Most people fighting with their waistlines have lost hundreds of pounds (well maybe that’s an exaggeration – millions of pounds) but they still look the same. The usual story is that we gain back any weight we manage to lose. A report in last week’s New England Journal of Medicine shows that weight fluctuations may be worse for people who already have evident coronary artery disease than just staying the same weight whatever it is. (1)
The authors of this study examined data from a previous study reported in 2005 conducted on 10,000 people with stable coronary disease who were treated with and without high doses of a statin. In that study high dose and more intensive lowering of LDL (bad) cholesterol helped. Since they had a lot of weights from the 5 years of follow up in that study they looked at the issue of variability of body weight between visits at 3, 6, 9 months, 1 year and then every 6 months during that study.
They found that the more weight fluctuated the worse patients did. Among patients with the highest variation in body weight, the risk of a heart attack was 117% higher, the risk of stroke 136% higher and death 124% higher than it was for those in the lowest quintile of body weight fluctuation. Moreover, body weight fluctuation was associated with the risk of new-onset diabetes. The associations observed were independent of mean body weight and traditional risk factors. Finally the risks of high body weight fluctuations were worse for persons who were overweight and obese than among persons of normal weight.
Obesity, but not so much overweight, is associated with more of all that bad stuff and big weight loss that is long lasting after obesity surgery has been shown to improve things significantly. So it seems logical that weight loss should be recommended.
There is also that other thing labelled the obesity paradox whereby people with established cardiovascular disease and even heart failure do better if they are overweight and obese than if they are normal weight. This phenomena is debated and most authorities still recommend weight loss even for obese patients with cardiovascular disease.
Tight correlation does not necessarily mean causation and I don’t know what the possible mechanism of harm of weight change might be and neither did the authors of this report, but maybe doctors should reconsider advising obese patients to lose weight.
John DiTraglia M.D. is a Pediatrician in Portsmouth. He can be reached by e-mail- firstname.lastname@example.org or phone-354-6605.