Heart Disease
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Obesity
2.59 Obesity has been recognised as a risk factor for coronary artery diseases, strokes and congestive heart failure. Obesity places an increased burden and pressure on the heart to supply blood to about 100,000 km of blood vessels (arteries, veins and capillaries) in the human adult body. The risk is determined not only by the amount of fat but also where the fat is located.
2.60 Individuals (men and women) gain weight in different locations. Some gain more weight around the abdomen and waist, which is the “male pattern” obesity. This type of obesity which makes you look like an “apple” is called “abdominal” or “android”. Another pattern of weight gain (men and women) is excessive weight around the hips and thighs, the “female pattern”. This type of obesity is called “peripheral” or “gynoid” type and the body resembles a “pear”.
2.61 Fat on the hips and thighs in “pear-shaped” people is different than on the abdomen in “apple-shaped” people and is considered to have a cardio protective effect. On the other hand, the abdominal obesity has long been associated with more than double the risk of heart attack and diabetes, with Indians genetically falling in even higher risk category because of their tendency to harbour potbellies. Indians have smaller bones, less muscle mass and more body fat as compared to Caucasians. A potbelly on an otherwise skinny frame is an even greater risk of cardio trouble. Abdominal fat is hormonally active, begetting diabetes, high blood pressure and high cholesterol which all exacerbate cardiovascular diseases. This is perhaps because abdominal fat is in close proximity to the liver, lungs, heart and the kidneys.
2.62 There are many guidelines to measure obesity. One commonly used is the “Body Mass Index” (BMI) which is calculated by dividing the body weight in kilograms by the square of height in metres. BMI of over 25 in the Western population is considered to be overweight/obese as compared at BMI of 23 for Asians and Indians due to their genetic make-up. However, BMI is not considered an accurate tool as heavily muscled bodies of players/athletes may be regarded as obese according to BMI even though there is little fat on their bodies.
2.63 Compared to BMI, Waist Measurement is a better tool. The waist normally refers to the thinnest part on the trunk but for this measurement, it is measured at the maximum part of the trunk. To be healthy in the West, the waist circumference for men and women should be under 100 cm and 85 cm respectively. Since Asians and Indians have genetically a higher percentage of body fat at lower weight, their waist circumference should be under 90 cm for men and 80 cm for women. There is a saying that “longer the waist line, shorter the lifeline”.
2.64 However, it has been argued that BMI and waist measurement are not the best ways to know if one is at an increased health risk from being overweight, obese or underweight. Some doctors, therefore, believe that a person’s Waist to Hip Ratio (WHR) is a much better way to evaluate his or her health status. WHR looks at the proportion of fat stored in the body around the waist and hips. They say the best way to determine the risk of obesity-related diseases is a measurement that divides the circumference of the waist (measured at the maximum part of the trunk) by that of the hips. For women, the WHR should be less than 0.85. Men have a little more wiggle room – a healthy WHR for them should be less than 0.90. The WHR greater than 1 for both males and females is a risk for cardiovascular disease. The link between increased WHR and increased heart attack is found in all countries and cultures.
