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From the University of Colorado Health Sciences Center, Denver (R.H.E.),
and Lawrence Berkeley National Laboratory, University of California, Berkeley
(R.M.K.).
Correspondence to Robert H. Eckel, MD, General Clinical Research Center, University of Colorado Health Sciences Center, 4200 E Ninth Ave, Denver, CO 80262.
In response to the emerging body of scientific, medical,
and behavioral data about the link between excess adiposity and
coronary heart disease, the American Heart Association (AHA) has
reclassified obesity as a major, modifiable risk factor for coronary
heart disease.
In doing so, the AHA focuses more of its attention and resources on the
role of obesity in cardiovascular disease and issues a "call to
action" to the medical and research community, as well as the public.
The actions that we request are listed below and begin with the need
for more funding for research on obesity, particularly the interrelated
roles of the biochemical and behavioral factors that underlie weight
regulation. Only through such research can we better understand this
disorder and develop more effective preventive strategies and
treatments for obesity.
Obesity research today is in its infancy, at a stage comparable to
lipid research 20 years ago. From epidemiology studies, we have learned
that obesity is a serious risk factor for coronary heart disease, on a
par with cigarette smoking, physical inactivity, and high blood
cholesterol. Because the research on this "new" risk factor for
heart disease is in its infancy, the solutions are less clear. Few
drugs exist to prevent and treat obesity, and certainly there are no
drugs comparable to the "statins" to reduce high blood cholesterol.
The long-term effects of the few treatments available remain unknown.
There are few tools for treatment, in part because we are still
learning about the complex causes of excess weight.
What we do know is that modest weight reductions of 5% to 10% of body
weight can decrease blood pressure and total blood cholesterol, improve
glucose tolerance in diabetic patients and those with impaired glucose
tolerance prone to develop diabetes, and reduce the severity of
obstructive sleep apnea. Given the rise in the prevalence of obesity,
even these small changes can be important to the nation's health.
The number of both men and women who are overweight is increasing. How
is overweight defined? The AHA has adopted the body mass index (BMI) as
an indicator to measure adiposity. BMI is defined as weight in
kilograms divided by height in meters squared (kg/m2). A
BMI between 25 and 30 is considered overweight, and a BMI >30 is
considered obese.
According to NHANES III (1988–1991), 65 700 000 American adults (30
million men and 35.6 million women) exceed the healthy weight range
defined by the US dietary guidelines. National Center for Health
Statistics data from NHANES III show the same alarming trend in
children and adolescents.
However, the measurement of excess weight is not an exact science. It
is sometimes difficult to establish a threshold level of BMI to define
obesity, especially in women, because in women, a BMI as low as 21 may
be associated with the greatest protection from coronary heart disease
mortality. For many women, a BMI near 30 may not be a threat to
cardiovascular health when the increase in adipose tissue is
distributed in the pelvis and not in the abdomen. Unfortunately, a
BMI-based definition fails to take body fat distribution into account.
The causes of obesity are complex. Although genes play an important
role in determining how individuals metabolize calories, lifestyle may
play the dominant role. For example, people have become more sedentary
both on the job and during their leisure time.
According to the Physical Activity and Health report by the
Surgeon General (1996), low levels of activity, resulting in fewer
calories used than consumed, contribute to the high prevalence of
obesity in the United States. Nevertheless, inactivity is only half of
the lifestyle equation. Calories also count.
Over the past three decades, public health authorities have exhorted
Americans to eat no more than 30% of total calories from fat and have
emphasized the importance of limiting consumption of saturated fat to
no more than 10% of total calories. In the matter of fat restriction,
we have done a good job of educating consumers. In the 1960s, the
average person consumed
However, despite indications that the percentage of calories consumed
as fat is decreasing, surveys indicate that we are consuming more
calories overall.
Simply put, fat restriction is only part of a heart-healthy diet. To
address the problem of obesity, it is vitally important that we couple
the message to the public of calorie restriction with our message of
lower fat consumption. In addition, we need to emphasize consuming
fruits and vegetables—at least five a day—as an excellent way to help
individuals restrict calories, attain a sense of satiety, and consume
nutrients, such as folate, vitamin B6, and vitamin
B12, that are important for overall cardiovascular health.
The key to decreasing obesity in the United States may be prevention,
especially because so few effective strategies exist to help people who
are already obese lose weight and maintain a healthier weight.
Prevention has become even more important because of the increasing
prevalence of obesity in children and adolescents. In light of the
emergent evidence about the increasing prevalence of obesity and its
link to coronary heart disease, we urge healthcare providers,
legislators, insurers, and the public to take action on the following
points:
© 1998 American Heart Association, Inc.
Cardiovascular News
American Heart Association Call to Action: Obesity as a Major Risk Factor for Coronary Heart Disease
40% to 42% of their total calories from
fat. Recent statistics from the early 1990s indicate that most people
are consuming 34% of their total calories from fat.
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J. Al Suwaidi, S. T. Higano, D. R. Holmes Jr., R. Lennon, and A. Lerman Obesity is independently associated with coronary endothelial dysfunction in patients with normal or mildly diseased coronary arteries J. Am. Coll. Cardiol., May 1, 2001; 37(6): 1523 - 1528. [Abstract] [Full Text] [PDF]
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E. J Parks A targeted goal for energy-restricted diets in the management of coronary risk? Am. J. Clinical Nutrition, February 1, 2001; 73(2): 147 - 148. [Full Text] [PDF]
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 S. R. Daniels, P. R. Khoury, and J. A. Morrison Utility of Different Measures of Body Fat Distribution in Children and Adolescents Am. J. Epidemiol., December 15, 2000; 152(12): 1179 - 1184. [Abstract] [Full Text] [PDF]
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H. Gaenzer, W. Sturm, and G. Neumayr Effects of Walking on Coronary Heart Disease in Elderly Men Circulation, July 11, 2000; 102 (2): e16 - e16. [Full Text] [PDF]
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National Task Force on the Prevention and Treatmen Overweight, Obesity, and Health Risk Arch Intern Med, April 10, 2000; 160(7): 898 - 904. [Abstract] [Full Text] [PDF]
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 J. Hauptman, C. Lucas, M. N. Boldrin, H. Collins, and K. R. Segal Orlistat in the Long-term Treatment of Obesity in Primary Care Settings Arch Fam Med, February 1, 2000; 9(2): 160 - 167. [Abstract] [Full Text] [PDF]
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J. O Hill, J. Hauptman, J. W Anderson, K. Fujioka, P. M O'Neil, D. K Smith, J. H Zavoral, and L. J Aronne Orlistat, a lipase inhibitor, for weight maintenance after conventional dieting: a 1-y study Am. J. Clinical Nutrition, June 1, 1999; 69(6): 1108 - 1116. [Abstract] [Full Text] [PDF]
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 R. F. Redberg, H. Gaenzer, G. Neumayr, J. R. Patsch, M. L. Daviglus, K. Liu, P. Greenland, J. Stamler, and L. B. Russell Cardiovascular Risk Factors and Medicare Costs N. Engl. J. Med., March 11, 1999; 340(10): 813 - 814. [Full Text]
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G. L Blackburn Benefits of weight loss in the treatment of obesity Am. J. Clinical Nutrition, March 1, 1999; 69(3): 347 - 349. [Full Text] [PDF]
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P. Balagopal, S. Sweeten, and N. Mauras Increased synthesis rate of fibrinogen as a basis for its elevated plasma levels in obese female adolescents Am J Physiol Endocrinol Metab, April 1, 2002; 282(4): E899 - E904. [Abstract] [Full Text] [PDF]
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