A healthy BMI doesn't prevent heart disease

Excess fat around the midsection poses an increased risk of heart disease even if your body mass index (BMI) is within a healthy range.

Nick Beare 3 minute read April 26, 2021
BMI heart disease

A new review of research looks at abdominal weight, not just the BMI. Getty

New research published by the American Heart Association published in their journal, Circulation, is shedding light on obesity and its impact on cardiovascular health.

The study suggests that people with abdominal obesity or excess fat around the midsection and organs have an increased risk of heart disease even if their body mass index (BMI) is within a healthy range.

Abdominal obesity, sometimes referred to as visceral adipose tissue, or VAT, is a common cardiovascular disease risk marker. VAT is determined by waist circumference, the ratio of waist circumference to height (taking body size into account) or waist-to-hip ratio and has been shown to predict cardiovascular death independent of BMI.

While high waist circumference or low waist-to-hip ratio could mean an increased risk of heart disease, abdominal obesity is also linked to fat accumulation around the liver that can lead to fatty liver disease, which adds to cardiovascular disease risk.

“Studies that have examined the relationship between abdominal fat and cardiovascular outcomes confirm that visceral fat is a clear health hazard,” said Tiffany M. Powell-Wiley, chair of the writing committee and chief of the Social Determinants of Obesity and Cardiovascular Risk Laboratory at the National Heart, Lung, and Blood Institute in Bethesda, Maryland. “The timing of this information is important because the obesity epidemic contributes significantly to the global burden of cardiovascular disease and numerous chronic health conditions that also impact heart disease.”

The researchers note that abdominal obesity is so risky that people who are overweight, or living with obesity based on their BMI, could still have lower risk of cardiovascular issues if they have lower levels of fat tissue around their midsection. This concept is called “metabolically healthy obesity”.

Enjoying this story? Subscribe to our newsletter here

It should be pointed out, however, that the origins of BMI are dubious and although it is now the standardized measure for body mass, BMI does not account for age, sex, race or bone structure.

Obesity is a complex disease with many societal influences including biological, psychological, environmental aspects which may determine why someone is living with it. But, it is also closely associated with heart disease and other cardiovascular conditions so researchers focused on ways of treating and managing it as part of this study.

The researchers found that reducing calories and aerobic exercise were two effective ways of reducing abdominal obesity. The analysis found that completing 150 minutes per week of physical activity may be sufficient to reduce abdominal fat, with no additional loss from longer activity times. The study also looked at diet and lifestyle changes as well as bariatric surgery as ways to reduce abdominal obesity.

“Additional work is needed to identify effective interventions for patients with obesity that improve cardiovascular disease outcomes and reduce cardiovascular disease mortality, as is seen with bariatric surgery,” said Powell-Wiley.

The study went on to identify of future research, including a call for further study of lifestyle interventions that may be most effective improving cardiovascular outcomes.

“It’s important to understand how nutrition can be personalized based on genetics or other markers for cardiovascular disease risk,” said Powell-Wiley. “As overweight and obesity prevalence increases among adolescents worldwide, it is critical to address how best to develop upstream primary prevention interventions and better treatment strategies, particularly for young patients with severe obesity.”

Nick Beare is a writer with Healthing.ca


Postmedia is committed to maintaining a lively but civil forum for discussion and encourage all readers to share their views on our articles. Comments may take up to an hour for moderation before appearing on the site. We ask you to keep your comments relevant and respectful. We have enabled email notifications—you will now receive an email if you receive a reply to your comment, there is an update to a comment thread you follow or if a user you follow comments. Visit our community guidelines for more information and details on how to adjust your email settings.