blood clots and lead to stroke, heart failure, or other heart-related complications.

In addition, obesity can lead to enlargement of the heart, which could be from untreated hypertension, Dr. Goldberg says.

It Forces Your Heart to Work Harder

Yes, the extra weight you’re carrying does put the heart under increased stress, in particular during the relaxation phase of the cardiac cycle — what’s called the diastole. As the heart fills with blood, there’s higher pressure, Goldberg explains. “Over time, that can cause people to have heart failure symptoms.”

It’s not just the number on the scale that matters. Where the extra weight is distributed also affects your risk of developing heart disease. Simply put, greater amounts of belly fat — what’s often called central or abdominal obesity — is associated with greater inflammation, which is damaging to your heart, Goldberg says. Excess belly fat also increases triglyceride levels, which can contribute to plaque rupturing, Stevens notes. That’s why your waist measurement really does matter, in addition to your overall weight.

If you’re overweight or obese, slimming down may help you reduce your risk of developing heart disease. “When people lose as little as 5 pounds, we can start to see improvements in blood pressure, blood sugar, cholesterol levels, and inflammatory factors,” Goldberg says. All of these changes are beneficial for your heart.

Losing excess weight helps with primary prevention of heart disease, as well as secondary prevention (preventing another heart attack or other cardiac event if you’ve already had one), Goldberg says. For secondary prevention, she adds, “you’ll need to take medicine, but maybe less of it if you lose weight.”

It’s not an easy process, Goldberg admits, but the best ways to lose weight are to improve your diet and exercise habits with the goal of losing 1 pound per week. Keep in mind: “If your BMI is in the higher range, it’s safer to go into a medically supervised weight loss program than to try to do it on your own,” Goldberg says.

If you’re doing it on your own, stick with a diet that’s filled with fruits and vegetables, whole grains, low-fat dairy products, fatty fish and skinless poultry, nuts and legumes, and healthy cooking oils, such as olive, walnut, sesame, or grapeseed oils. Avoid added sugars, highly processed foods, and fried foods. On the exercise front, do a combination of “aerobic exercise and weight training to increase your muscle mass and decrease body fat,” Goldberg suggests.

There’s proof that taking these steps can make a difference to your heart health for years to come. A study found that weight loss was associated with decreased risk factors for cardiovascular disease for at least five years, even if some weight was regained.

Losing weight can lower risk factors for heart disease “because it makes a difference in blood pressure, insulin sensitivity, and triglyceride levels,” Stevens says. “The great news is, what you do every day can make a difference.”

The most effective ways to shed pounds don’t involve a fad diet or starvation. Having the right mental attitude and a desire to live healthier is the formula for success. Try these strategies to help keep the number on the scale moving downward.

Make sure you’re ready. Long-term weight loss is a marathon — not a sprint — so you need to have a strong desire to change your habits for good. If you’re distracted by other pressures or use food to cope with stress, you may need support from friends, family, or healthcare professionals before you’re in the right frame of mind to change your lifestyle approach.
Set realistic goals. You can’t lose weight and keep it off if you don’t have a logical and achievable plan. For tips on how to set useful weight-loss goals, check out Everyday Health’s network site Lose It!
Embrace healthy foods. There are seemingly endless fruits, vegetables, whole grains, and other nutritious fare that’s tasty, fresh, and lower in calories than the processed foods that cause people to gain weight they may not be able to keep off. Aim for at least four servings of vegetables and three servings of fruit a day, and eat fewer refined grains and more brown rice, barley, and whole-grain breads and pasta.
Make an effort to move more. Changing how you eat is only half of the weight loss game. To keep pounds off, you need to exercise too. The Centers for Disease Control and Prevention recommend that adults get at least 150 minutes of moderate-intensity physical activity a week, and they should do muscle-strengthening activities at least twice a week.
Talk to your doctor about weight-loss medications. There are several prescription drugs approved by the FDA that can help with weight loss, including Wegovy and Zepbound. Find out if they may be the right fit for you.

Research shows that obesity increases your risk of developing diseases that harm your heart, including hypertension, cholesterol problems, and type 2 diabetes.
Carrying too much weight on your frame can also increase your odds for developing sleep apnea, chronic inflammation, and an irregular heartbeat. All of those issues have been scientifically linked to heart disease.
Losing weight through diet, exercise, and the motivation to make long-term lifestyle changes can significantly lower risk factors for cardiovascular disease and improve your quality of life.

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