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Cardiometabolic Disease — A Risk at Any Weight

By James LaValle, RPh, ND, CCN

Just because you are not obese, doesn’t mean you’re off the hook when it comes to increased risk for heart disease and diabetes — known as cardiometabolic disease. If you’re just a little pudgy around the middle, you may pat your belly and chuckle about those few extra beers you had last night, but it is no laughing matter.

Two studies recently looked at the cardiometabolic health of three categories of white adults: normal weight, overweight, and obese. Researchers measured blood pressure, triglycerides, fasting plasma glucose, C-reactive protein (CRP), high-density lipoprotein (HDL), and assessed whether the study subjects were insulin resistant.

What they found was eye opening — 23.5% of “normal weight” adults were metabolically abnormal — and surprisingly, the research done by Wildman’s group found that approximately 30% of the “obese” group was actually metabolically pretty healthy.¹ In the “overweight” group, it was split about 50-50 between those who were metabolically healthy and those who were at increased risk according to these measures.

So to summarize, the study found the risk for heart disease and diabetes in the three groups to be: normal body weight, 25% risk; overweight, 50% risk; obese, 70% risk.

Another study by Stefan et al. found that 25% of obese people did not have early signs of heart disease as determined by their blood vessel thickness and an oral glucose tolerance test used to measure insulin sensitivity.² Nor were these people categorized at high risk according to their lipid profiles and blood pressure readings.

Both of these studies assessed whether central adiposity (belly fat) raised the risk of heart disease the most, as has been seen in other studies. According to the American Heart Association, if a man’s waistline is greater than 39 inches and a woman’s waistline is greater than 34 inches, it’s time to take action.

Interestingly, the Stefan study found that in already obese patients, the most “at risk” fat was not belly fat, but liver fat. However, in normal and overweight people, belly fat did increase risk the most. (This may be because it is very unusual to see liver fat accumulating in normal weight people.) The Wildman study also found that normal weight or slightly overweight patients are more at risk for heart disease if they have belly fat.

The blogs are now flying about this research. I have seen statements like, “These studies once again prove that just because you are obese doesn’t mean you are unhealthy.” And indeed these studies show that if you are obese, you have a 25 to 30% chance of being in the group that hasn’t yet developed heart disease or diabetes. But the overwhelming number of studies consistently shows that the vast majority of obese people do have heart disease and/or diabetes.

Even in the Wildman and Stefan studies, only 25 to 30% were escaping risk so far. The other 70% were at risk. In the normal weight category, 75% were metabolically healthy and 25% were at risk. I would take those odds any day.

I know some obese individuals will want to hang on to that 25% chance they may not be unhealthy just because they are severely overweight — but there are other health problems that can develop too. Certainly if you fall into the obese category, you should at least be thoroughly evaluated to find out.

What are the take home messages from this research? You can be at cardiometabolic risk even if you are at a normal body weight, especially if you have increased waist size. This is not news to me and most health practitioners, but it is a big wake up call for many people.

Increased belly fat/waist size puts you at increased risk for heart disease and diabetes — and the more overweight you become, the greater your risks. So, no matter who you are, you should take steps to prevent insulin resistance and control your weight to have the greatest chance of avoiding these two devastating diseases.

We also need to further study the 25% of the obese population to see what is keeping them from developing insulin resistance. For instance, the Wildman study found that increased physical activity reduced risk. Other studies have found that increased antioxidant intake from foods like green tea and turmeric may prevent damage to insulin receptors from the oxidative stress that can cause insulin resistance.

Perhaps these individuals have better sources of, or utilization of, the mineral chromium which helps regulate blood sugar. Or, they might have increased vitamin C intake from fruits, vegetables, and supplements which reduces the risk of insulin resistance and diabetes.^3-4

Determining which factors can best lower risk of heart disease and diabetes, even in people who have not been able to lose weight, would be of tremendous value.

References

1. Stefan N, et al. Arch Intern Med. 2008;168:1609-1616.
2. Wildman RP, et al. Arch Intern Med. 2008;168:1617-1624.
3. http://www.nutritionandmetabolism.com/content/5/1/17.
4. Arch Intern Med. 2008;168:1485-1499.

[Ed. Note: James LaValle, R.Ph, ND, CCN, is the founding Director of the LaValle Metabolic Institute, one of the largest integrative medicine practices in the country. He was named as one of the 50 most influential pharmacists in the US by American Druggist magazine. Dr. LaValle is the author of more than a dozen books itxtncluding the bestseller, Cracking the Metabolic Code: 9 Keys to Optimal Health. To learn more, click here.]

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