Waist Size Matters!
Who would have thought that a small waist size protects you from a heart attack? Recent research has proved that abdominal obesity, defined by a waist circumference of >35 inches in women and >40 inches in men is strongly associated with an increased risk of Type 2 diabetes, cardiovascular disease, and death, even after controlling for body mass index (BMI).
This means that people who are not overweight, who have an increased waist size, are at higher risk of health problems than someone with a trim waist. Of course, that is one of the many reasons the BMI calculation is flawed, but that is a point of a different discussion.
Over the years, physicians have been blessed with the acquisition of many fancy imaging tools and the availability of laboratory tests to assess ones’ risk factors for heart disease and death. There are costly MRI scans, stress tests, and echocardiogram studies to use. Additionally, who could forget about the coronary angiography test?
As far a laboratory testing is concerned, there are several blood panels available with inflammatory markers such as the ESR and CRP, the cholesterol panel with LDL and subtypes, and measurement of insulin levels, etc.
Technology has really come a long way and added a tremendous amount of value to the field of medicine to diagnose and treat patients. I wonder though, through the availability of all these fancy tests, have we forgotten the importance of actually looking at the patient and assessing them based on their physical exam?
I wonder how much patients actually value their CRP levels and how effective that could be when you communicate with them as physician. “Mr. Smith, we have to fix your CRP or you’re going to have a heart attack.” Numbers are important in certain fields of medicine such as rheumatology. However, in my field of bariatric medicine, I can tell you fancy testing can only help so much.
As a bariatric physician, when I walk into a patient’s room and during the first few seconds of interaction, I can predict the heath of that patient and assess their cardiovascular risk without looking at scans or laboratory tests. I can be in a room of a few hundred people and with a glance, I can tell you who is healthy or unhealthy, and predict their risk of death from a heart attack without a single test.
Am I a genius or do I have a crystal ball? I wish. The real secret lies behind a powerful predictor that is assessed easily based on looking at somebody. This “powerful” indication for cardiovascular health is not CRP levels; rather it is the waist size. In fact, one of the largest and longest studies ever done, The Nurses’ Health Study, has looked at the relationship between waist size and death from heart disease and cancer in women. At the start of the study, all of the subjects measured and documented their waist size.
All 44,000 study volunteers were healthy at the start of the study. After 16 years, women who had a waist size 35 inches or higher had nearly double the risk of dying from heart disease, compared to women who had reported the lowest waist sizes (less than 28 inches). Similarly, they had a high risk of death from cancer compared with women with the smallest waists.
This is a powerful finding and needs to be taken seriously to help patients achieve optimal health and prevent disease. I believe that prevention is EVERYTHING! Why wait until you have coronary artery blockage and lack of blood to the heart muscle (ischemic heart disease) before something is done? Why wait until somebody is on three or four medicines for diabetes and blood pressure before taking different action?
As a proud member of the American College of Bariatric Physicians, I can tell you that through the teaching of the college, new emphasis is brought to the treatment of risk factors and prevention of disease, rather than treatment. There is now hope for patients seeking help, which is exciting! How is that possible? How does waist line predict cardiovascular risk? Well, a large waist size is risky because it reflects the presence of visceral fat.
There are two types of body fat: visceral and subcutaneous. While subcutaneous fat is under the skin, visceral fat surrounds your vital organs inside the abdomen, including the heart and liver. Subcutaneous fat is the one you can pinch off with your fingers on your abdomen, arms, thighs, and “love handles.” On the other hand, visceral fat is visualized only with fancy scans such as the MRI, because it cannot be pinched and lies deep inside the abdomen.
The visceral fat is sort of puffy and gives the appearance of the “bear belly” or “pot belly.” Visceral fat is linked to heart disease and diabetes, because it causes inflammation that causes damage in the arteries. One of the first signs can be the development of insulin resistance, where the blood sugar and insulin levels begin to rise. If not treated rather quickly through proper nutrition, fitness, and ultimately weight loss, then it will develop into permanent diabetes, heart disease, and put one at a high risk for heart attack and death.
The Secret to Reversing Disease
If you have an increased waist size and have been diagnosed with high blood sugar, high cholesterol, and hypertension, your diagnosis is metabolic syndrome, which is an important risk factor for heart disease, stroke, and death. Metabolic syndrome is a very common disorder in the US, and according to the National Health and Nutrition Examination Survey (NHANES) 1999-2002, 34% of the adult population had metabolic syndrome. No wonder heart disease is the biggest killer in the U.S.
But here’s the most exciting and amazing finding related to metabolic syndrome and how you can literally reverse disease. Remember, I told you the most important indicator for heart disease is waist size, not blood sugar levels or cholesterol. So, if you have been diagnosed with metabolic syndrome, there is hope, but you must intervene quickly before the damage becomes irreversible. Interestingly, the studies show that you can reverse disease by losing as little as 10% of your body weight.
For example, if you weigh 200 pounds, losing about 20 pounds can be lifesaving! By losing only 20 pounds, you can decrease your cardiovascular risk factors by a lot. Here’s where laboratory tests can be important, because repeat blood draws after weight loss of only 10% shows tremendous improvement, disproportional to a small amount of weight loss. In English, you lose a little bit of weight but get large health benefits.
I mention this study and discuss the importance of the 10% weight loss rule, because most people tend to put off losing weight as they put a tremendous amount of pressure on themselves to lose a significant amount of weight, such as 80 to 100 pounds. Aiming for a large amount of weight loss psychologically becomes an impossible task, so as human beings we tend to procrastinate by putting off weight loss until we find the “perfect time” in our lives to begin dieting.
In bariatric medicine, physicians emphasize that losing as little as 10% body weight is urgent and can be lifesaving. Once you have lost that 10% and remove yourself from the danger zone, proceed with your weight loss goals for aesthetic purposes to look sexier. Take care of your heart first, then you can take your time to look good. For help towards your weight loss goal, contact a bariatric physician specialist near you.