Why Waist Size is More Than Just a Number
In the case of heart disease, an apple a day does not keep the doctor away. In fact, an apple-shaped physique can be the reason someone needs to see their doctor more often.
Diving into the world of heart disease can be complex. There are many factors that increase a persons susceptibility to heart disease, whether due to genetics or lifestyle choices. These factors include pre-existing or family history of diabetes, high blood pressure and cholesterol and obesity, specifically surrounding the abdominal region. Body shape is an apparent genetic factor that cannot be changed, but if you are an apple-shaped person and living a sedentary lifestyle you are unknowingly increasing your chances of heart disease.
Apple vs. Pear Shape
It may be awkward to tell a patient they are shaped like an apple or pear but in the context of health, these shapes matter. When explaining the two shapes, it breaks down to where a person’s fat is predominantly located. Being a pear means you have more hip and leg fat, while an apple means you have more fat at your core or trunk area.
A study published in the European Heart Journal measured the association between body fat and cardiovascular disease (CVD) risk among postmenopausal women with normal BMIs and they concluded that having more trunk fat increases the risk for CVD, while being a pear shape did not yield the same risk. Interestingly, women with both waist and leg fat were at a three-fold increased risk for cardiovascular disease. They also concluded that patients known as apple-shaped were associated with more metabolic disturbances including elevated insulin levels, hypertension and high cholesterol.
While these conditions may seem common in many Americans today, looking at the big picture leads to bigger problem. Diabetes, obesity, high blood pressure, and cholesterol make up the cocktail that is Metabolic Syndrome; which simply put means having these conditions make your risk for CVD much greater. Regardless of how awkward it may be to tell your patient their body shape is increasing their risk of CVD and possibly death, this conversation is an integral part of preventing poor health outcomes.
What Should the Future of Healthcare Look Like?
Discussing a patients CVD risk during each office visit is crucial to help prevent future health problems and navigate your patients into a healthier lifestyle. According to a consensus made by the International Atherosclerosis Society (IAS) and International Chair on Cardiometabolic Risk (ICCR), the use of BMI to assess cardiovascular risks and a patients risk of death should be replaced with measuring waist circumference.
“Waist circumference better predicts obesity-related outcomes than does BMI and should become a routine vital sign in clinical practice”
So in context, it is more valuable to measure a patient’s waist and advise them on lifestyle modifications if they are apple-shaped than to give them a goal BMI to maintain. Clinically, lifestyle modifications and medications to treat any metabolic disturbances a patient currently suffers from are key to preventing cardiovascular disease. Even though there are only a few medications on the market targeted to aid weight loss, it is a valuable conversation to have with patients, as beginning an intervention to aid in weight loss can help prevent other health problems. With the overwhelming amount of diets and health trends on the market now, helping a patient pick out a heart healthy diet will be an important conversation to have during visits. Along with weight management, treating coexisting metabolic disturbances is needed to not only manage current conditions but to help prevent CVD and other health problems.
Conclusion
The conversations you have with patients matter.
The upward trend of obesity and more importantly Metabolic Syndrome among patients is shinning a light on the role of health care workers and the need for them to make interventions on lifestyle changes. As significant as medications are for metabolic disorders like diabetes and high blood pressure, these conditions and furthermore, cardiovascular disease can be avoided if interventions for obesity are started before these other health disorders begin or worsen.
It is extremely important for a health care team to discuss these topics with patients at each office visit: diet and exercise, adherence to medications, waist circumference and the degree of significance their body shape can have on their health.
Frances Nixon-Simon
Massachusetts College of Pharmacy Pharm-D Candidate
