Combating obesity - The effect of excess weight on cholesterol levels
Obesity is a growing public health concern and appropriate management and education on the complications that can arise from this health related disease are key to tackling the problem. This article will focus on the link between obesity and high cholesterol levels and how practical steps can be taken to manage these public health issues.
Obesity is one of the biggest health challenges we face. Currently almost 1 in 4 adults are obese and if this continues by 2050, the government predicts around 9 in 10 adults in England will be overweight or obese1. At present, obesity is responsible for 9000 premature deaths each year in England2 and the cost to the NHS is estimated to be £4.2 billion3. This is forecasted to more than double by 2050.
What is obesity?
Obesity is a condition in which excessive fat accumulates in the adipose tissue. It is defined in adults as a body mass index (BMI) above 30. Causes of obesity include factors such as lack of exercise and poor dietary habits and, in some cases, a family history of obesity. People who are obese or overweight are more likely to have increased levels of blood cholesterol, high blood pressure and an increased risk of diabetes, and are more likely to suffer from coronary heart disease, osteoarthritis and some types of cancer3. Body weight is influenced by energy intake, energy expenditure (basal metabolism) and physical activity. If a person regularly consumes more energy than they use, they will gain weight and could eventually become overweight or obese.
Obesity and cholesterol
Being obese means you’re more likely to have a higher level of Low Density Lipoprotein (LDL) cholesterol in the body4. This is a type of cholesterol which tends to accumulate inside blood vessel walls, restricting blood flow, causing the process known as atherosclerosis. This can lead to narrowing of the arteries, increasing the risk of cardiovascular disease (CVD) and heart related problems.
Having fat deposited around the waist (central obesity or ‘apple shaped’), rather than the hips and thighs, is also an important risk factor for CVD and high cholesterol. This fat has easier access to the blood supply of the liver increasing the production of very low-density lipoprotein cholesterol (VLDL cholesterol) which converts to LDL in the bloodstream5. A simple way to measure whether a patient is ‘apple shaped’ or not, is to measure the waist circumference.
The medical consensus in the UK recommends a desirable level of total cholesterol to be no higher than 5.0 mmol/l and LDL cholesterol less than 3.0mmol/l. However, for those at a higher risk of heart disease i.e. those with high blood pressure or diabetes, recent guidelines suggest a total cholesterol of less than 4.0mmol/l and LDL less than 2.0mmol/l 6. A routine blood test by health care professionals or GP’s can assess patients’ cholesterol levels.
Obesity Measurement
BMI, as well as waist circumference measurement, is used to classify healthy weight, overweight and obesity in both adults and children. BMI involves comparing an individual’s weight to their height and is classified as follows:
Source: Food Standards Agency
Waist circumference may be of use in cases where BMI in isolation may be inappropriate such as sportspersons with large amounts of muscle mass, and some ethnic groups. It can also be a useful tool in giving feedback on central adiposity. In general, men are at increased risk of obesity-related diseases when their waist circumference reaches 94cm (37 inches) or 90cm (35.5 inches) for Asian men. For all women, risks increase at 80cm (32 inches). The best way to assess obesity and associated health risks is a combination of BMI, waist circumference and body shape.
Health and lifestyle management
In many individuals obesity and high cholesterol can be managed and prevented through diet and lifestyle. The most likely cause of being overweight is related to eating habits - a diet that is high in fats, sugar and also alcohol. Eating a healthy diet and being physically active can all help to reduce the risk. It is important for patients to make sure that energy intake does not exceed energy output/expenditure.
Practical food-based advice for tackling obesity and also high cholesterol levels remains consistent with general healthy eating guidelines7. Recommendations include:
Diet:
• Maintaining a healthy body weight (BMI 18-25 kg/m²)
• Reducing the amount of saturated fat in the diet. It is this type of fat which has the biggest impact on cholesterol levels. Saturated fats are those found in foods such as high fat dairy products, in fatty cuts of meat, and are also hidden in cakes, biscuits and pastries.
• Eating more high fibre and whole-grain foods such as brown rice, wholewheat pasta and wholegrain bread and breakfast cereals.
• Eating plenty of fruit and vegetables (at least 5 portions a day).
• Eating fish regularly (twice weekly) making sure to include oily fish (such as salmon, mackerel, trout and sardines) once a week.
• Drinking no more than 3-4 units of alcohol per day for men and 2-3 units per day for women.
• Eating foods designed to reduce cholesterol such as plant sterol/stanol enriched foods like Benecol®, which are clinically proven to lower cholesterol8/9.
Exercise:
Lack of physical activity is an important factor contributing to the increasing prevalence of obesity. Physical activity not only benefits well-being but is also necessary for good health and helps to play a role in disease prevention, having a beneficial effect on a wide number of diseases. Regular exercise not only helps with weight loss management but also raises HDL cholesterol levels (good cholesterol) and lowers LDL cholesterol levels (bad cholesterol) - all beneficial for helping to lower cholesterol.
A report by the Chief Medical Officer in 2004 on physical activity emphasized the beneficial relationship between physical activity and health10. It recommended:
• All individuals should participate in at least 30 minutes of moderate intensity activity on five or more days a week.
• 30 minutes of physical activity does not have to be taken all at once. For example three brisk walks of 10 minutes in duration is equally beneficial.
• In order to prevent obesity, individuals will need to participate in between 45 and 60 minutes of moderate intensity physical activity each day.
References
1. Department of Health www.dh.gov.uk/en/Publichealth/Healthimprovement/Obesity
2. Department of Health June 2009 www.dh.gov.uk/en/Publichealth/Healthimprovement/Obesity/DH_078098
3. British Nutrition Foundation www.nutrition.org.uk
4. Guardian.co.uk (in partnership with BMJ) http://www.guardian.co.uk/lifeandstyle/besttreatments/obesity-high-cholesterol-and-obesity#bt_t_d2e3010
5. British Nutrition Foundation 2004 www.nutrition.org.uk
6. Joint British Medical Societies Recommendations on prevention of coronary heart disease in practice: summary. British Medical Journal 2000 Vol. 320: 705-708.
7. www.eatwell.gov.uk
8. Ref: Miettinen T. et al, Reduction of serum cholesterol with sitostanol-ester margarine in a mildly hypercholesterolemic population. The New England Journal of Medicine, 1995, 333:1308-1312.]
9. Law M. Plant sterol and stanol margarines and health. BMJ, 2000, Vol 320, p 861 –864
10. Department of Health, Physical Activity,Health Improvement and Prevention- Chief medical officer report 2004: At least five a week: evidence on the impact of physical activity and its relationship to health
Published in partnership with the Royal College of Nursing's Practice Nurse Association
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