What’s the Link Between Obesity and Heart Disease?

Obesity happens when there’s a rise in the size and number of fat cells in your body. Healthcare professionals use a tool called body mass index (BMI) to help classify obesity.

BMI is a measure of your body size that takes your weight and height into account. It’s calculated by dividing your weight in kilograms by the square of your height in meters.

It’s important to note that BMI is a screening tool and doesn’t take things like body composition and other factors into account. For example, because muscle is denser and heavier than fat, some athletes may have a high BMI, due to their muscle mass, but still be considered a healthy weight.

According to the American Diabetes Association, your waist-to-hip ratio (WHR) is more accurate than BMI for predicting the risks of cardiovascular disease. This measurement estimates how much fat is stored around your waist and hips.

All you need is a tape measure to figure out your waist-to-hip ratio. Once you’ve measured your waist (just above your belly button) and the widest part of your hips, you simply divide your waist circumference by your hip circumference.

Waist-to-hip ratio chart

Having obesity is a risk factor for heart disease. In fact, a large 2018 study found that, compared to individuals with a healthy BMI, people with obesity not only had a higher risk of heart disease but they also had a higher risk of death due to heart disease.

The effects of obesity can impact your heart in many ways. Let’s take a closer look at what those impacts are.

Increases the risk of atherosclerosis

Increased levels of fat, particularly abdominal fat, can cause changes that raise inflammation levels and increase insulin resistance in the body. Both of these factors can promote atherosclerosis.

Atherosclerosis happens when a sticky substance called plaque builds up on the walls of your arteries. This causes the arteries to narrow. When this happens, the flow of blood through the arteries is reduced.

Atherosclerosis can cause coronary artery disease, which is when plaque accumulates on the walls of the arteries that supply the heart, making it harder for blood to get to your heart. Coronary artery disease can, in turn, lead to conditions like angina and heart attack. Atherosclerosis can also cause cerebrovascular disease, which affects the blood flow in the brain, increasing the risk of stroke.

Taxes the heart

Increases in body fat can also lead to increases in the volume of blood in your body. This can cause your heart to beat harder in order to circulate that blood.

As time passes, the extra effort that’s required of the heart can cause structural changes around the ventricles, the heart’s main pumping chambers. This can eventually lead to heart failure.

Affects heart rhythm

Obesity has also been linked with , a type of arrythmia that can lead to dangerous blood clots. In fact, a 2021 review notes that previous research has found that obesity may make up one-fifth of all cases of AFib.

AFib may happen in obesity due to structural changes in the heart that impact the electrical signaling that coordinates the heartbeat. There are likely multiple factors that contribute to this, including:

• increased fat deposits around the heart
• high levels of inflammation in the body
• changes in blood volume associated with obesity
• other obesity-related conditions, such as heart failure, sleep apnea, and high blood pressure

Can lead to high blood pressure (hypertension)

According to a 2020 review, obesity is thought to be the cause of high blood pressure in 65% to 78% of cases. Having a higher amount of fat tissue can cause many complex changes in your body that can all impact your blood pressure and cause it to be higher than what’s considered a healthy range.

Over time, the force of high blood pressure in your body can stiffen your arteries. This can make your arteries more prone to plaque buildup and can cause them to narrow, resulting in atherosclerosis.

High blood pressure also requires your heart to work harder. This can cause the heart muscle to thicken as it works to handle the increased pressure. The changes to the heart muscle and the arteries can raise the risk of coronary artery disease, heart attack, and heart failure.

Increases the risk of diabetes-related heart complications

Obesity is a leading risk factor for type 2 diabetes. Over time, high levels of blood sugar can damage the blood vessels in and around your heart, as well as the nerves that control your heart.

In fact, adults who have diabetes are almost twice as likely to develop heart disease or stroke compared to adults who don’t have diabetes.

May cause sleep apnea and high blood pressure

Obesity is a common cause of sleep apnea. The effects of apnea episodes can lead to raised blood pressure that may be difficult to control. High blood pressure, which can cause your heart to work harder, is also a risk factor for heart failure.

Your body shape can also be a risk factor for heart disease. Carrying excess weight around your waist is associated with an increased risk of heart disease. You may see this referred to as having an “apple” body shape.

A 2019 study compared postmenopausal women with more body fat at the waist (apple-shaped) to those with more body fat at the hips and legs (pear-shaped). All women had a healthy BMI and no previous history of heart disease.

After adjusting for demographic and lifestyle factors, the researchers found that having higher body fat around the waist and reduced body fat at the hips and legs was associated with an increased risk of heart disease.

Why is this? Generally speaking, waist size is correlated with something called visceral fat. This is hidden fat found around your abdominal organs. It’s different from subcutaneous fat, which is the fat at your waistline that you can pinch.

Visceral fat is associated with higher levels of inflammation. It’s also linked to a higher risk of heart disease and diabetes.

The good news is that losing weight can help your heart health. Indeed, research has found that weight loss in people with obesity can reduce the risk of heart disease, particularly coronary artery disease.

So, how much weight needs to be lost before you begin to see health benefits? An older 2011 study, which looked at the effects of weight loss in people with type 2 diabetes and overweight or obesity, found that even modest weight loss can help.

After a year, those that lost 5% to 10% of their baseline body weight had a higher likelihood of notable decreases in A1C levels, blood pressure, and triglycerides as well as improvements in HDL (healthy) cholesterol.

While modest weight loss was associated with benefits, researchers observed an even greater improvement for those who lost 10% to 15% of their baseline body weight.

It’s normal to feel unsure about how exactly to get started with healthy weight loss. But there are tried and true strategies that work. Here are some effective ways to to get started on your weight loss journey.

Talk to your doctor

Everyone is different. Before starting with a weight loss plan, talk with your doctor to discuss your specific health situation. They can provide advice on the best way to tackle your weight loss and the lifestyle changes that you need to focus on.

Adjust your diet

Diet is one of the biggest components of weight loss. The goal is to burn more calories than you take in. However, it’s also important to focus on foods that are good for your overall health, including heart health.

According to numerous studies, the Mediterranean diet has been shown to boost weight loss and help reduce the risk of heart attack and premature death.

For optimum health, try to focus on including more of these foods in your diet:

• fresh fruits and vegetables
• whole grains like brown rice, oats, barley, rye, whole wheat, and corn
• legumes like beans, peas, lentils, and chickpeas
• low-fat or nonfat dairy
• certain proteins like fish, poultry, lean cuts of meat, beans, and nuts
• healthy fats like olive oil, olives, avocados, and avocado oil

At the same time, try to avoid foods that are high in saturated or trans fats, refined carbohydrates, and salt.

Another weight loss strategy that works for some people is intermittent fasting, which involves regular periods of little or no food consumption. You may want to talk to your doctor about whether this could be a safe and effective weight loss strategy for you.

Pay attention to your portion sizes

In addition to choosing healthier foods, it’s also important to control your portion sizes. Try to limit your portion sizes, especially when it comes to foods that contain a higher number of calories.

You can also use your plate as a visual tool by filling at least your plate with non-starchy vegetables. You can then fill the other half of your plate with lean proteins, such as fish, turkey, or chicken, and grains or starches, such as brown rice or a baked potato.

Increase physical activity

Regular physical activity not only helps you lose weight, it can also strengthen your heart, boost your mood, and raise your energy levels.

The Physical Activity Guidelines for Americans recommends that adults get at least 150 minutes of moderate-intensity physical activity each week. This breaks down to about 22 minutes of exercise each day.

This level of activity is safe for most people and can include many types of activities like brisk walking, swimming, cycling, and even .

If it’s hard for you to fit 20 minutes of exercise into your daily schedule, try breaking it up into 10 to 12 minutes of exercise twice a day.

Identify your triggers

Sometimes certain thoughts, feelings, and situations can trigger the urge to reach for certain foods. For instance, going to a sporting event or party, or feeling angry, bored, or stressed may prompt you to eat unhealthy foods or to eat more than you should.

Try to think of the situations that may trip you up with making healthy food choices. Then, come up with ways to deal with each trigger. For instance:

• if you feel stressed or frustrated, try going for a walk or calling a friend instead of reaching for food
• if you’re at a party, try to fill your plate with healthy choices, or put distance between yourself and the food

Focus on realistic goals

It’s totally normal to want to see changes right away, but keep in mind that even small changes can lead to big results over time.

As such, try to set realistic, specific goals like “I will walk for at least 25 minutes, 4 days this week.” Or “I will add 1 extra serving of fresh fruits or vegetables to my diet this week.”

Use your support network

Remember that you’re not alone. There are many people around you who can help and support you on your weight loss journey. Be sure to reach out to your friends, family, coworkers, doctor, or healthcare team for support, especially during challenging times.

If you have insurance, you may also want to check with your health plan to see if they offer nutrition counseling or health coaching. These resources can help give you the tools you need to work toward your weight loss goals.

Also check to see what resources are available in your community. This could include walking groups, fitness clubs, or healthy cooking classes. You may also want to look into weight loss support groups online or in your community.

Talk to your doctor about other weight loss options

If you still have a hard time losing weight after adjusting your diet and portion sizes, and increasing your physical activity, talk to your doctor about other options, such as prescription medications or weight loss surgery.

• Prescription medications for weight loss work in different ways. Some types of medications can help curb your hunger, while other medications may make it more difficult for your body to absorb fat from the food you eat.
• Weight loss surgery, also known as bariatric surgery, treats obesity by decreasing the size of your stomach which, in turn, limits how much food you can comfortably eat. There are different types of bariatric surgery, including:
  • Gastric sleeve: With gastric sleeve surgery, about 80% of your stomach is removed. The part of the stomach that remains is sewn into a banana-shaped pouch. This is the most common type of weight loss surgery in the United States.
  • Gastric bypass: With this type of surgery, also known as Roux-en-Y gastric bypass, the surgeon removes a large portion of your stomach and the first part of your small intestine.
  • Gastric band: A less invasive procedure, gastric band surgery involves the placement of a band around the top of the stomach to create a pouch that holds a smaller amount of food. The band is adjustable, which means your surgeon can change the size of the pouch if necessary.

Obesity is a risk factor for heart disease as well as other conditions like diabetes and some cancers. Examples of the types of heart disease that obesity has been linked to include coronary artery disease, heart failure, and AFib.

Body shape, specifically having more fat at your waist, also increases heart disease risk. This is because visceral fat can contribute to increased inflammation in the body.

If you’re interested in losing weight, talk with your doctor to discuss a healthy weight loss strategy that’s right for you.