The weighty issue of heart disease
Heart disease rates have dropped over the past decade, but increasing weight gain among Americans could change that.
- Reviewed by Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing
Heart disease remains the leading cause of death in men, accounting for one in every four fatalities. But there is good news. The prevalence of heart disease among men dropped in the last decade, falling from 8.3% in 2009 to 7.2% in 2018.
"Much of this decline can be attributed to the more aggressive lowering of cholesterol and the number of men who have quit smoking," says Dr. Christopher Cannon, a cardiologist with Harvard-affiliated Brigham and Women's Hospital and editor in chief of the Harvard Heart Letter.
Now the not-so-good news: men's heart disease rates have idled in recent years, and a 2022 report in the Journal of the American College of Cardiology predicts they will rise significantly by 2060. The reason? We are getting too fat.
The report also pointed out that the combined rates of obesity and type 2 diabetes (for which weight gain is a leading contributor) will outpace all other risk factors for heart disease.
"The hope is that by identifying this trend, more men can take steps to address their weight management and hopefully slow or reverse weight gain," says Dr. Cannon.
Reading the scale
More than 70% of adults in the United States are obese or overweight, according to the CDC. Obesity is defined as having a body mass index (BMI) of 30 or higher, while a BMI of 25 to 29.9 indicates someone is overweight. (BMI is a measurement of weight in relation to height; you can calculate yours at /bmi.)
Excess weight can increase blood pressure, raise cholesterol levels, and cause widespread inflammation, increasing the risk of heart attacks and strokes. Being overweight also makes the body more resistant to insulin, the hormone that facilitates the transfer of glucose (sugar) from the blood into the body's cells. This can raise blood sugar levels and ultimately lead to type 2 diabetes. And people with diabetes are twice as likely to suffer a heart attack or a stroke than those without the disease.
However, even if you are not officially obese or overweight, you should keep tabs on the scale and your waistline. "People just below the BMI line for being overweight are still in danger of heart disease, as it's easy to add a few pounds without noticing, and that can send you in the wrong direction," says Dr. Cannon. He adds that even a modest loss of 2% to 5% of your body weight is associated with heart health benefits, including lower blood pressure, blood sugar, and triglyceride levels.
When do you need medication?People who struggle with weight loss despite making lifestyle changes may benefit from taking one of the new anti-obesity medications. These prescription drugs are designated for treating obesity (defined as a body mass index, or BMI, of 30 or higher) and people with a BMI of 27 or higher who also have a weight-related medical condition like high blood pressure, type 2 diabetes, or high cholesterol. Although there are 10 FDA-approved anti-obesity drugs in the United States, older agents offer only moderate sustained weight loss, says cardiologist Dr. Christopher Cannon with Brigham and Women's Hospital. However, some newly approved medications, known as glucagon-like peptide 1 (GLP-1) receptor agonists, which were originally designed to treat diabetes, can be effective. Examples include semaglutide (Wegovy) and tirzepatide (Mounjaro). The downside: they are expensive, and health insurance may not cover the cost. |
Making change
While the rise in America's weight gain can't be entirely explained by consuming too many calories and exercising too little, those are two factors people can control. Still, it's no simple feat. For instance, health issues and physical limitations can make weight-loss activities a challenge. And many men don't consistently follow healthy eating plans or keep tabs on their intake of high-calorie foods.
"Men need to equip themselves with the right tools to be successful with weight loss and weight management," says Dr. Cannon.
One tool Dr. Cannon recommends is a hospital-based weight management program. Here, men work with a team of physicians, nutritionists, exercise physiologists, life coaches, and counselors to create weight-loss goals and strategies on how to reach them.
The programs typically include weekly group sessions and regular check-ins via phone, text, or Zoom. The duration can vary from several months to a year and longer, depending on the person's weight-loss needs.
Ask if your doctor's practice or clinic offers weight-loss interventions or programs that support weight management. Also, contact your health insurance company and inquire about programs your plan covers.
Image: © Deepak Verma/Getty Images
About the Author
Matthew Solan, Executive Editor, Harvard Men's Health Watch
About the Reviewer
Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing
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