Belly fat or abdominal obesity is a big concern today. The pandemic-induced lockdowns and subsequent popularity of the work-from-home culture over the past two years have only given a fillip to sedentary lifestyles, including in the younger generation. The result: weight gain and that paunch around the belly, putting people at risk of heart problems and stroke.
Working from home for over two years, 34-four-year-old IT professional Shriram (name changed on request) in Bengaluru had a hectic schedule and a sedentary lifestyle. Two months ago, he developed breathlessness. Being a smoker, he thought his physical endurance had reduced due to a lung issue. Shriram started treatment after consulting a doctor, but the medications helped only momentarily. He was also finding it difficult to sleep due to breathing troubles.
Following further investigation with an ECG, blood tests and an angiogram, Dr Pradeep Haranahalli, consultant, interventional cardiology, Manipal Hospitals, Bengaluru, diagnosed a 95 per cent block in his heart. Shriram had to immediately undergo surgery.
“Dr Pradeep said that the reasons for the block were my sedentary lifestyle, abdominal obesity, diet and smoking,” Shriram says. “According to my height, I should weigh around 75kg but I was about 89kg. The doctor has advised me to make some lifestyle changes.”
What is abdominal fat?
Dr Haranahalli says belly fat accumulation is typically an imbalance between the diet we consume and the calories we burn. Primarily, it is caused by a lack of physical activity, a sedentary lifestyle and an improper diet.
In classical textbook description, he says, heart-attack risk is said to occur in the 45-plus age group in Indian population, but it is probably time to revise the data. “In our practice, we also see the 35-plus age group coming with heart problems,” he says. “They should continue to strive towards losing the belly fat by improving their physical activity and diet,” he concludes.
Dr AM Karthigesan, senior consultant cardiologist and electrophysiologist, Apollo Hospitals, Chennai, says abdominal obesity is a common problem. “It leads to insulin resistance, lipidaemia (abnormalities in cholesterol levels) and blood pressures,” he says. “All these issues put together are called metabolic syndrome. This is very closely related to risk of heart attack. The younger population is now more prone to it due to abdominal obesity because of their unhealthy food and sedentary lifestyle.” He says other factors like smoking also increase the risk of heart attack.
“In western countries, people who are over 65 years get heart attack, but in India we see cases in younger age as well,” he says. “People get heart attacks even in their thirties. One of the main reasons is abdominal obesity or metabolic syndrome.”
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How is obesity determined?
“One [way to determine obesity] is by body mass index, that is height divided by square of weight. The other way to determine obesity is by abdominal curve. Typically, for Asian men, when the abdominal curve is more than 40 inches (or 102cm), and for Asian women it is more than 35 inches (or 85 cm), we call it obesity,” Dr Haranahalli says, adding that the definition varies in different races.
Does a big stomach indicate heart problems?
Dr Karthigesan calls abdominal obesity a “major culprit” in heart attacks. “If the risk factor is not addressed and the abdominal obesity remains, they are more prone to develop another heart attack,” he says. “We advise patients to cut down on junk and their abdominal obesity, and to do exercises like walking to reduce the otherwise continued risk of heart attack and stroke.”
Belly fat is the most dangerous type of fat that can surround internal organs. Visceral fat (fat stored in the abdominal cavity) can lead to inflammation of body tissues, higher lipid levels and narrow the blood vessels. According to Harvard Health, 10 per cent of a person’s total body fat will be visceral fat.
Belly fat is also linked with ectopic fat (fat accumulated in the liver, heart, pancreas and muscles), which increases risk for atherosclerosis, coronary heart disease and hypertension.
“The increased fat tissues in body are the source of inflammation in the body and, in turn, increase the risk of heart attack,” Dr Haranahalli says. “The secondary impact of belly fat is the body weight. The increase in body weight can lead to rise in hypertension. For every 10kg that you put on, the blood pressure increases by 3 to 4mmHg and the chances of suffering a heart attack increases by 12 per cent.”
According to a 2020 study — ‘Abdominal obesity and the risk of recurrent atherosclerotic cardiovascular disease after myocardial infarction’ by Hanieh Mohammadi, Joel Ohm, Andrea Discacciati et al. and published in the European Journal of Preventive Cardiology, a journal of the European Society of Cardiology — people with abdominal obesity are at higher risk of repeated heart attacks.
“In our study, patients with increasing levels of abdominal obesity still had a raised risk for recurrent events despite being on therapies that lower traditional risk factors connected with abdominal obesity — such as anti-hypertensives, diabetes medication and lipid lowering drugs,” researcher Mohammadi said in a press release.
Link between obesity and heart disease
To reduce risk of cardiovascular problems, Dr Haranahalli says, it is important to manage diabetes, cholesterol, BP and also lose belly fat. Here’s why:
- Belly fat can lead to abnormal cholesterol levels. It can reduce good cholesterol levels and increase bad cholesterol and triglycerides levels. HDL or good cholesterol also plays a vital role in reducing LDL or bad cholesterol levels.
- It can lead to rise in blood pressure since people with obesity need more blood to supply oxygen and nutrients to the body. Hypertension is also a risk factor for heart attacks.
- People with abdominal obesity are at higher risk of developing diabetes, which makes them two to four times more likely to develop a heart disease.
- It is directly linked with visceral and ectopic fat, which leads to accumulation of fat on the internal organs and inflammation, increasing the risk for heart attacks.
Belly fat and heart attack risk
Experts agree that abdominal obesity is a risk factor for repeat heart attacks. And that it is not advisable for people who have suffered a heart attack to indulge in physical activity immediately after the event. It is important to give time to recovery and rest to the heart.
Dr Haranahalli says the immediate goal is stable recovery. “Heart attack is an injury to your heart muscle, and it takes time to heal,” he says. “Supporting it through the healing phase is important to have long-term and intermediate goals. The first focus should be to take rest and let the heart heal. One can then gradually start and continue physical activities or dietary measures to lose weight and reduce abdominal girth that can help reduce the risk of another heart attack.”
Dr Karthigesan says recovery may take four to six weeks and depending on the severity of the condition people are advised to do exercises. “Dietary changes can be made immediately but regular physical activity can be started after a stress test with their doctor, which determines the pumping of their heart and physical endurance,” Dr Karthigesan says.
But each case is different. “All heart attacks are not identical and not every person will be in the similar condition,” Dr Haranahalli says. “Some might be critical while some could be very stable if they sought help at the early stage. Roughly, a person should take rest for two weeks and take things lightly. Post it, they can resume their routine activity and gradually increase activities as per their physical endurance.”
IT professional Shriram says he has now decided to be more physically active and has taken to brief walks. “I’m still recovering and hence the doctor has advised me not to exert myself with intense workout,” he says.
Belly fat is an independent risk factor. In common scenarios, as people grow old, people tend to lose muscle mass and accumulate fat, yet maintain an ideal body weight. “Just mere maintenance of an ideal body weight need not always mean the risk is lower,” says Dr Haranahalli. “We need to realise that accumulation of fat has happened at the cost of muscle mass. Despite a normal weight, with abdominal obesity, they will still have higher risk of heart attack compared to those with lower abdominal girth.”
Dr Haranahalli recalls the case of a 52-year-old homemaker with abdominal obesity who was finding it difficult to walk due to a block in her heart. This made her further physically inactive, leading to an increase in her body weight and also affecting her knee and ankle joints. She would feel breathless when she walked.
The woman, who consulted Dr Haranahalli after her condition worsened, had to undergo an angioplasty. “Post recovery, she increased her physical activity and managed to reduce 20kg in six months, which improved her knee and ankle joints as well,” the doctor says.