Reducing obesity cuts heart-health risks, and new guidelines from experts may help doctors and their plus-sized patients devise an effective -- and perhaps lifesaving -- weight-loss plan.
What works best are lifestyle changes, not crash diets, according to the guidelines, which were released Tuesday by the American Heart Association, the American College of Cardiology and the Obesity Society.
"Our recommendation is that doctors prescribe a diet to achieve reduced caloric intake as part of a comprehensive lifestyle intervention," guideline co-author Dr. Donna Ryan, a professor emeritus at Louisiana State University's Pennington Biomedical Research Center in Baton Rouge, said during a press conference. The diet should be tailored to patient preferences and any drugs they take, she said.
Diet, physical activity and face-to-face behavioral counseling combined can lead to "clinically meaningful health improvement," Ryan said. "These benefits begin with weight loss in the range of 3 percent to 5 percent." The most effective behavior programs include two to three meetings a month for six months or more, according to the report.
Nearly 155 million American adults are overweight or obese, which puts them at risk of heart attack, stroke, diabetes and early death. Weight loss will lower blood pressure, improve blood cholesterol levels and reduce the need for medication to manage heart health, Ryan said. For Americans, heart disease is the leading cause of death.
The experts said doctors should use a patient's body-mass index (BMI) to assess whether a patient is obese or not. BMI is a measure of body fat based on height and weight; a BMI of 25 or more is overweight.
"BMI is a quick and easy first screening step," Ryan said. Calculating BMI at least once a year will help identify those at a higher risk of heart disease and stroke because of their weight, she added. Waist circumference is also an indicator of risk.
Weight-loss surgery, also called bariatric surgery, may be the right option for those who are severely obese (a BMI of 35 or higher), especially if they have two other cardiovascular risk factors, such as diabetes and high blood pressure.
This emphasis on obesity is critical, said Dr. Hector Medina, a cardiologist at Scott & White Healthcare in Round Rock, Texas, who was not involved with the report.
The problem? "Most patients don't think they are overweight or obese even with a BMI above 40," he said.
Besides reducing obesity, the new guidelines emphasized the need to maintain safe cholesterol levels, eat a healthful diet and assess other risk factors for heart attack and stroke.
High cholesterol can cause clogged arteries and lead to heart attacks or strokes.
"We focused specifically on the use of cholesterol-lowering therapy to determine what works best to reduce the risk of heart attack and stroke," Dr. Neil Stone, professor of medicine at the Northwestern University Feinberg School of Medicine and chairman of the cholesterol committee, said during the press conference.
According to the guidelines, you should take statin drugs to lower your cholesterol if you have cardiovascular disease, if your bad (LDL) cholesterol is 190 milligrams per deciliter or more, if you're middle-aged with type 2 diabetes or if you're middle-aged with an estimated 10-year risk of cardiovascular disease of 7.5 percent or more.
Statins are the most effective drug for reducing cholesterol and should be combined with lifestyle changes for the best result, according to the report. This approach is better than trying to get cholesterol as low as possible by combining statins with other drugs, the authors said.
The committee also said matching patients with the appropriate level of statin therapy is more important than achieving a target number.
"Basically it suggests that treatment should be individualized," said Medina, the cardiologist. This might mean you need a higher dose of a more potent statin than if your risk is lower, he said.
For young adults, preventing high cholesterol in the first place can go a long way toward avoiding heart attacks and strokes, the committee said.
Healthy Diet and Exercise
A healthy diet -- not necessarily a low-calorie diet -- and exercise reduce the risk for cardiovascular disease by lowering blood pressure and cholesterol.
"Dietary patterns that are heart-healthy ... include lots of fish, vegetables and whole grains, and limit saturated fats, trans fats and sodium," cholesterol committee co-chairman
Dr. Robert Eckel, professor of medicine at the University of Colorado Anschutz Medical Campus in Aurora, said during the press briefing.
A heart-healthy diet of 2,000 calories per day should include:
- Four or five servings of fruit daily
- Four or five servings of vegetables daily
- Six to eight servings of whole grains daily
- Two or three servings of fat-free or low-fat dairy products daily
- Six or fewer ounces of poultry or fish daily
- Four or five servings of nuts, legumes and seeds a week
- Two or three servings of healthy oils a day
- Limited sweets and added sugars
To reduce high blood pressure, limit salt intake to 1,500 milligrams a day, the committee said. U.S. adults currently consume an average of about 3,600 milligrams a day.
One key to heart-healthy eating is avoiding trans fats, which serve no nutritional purpose but are often added to foods to extend shelf life or improve texture. The U.S. Food and Drug Administration announced a plan last week to ban these man-made fats from all processed foods. These are often listed on labels as partially hydrogenated oils.
The guidelines also recommend moderate- to vigorous-intensity aerobic exercise, such as brisk walking, for about 40 minutes three or four times a week.
About one-third of adults at risk for a heart attack or stroke have not been diagnosed but could benefit from primary prevention, including taking statins, according to the report.
Doctors should use known risk factors -- such as age, cholesterol levels, blood pressure, smoking and diabetes -- to assess cardiovascular risk. "These are the strongest predictors of 10-year risk for cardiovascular disease," Dr. Donald Lloyd-Jones, professor of preventive medicine at the Northwestern University Feinberg School of Medicine and co-chairman of the committee, said during the press conference.
Patients at risk of a heart attack or stroke within the next 10 years should get immediate drug therapy and be encouraged to change their lifestyle, Lloyd-Jones said.
Those at lower risk of heart attack or stroke should be counseled to make lifestyle changes and probably do not need drug therapy, he said.