Scale back on weight obsession, urges obesity expert

"We need to change how we look at obesity, stop obsessing on weight and BMI and, above all, redefine the proper clinical use of weight loss drugs," says noted obesity expert Dr. Jean-Pierre Després, delivering the Heart and Stroke Foundation of Canada Lecture at the Canadian Cardiovascular Congress 2007.

"Some obese people are healthy yet others, with the same amount of body fat, will have heart disease or diabetes. There are simple ways to tell the difference but health professionals are not yet using basic tools to identify who is at greatest risk."

"Research, health programs and information to help tackle obesity are a strategic priority of the Heart and Stroke Foundation," said Stephen Samis, director of health policy for the Heart and Stroke Foundation of Canada. "That's why we're thrilled to have an international leader in this field of Dr. Després' calibre as our lecturer this year."

The Foundation is funding targeted obesity research and has created a national obesity action plan to provide practical ways to take on obesity in communities across the country. Dr. Després, who is director of research in cardiology at the Hôpital Laval Research Center and scientific director of the International Chair on
Cardiometabolic Risk at Université Laval in Quebec City, advocates for two simple measures to identify those at greatest risk of metabolic syndrome, a cluster of risk factors related to heart disease, stroke and diabetes. "A large waistline combined with high levels of fasting triglycerides in the blood means that there is about an 80 per cent chance that the person has metabolic syndrome."

According to Després, an investigation of middle-aged men living in Quebec City - the well-known Quebec Cardiovascular Study - indicated that showing some features of metabolic syndrome was associated with a 20-fold increase in the risk of ischemic heart disease. A waist circumference above 90 cm could be unhealthy if accompanied by blood triglyceride levels greater than 2 mmol/L. Dr. Després believes that these measures should be standard for any physical exam by a medical professional.

"Obesity is the cholesterol of the 21st century. Despite being a recognized risk factor for heart disease and other conditions, obesity is still not well understood or well defined."

The tale of the tape

According to Dr. Després, the issue of obesity goes beyond weight and body fat, which is why body mass index (BMI) can fail to identify those at risk, or falsely identify those whose weight may not be putting them at increased risk of heart disease. He notes that waist circumference determines whether the person is carrying abdominal fat, and triglycerides indicate how the body is storing the fat. Visceral fat is the far more dangerous kind, packed in among the organs
in the abdomen. Subcutaneous fat is fat that is just under the skin. High triglycerides indicate the presence of potentially dangerous visceral fat.

The skinny on weight loss drugs

Dr. Després urges caution in prescribing weight loss drugs to 'treat' obesity. "I completely disagree with using weight loss drugs only to lose weight," he says. "In some cases drugs are medically necessary, but we need to be much more targeted about who gets them, and focused on their overall health, not just their weight."
Dr. Després has seen the importance of this global health focus in his own clinical studies. "We had a man who lost only one pound in a year long program, but dropped his waist size by 6 cm - a substantial loss of visceral fat that was much better for his health than if he had dropped more pounds."

A simple prescription to stop obesity

Dr. Després believes that there are two simple steps that would go a long way to slowing and hopefully reversing the alarming rise in obesity we see today.
The first is to do a much better job in clinical practice of identifying and managing individuals whose weight is a risk to their health, and provide much more support to people who are trying to change their lifestyles for better heart health.

"From the results of our ongoing lifestyle modification study, we know that patients who have the support of a health care team, with regular and ongoing access to a dietitian and an exercise physiologist/kinesiologist, will be much more successful at making permanent lifestyle changes." Dr. Després estimates the cost of these services to be about $1,000 per patient per year - a bargain compared to the hospitalization and ongoing health care costs for those who develop heart disease or diabetes.

The second is to rethink the environment we live in. "There's no debate our kids should have physical activity and healthy foods in school every day," says Dr. Després. "But they also need to learn by example, so we all need to increase physical activity and healthy eating in our day-to-day lives."

"Above all, we need to ban the word 'dieting' and focus on physical activity/fitness and healthy eating rather than weight."

Statements and conclusions of study authors are solely those of the study authors and do not necessarily reflect Foundation policy or position. The Heart and Stroke Foundation of Canada makes no representation or warranty as to their accuracy or reliability.

The Heart and Stroke Foundation (www.heartandstroke.ca), a volunteer-based health charity, leads in eliminating heart disease and stroke and reducing their impact through the advancement of research and its application, the promotion of healthy living, and advocacy.