How does obesity cause heart disease?

Heart disease is the leading cause of death for adults in the US. Every 34 seconds, someone in the US dies due to heart disease, accounting for about 1 in every 5 deaths. Certain medical conditions can increase the risk for heart disease, including overweight and obesity. By definition, overweight is a body mass index (BMI) of 25-29 kg/m² and obesity is a BMI of 30+ kg/m². There’s no denying that obesity has been on the rise for decades, now affecting approximately 42% of US adults. In this article, we’ll discuss the link between obesity and heart disease and what can be done to achieve a healthy body weight to support a healthy heart.

Obesity and heart disease

It has been well established that excess body weight increases the risk for cardiovascular disease through several mechanisms as explained below.

Fat deposition

People living with obesity have increased fat stores and fat can accumulate in and around our organs ( known as visceral fat). Visceral fat secretes different hormones as well as inflammatory signals known as cytokines that are thought to underlie many of the harmful effects of excess weight on our health. For example, researchers found that increased fat accumulation around the heart (specifically the outermost part called the epicardium) was linked to worse cardiovascular health. 

High blood pressure (hypertension)

Obesity can lead to the development of high blood pressure. The accumulation of fat around our blood vessels as well as the inflammatory cytokines released from fat cells themselves can activate our “fight or flight'' system (aka the sympathetic nervous system) causing the blood vessels to constrict. Additionally, when fat starts to compress the kidneys and their blood vessels, it leads to the production of hormones that cause blood pressure to increase in part due to increased reabsorption of water and sodium by the kidneys. Hypertension also increases the risk for heart disease, stroke, and kidney disease.

High cholesterol

High cholesterol in people with obesity is typically not just an excess of the unhealthy LDL (low-density lipoprotein) cholesterol particles but also an increase in triglycerides, a type of fat found in the blood. It is thought that the enzyme lipoprotein lipase (LPL) is less active in people with obesity. This enzyme normally degrades triglycerides, so without it working normally, it leads to an excess accumulation of triglycerides. This excess also causes the downstream effect of increasing LDL as well as decreasing the healthy HDL (high-density lipoprotein). Another term for this combination of low HDL and high triglycerides and LDL is dyslipidemia, which is strongly linked to heart disease. LDL cholesterol particles contribute to the formation of cholesterol plaques in the arteries which can block the flow of blood to important organs such as the heart leading to a heart attack or the brain leading to a stroke.

Type 2 diabetes

Insulin is a hormone produced by the pancreas that lowers the levels of sugar in the blood.  Obesity can lead to the development of insulin resistance whereby the body does not listen to the signal of insulin and blood sugar levels remain high. Eventually this can progress to type 2 diabetes which is characterized by abnormally high levels of blood sugar. Type 2 diabetes is a known risk factor for cardiovascular disease including coronary artery disease (blockage of the coronary arteries due to cholesterol plaques), stroke, and heart failure. Cardiovascular disease is the number one cause of death for people with type 2 diabetes.

Obstructive sleep apnea

Obstructive sleep apnea is a condition where a person stops breathing when they are sleeping. It has been estimated that the prevalence of sleep apnea is 41% among people with a body mass index (BMI) over 28 kg/m². In patients referred for bariatric surgery (BMI of 35 kg/m²  or higher), up to 78% may have sleep apnea. A scientific statement from the American Heart Association reported that 40-80% of people with heart disease also had sleep apnea. Part of the link between sleep apnea and heart disease is the overactivation of the “fight or flight'' system that can contribute to the development of high blood pressure. Symptoms of sleep apnea can include snoring, stopping breathing while sleeping, waking up gasping for air, and significant daytime fatigue, but in many cases a person may not have these classic symptoms.  

Does treating obesity reduce the risk for heart disease?

Yes! Studies have shown that with as little as 5-10% body weight loss decreases the risk of heart disease. Weight loss can lead to improvements in blood sugar, cholesterol, and blood pressure which are also risk factors for heart disease. So what is the best way to lose weight? A comprehensive and effective obesity treatment plan involves the key foundational components of healthy nutrition, increased physical activity, and mindset shifts to support a healthy lifestyle. Individuals who are unable to lose weight or successfully maintain weight loss with these lifestyle tools, may be candidates for additional treatment options such as medication or surgery. At Form Health, our expert clinical team supports patients with these crucial lifestyle changes and, if appropriate, may prescribe FDA-approved medications for weight loss.

Lifestyle changes for a healthy heart

There are various different dietary patterns that have been studied in relation to their effects on cardiovascular health including the Mediterranean Diet, DASH Diet, The Ornish Diet, and Plant-Based Diets. The American Heart Association recommends avoiding excessive calorie intake and prioritizing fruits, vegetables, whole grains, and plant-based sources of protein and fish. If you eat meat or poultry it’s recommended to choose lean cuts and minimize processed meats (e.g hot dogs, deli meats, etc.). They also suggest reducing added sugars and salt in foods. Physical activity is encouraged with a goal of at least 150 minutes of moderate (or 75 minutes of vigorous) activity each week.  

Form Health can help you lose weight (and protect your Heart)

Since obesity contributes to heart disease in countless ways, maintaining a healthy weight is crucial for a healthy heart. At Form Health, we use research-backed tools that have been shown to be most effective for weight loss in a supportive environment to help you reach your weight loss and health goals. Through weight loss, we have helped thousands of  patients improve their cholesterol, blood pressure, and blood sugar levels as well as reduce their risk of developing cardiovascular disease. We support patients with lifestyle changes like those recommended by the American Heart Association with the added focus on weight reduction. Our patients work closely with their Registered Dietitian to develop a personalized nutrition plan that is both sustainable and enjoyable.

Medications for weight loss

Individuals who are unable to lose weight or successfully maintain weight loss with lifestyle changes alone and have a BMI of 30+ kg/m² or a BMI of 27+ kg/m² with a weight related medical condition (e.g. high blood pressure, high cholesterol), or may be a candidate for FDA-approved medications for weight loss. At Form Health, your expert doctor  carefully considers your individual circumstances and medical history to determine the best option in terms of safety and efficacy, it is not a one-size-fits all approach.  

It is worth mentioning in the context of heart disease that there are two commonly used medications for weight management that have also demonstrated a benefit in terms of cardiovascular disease in patients with type 2 diabetes: GLP-1 receptor agonists (liraglutide and semaglutide) and metformin. GLP-1 receptor agonists are a group of medications that include semaglutide (Ozempic® which is FDA-approved for type 2 diabetes and Wegovy® which is FDA-approved for weight loss) and liraglutide (Victoza® which is FDA-approved for type 2 diabetes and Saxenda® which is FDA-approved for weight loss). Keep in mind, there are many other FDA-approved medications available, and finding the right fit for each unique individual is our focus. We also emphasize that these medications are used in combination with healthy nutrition and increased physical activity, and Form Health provides the support you need to make sustainable lifestyle changes.

We are here to help you care for your body, live a healthy life, and successfully manage your weight. Visit Form Health online to start your weight loss and healthy heart journey! You can also take our quiz to find out if you are eligible for the Form Health medical weight loss program.

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