Weight or inches: Which matters most for heart health?

There’s no doubt that being overweight is bad for your heart. Research has shown that obesity may increase your chances of death from heart disease by as much as 60 percent.

And doctors remind many of us to lose weight to lose the risk.

But some obese people have better cardiovascular health than people of healthy weight.

The concept is known as “metabolically healthy obesity,” and though it can differ depending on race/ethnicity and sex, there is one specific thing this group has in common besides their health…

And that’s their waist-to-hip-ratio.

Belly fat is more dangerous than extra pounds 

A recent scientific statement from the American Heart Association identifies visceral adiposity, better known as belly fat, as a bigger risk factor for heart disease and stroke than simply being overweight or obese.

In fact, the risk-inducing power of abdominal obesity is so strong that you can carry excess fat over the rest of your body — but only low levels around the belly — and still have lower cardiovascular risks.

And the folks who have normal body weight — and only a spare tire across the midsection? That belly fat still makes them more of a candidate for a heart attack than weighing too much…

It may be shocking but true: “… there have been a number of studies over the past 15 years that really highlight the relationship between elevated waist circumference, even in the setting of normal BMI, and cardiovascular risk,” says lead author Dr. Tiffany Powell-Wiley of the National Heart, Lung, and Blood Institute, Bethesda, MD.

So why is merely carrying belly fat so much worse?

One reason for this is non-alcoholic fatty liver disease. If you have more adipose fat around your midsection, you also have more of it accumulating inside your body around your organs — especially your liver. Fatty liver disease is a known factor for increased cardiovascular disease risk.

Another reason may be the fact that belly fat is not only metabolically active, but it’s also hormonally active. It can disrupt insulin function which increases risk of heart disease. And it also produces cytokines that negatively impact blood pressure and blood clotting,

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The proof

Here’s a quote from the AHA statement that offers proof of how deadly belly fat is:

“Lifestyle modification and subsequent weight loss improve both metabolic syndrome and associated systemic inflammation and endothelial dysfunction. However, clinical trials of medical weight loss have not demonstrated a reduction in coronary artery disease rates. In contrast, prospective studies comparing patients undergoing bariatric surgery with nonsurgical patients with obesity have shown reduced coronary artery disease risk with surgery.”

In other words, the data shows that exercise and diet changes may improve metabolic syndrome, reduce inflammation and improve blood vessel function, cholesterol levels and blood sugar — but they haven’t done much to lower rates of coronary artery disease. 

However, in patients who undergo bariatric surgery (weight loss surgery, including gastric bypass) the risk of coronary artery disease has been reduced, probably due to significant weight loss, including belly fat.

How to lose belly fat

If your heart is healthy, but you’re carrying around that belly bulge, NOW is the time to start getting rid of it. 

And, if you’ve had a heart attack, it’s also urgent that you take steps to reduce abdominal fat. Research tells us that belly fat is a greater factor in repeat heart attacks than either cholesterol or blood pressure.  

So, where to begin?

Trade meat for mushrooms. That’s right – mushrooms can shrink your waistline! In a yearlong study at Johns Hopkins Bloomberg School of Public Health, participants lost (and kept off!) an average of seven pounds. And, they reduced their waistlines by an average of nearly three inches!

Keep track of your carb and sugar intake. Studies show that cutting back on your carbs even a little bit can lead to less belly fat. That’s because refined carbs and sugar cause your blood sugar to spike, which triggers hormonal changes that tell your body to store fat. Instead, choose foods with protein and fiber that keep your blood sugar stable.

Do strength and resistance training. Building stronger muscles makes your body release fat-burning hormones that reduce belly fat.

Try high-intensity interval training (HIIT). Research shows that high-intensity interval training triggers the “afterburn effect,” which means your body continues to burn calories long after you’re finished exercising. That makes it great for weight loss in your belly… and everywhere else.

What doesn’t work on belly fat? Intermittent fasting. In a study of obese mice:

• During fasting, fat tissue normally provides energy to the rest of the body by releasing fatty acid molecules. Visceral fat became resistant to this release of fatty acids during fasting.
• There were also signs that visceral and subcutaneous fat increased their ability to store energy as fat, likely to rapidly rebuild fat stores before the next fasting period.

However, there is evidence that using intermittent fasting as a jumpstart to a committed diet may lead to lasting weight loss and lower blood pressure.

Sources:

More belly weight increases danger of heart disease even if BMI does not indicate obesity — Science Daily

Obesity and Cardiovascular Disease: A Scientific Statement From the American Heart Association — Circulation

Belly Fat the Biggest Driver of Obesity-Related CVD, Says AHA — Cardiovascular Research Foundation

The link between abdominal fat and repeat heart attacks — Medical News Today

Refined Carbs and Sugar: The Diet Saboteurs — HelpGuide