The Correlation Between Obesity and Heart Disease
Obesity is a chronic disease that has reached epidemic proportions, and heart disease is described as the “silent killer.” The link between obesity and heart disease is indisputable and multifactorial. Carrying those extra pounds can negatively impact your health in many ways. But if you live with obesity, losing just 5% of your body weight can improve your overall and heart health.
In the United States, about 42% of all adults live with obesity. Two-thirds of U.S. adults meet the body mass index (BMI) criteria for overweight (>25 kg/m2) or obesity (>30 kg/m2).1,2 According to the National Health and Nutrition Examination Survey (NHANES) data from 2017 to 2018, nearly 20% of U.S. children ages 2 to 19 have obesity.3
According to the American Heart Association, cardiovascular disease accounted for 928,721 deaths in the U.S. in 2020, and heart disease remains the number one cause of death in the U.S.
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How Obesity Contributes to Heart Disease
Obesity is associated with over two hundred medical conditions, including high cholesterol levels, high blood pressure, type 2 diabetes, sleep apnea, and increased inflammation. These are risk factors for heart disease.
Where excess fat is stored is also important. Abdominal fat and fat around internal organs are metabolically active and secrete chemicals that increase inflammation and your risk for cardiovascular disease, diabetes, and metabolic syndrome.
Increased abdominal fat is associated with:4
- Increased blood glucose
- High triglycerides
- Low HDL (good) cholesterol
- Increased blood pressure
Inflammation, increased cholesterol, and triglycerides increase your risk for atherosclerosis. This condition results when fat and cholesterol plaque deposits line the inside of blood vessels, causing them to become narrow. This leads to increased blood pressure and decreased blood flow to critical organs, such as the heart.
In addition to putting excess strain on the heart, obesity can increase your risk for atrial fibrillation. This irregular heart rate increases your risk for blood clots and cardiac arrest. Compelling research suggests that obesity can increase atrial remodeling and fat deposition around the heart, which increases the risk of arrhythmias.6
Metabolic syndrome is diagnosed when three of the following five health markers fall out of the suboptimal range.
- A waist measurement of 35 inches or more for women and 40 inches or more for men
- Fasting glucose that exceeds 100 mg/dL
- HDL cholesterol less than 40 mg/dL in men and less than 50 mg/dL in women
- Triglycerides above 150 mg/dL
- Blood pressure equal to or higher than 130/85 mmHg
High blood pressure, high triglycerides and cholesterol, insulin resistance, and inflammation from obesity are all interrelated metabolic processes that increase your heart disease, diabetes, and stroke risk. Research suggests that the lifetime risk for heart disease is high for all U.S. adults but is even higher for adults who are overweight or obese. Adults with obesity had an earlier onset of heart disease, a greater proportion of their lifetime was described as in poor health, and a shorter survival when compared with adults with a healthy BMI.5
How Heart Disease Contributes to Obesity
Heart disease can also contribute to obesity, though the connection is through its impact on your lifestyle. Having heart disease can decrease your endurance and your ability to exercise. A sedentary lifestyle is a risk factor for obesity.
What Does a Healthy Heart vs. an Obese Heart Look Like
In childhood, cholesterol and fats are already being deposited on the inner lining of blood vessels. Insulin resistance and inflammation associated with obesity accelerate these processes, leading to a narrowing of blood vessel lumens and decreasing blood flow to heart muscle. Living with obesity increases your risk for coronary heart disease and heart attacks.
Excess body fat can also change the structure of your heart, increasing your risk of heart failure and arrhythmias. Increased inflammation and insulin resistance increase fat deposition in and around the heart and cause changes to heart muscle structure, which can lead to scarring. Scarring can lead to abnormal heart rhythms and decreased heart contractility.
Causes and Risk Factors
Obesity and heart disease share several risk factors. Reducing these risks can help with weight management and reduce your risk for heart disease.
Risk factors for obesity include:
- Poor quality diet: A diet high in saturated and trans fats, refined carbohydrates, and highly processed foods increases your risk of obesity and heart disease. Sugary beverages, fast foods, large portions, and highly processed foods increase your risk of obesity.
- Physical inactivity: A sedentary lifestyle decreases calories burned throughout the day. Without a proportional decrease in calories consumed, excess calories are stored as fat.
- Genetics: Family history and genetic predisposition play an important role in obesity risk. Whether you gain weight is not as simple as the adage that weight gain occurs when you consume more calories than you burn.
- Psychological factors: Chronic stress, anxiety, and depression can increase your risk of obesity.
- Lack of sleep: Inadequate or unrestful sleep is associated with weight gain. Research suggests that changes in hormone levels and eating patterns cause people with poor sleep to consume more calories.
- Medications: Some medications, such as antidepressants and corticosteroids, are associated with weight gain.
- Medical conditions: Hypothyroidism and polycystic ovary syndrome (PCOS) are examples of medical conditions that contribute to weight gain and obesity.
- Food Access: Socioeconomic factors and a lack of access to high-quality foods can increase the risk of obesity.
Risk factors for heart disease include:
- Unmanaged stress: Unmanaged or chronic stress affects your heart health by increasing heart rate and contractility, which puts added pressure on heart muscle.
- High blood pressure: High blood pressure rarely has symptoms, which makes it even more important to monitor your blood pressure regularly and identify hypertension early.
- Smoking: If you use nicotine products and want to quit, consider asking for medical help as part of a smoking cessation program.
- Excessive alcohol consumption: The nutrition-poor calories in alcohol contribute to obesity and liver disease, which are both risk factors for heart disease.
- Poor-quality diet: A diet high in saturated and trans fats and processed foods increases your risk of obesity and heart disease.
- Physical inactivity: Choosing a sedentary lifestyle can increase your risk of obesity and decrease your overall cardiovascular health.
- High blood sugar: If you have a family history of type 2 diabetes or obesity, ask your doctor whether you should have your blood sugar tested to determine whether you are at risk for type 2 diabetes.
Lifestyle changes can help you manage your weight and improve your cardiovascular health. New and upcoming wearable devices make it easy to track your progress. Whether you want to follow your weight, body measurements, steps, calories consumed, blood pressure, heart rate, or other metrics, smartphone apps can make it easy.
Lifestyle changes that reduce your risk of obesity include:
- Nutritious diet: Consume a healthy, reduced-calorie diet rich in fresh fruits and vegetables, whole grains, legumes, low-fat dairy, and healthy sources of protein and fats.
- Eating Habits: Watch out for habits such as uncontrolled portion sizes, impulse eating, mindless eating, and convenience snacking. These habits can sabotage your weight-loss efforts.
- Physical Activity: Aim for at least 150 minutes of moderate-intensity physical activity and two muscle-building sessions each week.
- Limit sedentary behavior: Walking around the house or other movements throughout the day can increase calorie burn and reduce your risk of obesity.
- Prioritize restful sleep: Get 7 to 9 hours of high-quality sleep each night. Lack of sleep is associated with weight gain.
- Manage stress: Use breathing exercises, yoga, or meditation to manage stress and anxiety.
- Hydration: Drink plenty of water throughout the day to optimize your metabolism.
- Seek support: Ask family and friends to help support your lifestyle changes as you work on improving your overall health.
Lifestyle changes that reduce your risk for heart disease include:
- Exercise: improve your cardiovascular fitness by making heart-healthy exercise part of your daily routine.
- Quit smoking: The hundreds of chemicals in cigarette smoke increase your risk for heart and lung disease.
- Heart-healthy diet: Consume a diet rich in fruits and vegetables, whole grains, and lean proteins and low in saturated and trans fats, sodium, and added sugars.
- Monitor blood pressure: Check your blood pressure regularly and contact your doctor if you notice a consistent increase in your blood pressure.
- Monitor “bad” cholesterol and triglycerides: Make any necessary dietary changes and take prescribed medications to manage your cholesterol and triglycerides.
- Limit alcohol use: Excessive alcohol consumption increases your risk of heart disease.
- Manage stress: Use breathing techniques, meditation, or yoga to manage stress. Schedule time for relaxing and engaging in your favorite activities and hobbies.
Medications are commonly used to improve heart function and treat obesity. Telemedicine platforms, such as TelegraMD, make it convenient to consult with a doctor on call to discuss your health concerns, receive an online diagnosis, and, if appropriate, have an online prescription transmitted to your local pharmacy or delivered to your home.
Medications commonly prescribed to treat obesity include:
Medications commonly prescribed to treat heart disease include:
- Statins: lower cholesterol
- Antiplatelet agents: reduce blood clot risk
- Beta-blockers: slow heart rate and reduce blood pressure
- ACE inhibitors (Angiotensin-Converting Enzyme Inhibitors): lower blood pressure and improve heart function
- ARBs (Angiotensin II Receptor Blockers): dilate blood vessels and lower blood pressure
- Diuretics: remove excess water and salt from the body
- Calcium channel blockers: decrease the workload on the heart
- Nitrates: Improve blood flow to the heart
- Digitalis medications: reduce the risk of arrhythmias
- Antiarrhythmics: reduce the risk of arrhythmias
Surgical options are also available to treat obesity and heart disease.
Surgical options to treat obesity are used to reduce the size of the stomach to reduce appetite. These procedures fall under the umbrella of bariatric surgery and include:
- Gastric bypass surgery
- Sleeve gastrectomy
- Lap bands
- Duodenal switch
- Biliopancreatic Diversion with Duodenal Switch (BPD/DS)
- Intragastric balloon
Examples of surgical procedures used to treat heart disease include the following:
- Coronary artery bypass grafting: used to bypass blocked coronary arteries
- Angioplasty: minimally invasive procedure used to open blocked coronary arteries
- Heart valve surgery: repair or replace damaged heart valves
- Aneurysm repair: surgically support a weakened section of an artery
- Heart transplant: replace a severely damaged heart with a donor heart
- Left ventricular assist device: an implantable device that assists the heart in pumping blood
- Defibrillators: surgically implanted devices used to restore normal heart rhythms
While we strive to always provide accurate, current, and safe advice in all of our articles and guides, it’s important to stress that they are no substitute for medical advice from a doctor or healthcare provider. You should always consult a practicing professional who can diagnose your specific case. The content we’ve included in this guide is merely meant to be informational and does not constitute medical advice.
1. The Organization for Economic Co-operation and Development. Obesity Update 2017. https://www.oecd.org/health/health-systems/Obesity-Update-2017.pdf
2. Stierman B, Afful, J., Carroll, M. D., Chen, T.-C., Davy, O., Fink, S., Fryar, C. D. H., Gu, Q., Hales, C. M., Hughes, J. P., Ostchega, Y., Storandt, R. J., & Akinbami, L. J. National Health and Nutrition Examination Survey 2017–March 2020 Prepandemic Data Files—Development of Files and Prevalence Estimates for Selected Health Outcomes. Vol. 158. 2021. https://www.cdc.gov/nchs/data/nhsr/nhsr158-508.pdf
3. Trust for America’s Health. The State of Obesity: Better Policies for a Healthier America. 2021:91. https://www.tfah.org/wp-content/uploads/2021/09/2021ObesityReport_Fnl.pdf
4. Lee, J. J., Pedley, A., Hoffmann, U., Massaro, J. M., & Fox, C. S. (2016). Association of changes in abdominal fat quantity and quality with incident cardiovascular disease risk factors. Journal of the American College of Cardiology, 68(14), 1509–1521. https://doi.org/10.1016/j.jacc.2016.06.067
5. Khan SS, Ning H, Wilkins JT, Allen N, Carnethon M, Berry JD, Sweis R.N., Lloyd-Jones D.M. Association of Body Mass Index With Lifetime Risk of Cardiovascular Disease and Compression of Morbidity. JAMA Cardiol. 2018 Apr 1;3(4):280-287. doi: 10.1001/jamacardio.2018.0022. PMID: 29490333; PMCID: PMC5875319.
6. Powell-Wiley, T. M., Poirier, P., Burke, L. E., Després, J.-P., Gordon-Larsen, P., Lavie, C. J., Lear, S. A., Ndumele, C. E., Neeland, I. J., Sanders, P., St-Onge, M.-P., & On behalf of the American Heart Association Council on Lifestyle and Cardiometabolic Health; Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; Council on Epidemiology and Prevention; and Stroke Council. (2021). Obesity and cardiovascular disease: A scientific statement from the American Heart Association. Circulation, 143(21). https://doi.org/10.1161/cir.0000000000000973