Waistline and increased risk of premature death: what’s so new?

A recent European Society of Cardiology Congress in Munich coincided with the last days of a Gallery of the Modern exhibition of caricatures by Munich satirist Karl Arnold:  amongst them a striking 1922 image of a stylish corpulent man said for 20 years not to have been able to see his feet. Then a social observation, it is of course now well recognized that the frankly obese are at high risk of diabetes, heart disease, stroke and other medical conditions.

At first sight surprising, that there should have been major interest from scientists and the press in new US research presented at the Heart Congress linking a larger waistline to premature death; and not just from a beer belly, but for anyone with a body shape with above normal waist to hip circumference.  What’s so unusual? Surely everyone knows that being overweight increases risk of serious medical problems.

What did these American researchers do? They looked at the strength of the link between different measures of obesity and risk of early death. In the research, lead by Professor  Francisco Lopez-Jimenez from the Mayo Clinic, almost 13,000 American men and women were studied for around 14 years, within a cohort study: the Third National Health and Nutrition Examination Survey (NHANESIII). There were around 2500 deaths of which around 1100 were from cardiovascular causes. The researchers measured body-mass index (BMI), a general measure of fatness, and waist-to-hip ratio (WHR), a measure of central obesity. This meant they were able to include people not currently considered obese based on BMI, but who had a relatively large belly, as well as those overweight both based on BMI and abdominal girth. The surprising finding of the study was that, compared to subjects with normal BMI and WHR, the group with normal BMI but relatively high central fat not only had a high death rate (2.8 times for cardiovascular disease and 2.1 times for all causes), but their risk of premature death was much higher than participants who were obese based on BMI (1.4 times normal cardiovascular risk).

It is already well established that abdominal fat is particularly deadly in relation to risk of heart disease. This new NHANESIII research in addition reported that increasing waist-hip ratio is linked to earlier death from all causes, not just for heart disease. It also provided objective data of the graded increase in risk as abdominal fat and waist-hip ratio increases.

What messages to take from this study? Obvious questions include whether it is reliable and if so generalizable from US to European and other international populations. As a prospective observational study, the results are open to bias – i.e. factors co-incidentally present in the larger waisted people may have been responsible e.g. the type of diet causing the central overweight rather than distribution of the fat itself.

However the authors reported that their findings were similar after adjusting for other well-known risk factors for premature heart disease and death, such age, male gender, ethnicity, socio-economic factors, smoking, hypertension, and diabetes.  Furthermore, this new report from Munich supported the previous systematic review by the authors noting similar findings in patients with coronary artery disease: i.e. central obesity a much stronger link  than BMI to premature death.

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Keeping weight in check – does the weight of the adviser matter?

A wide range of advisers – from family doctors to pharmacists – can be effective in providing lifestyle advice aimed at reducing risk of serious diseases of the heart, brain and circulation – including advice on diet and exercise aiming to help with weight loss.

However a new study, organised by the Royal Society for Public Health, suggests that people seeking advice on weight loss are less likely to take it seriously from someone who is overweight, whether from a health professional or another source, including hairdressers and celebrities.
In response to this report, the Royal Society for Public Health is recommending that NHS staff not only advise ‘do what I say’  but also ‘do what I do’ when it comes to advise on weight loss – ie NHS staff and others involved in advice on reversing overweight should be aware of the importance of acting as role models to help the public at risk to engage in losing weight.

Poetry to prevent childhood obesity? The Healthy Heart Poetry Project.

Unhealthy lifestyle in children increases risk of premature and preventable heart disease in later life. The aim of the Healthy Heart Poetry initiative is to encourage interest among children of all ages in lifestyle that helps to keep the heart healthy.

Healthy heart poetry for schools was a theme during the 6th International Symposium on Poetry and Medicine held in London on 22nd May 2015.

Since 2011, 22 schools have received Healthy Heart Awards from the healthy heart charity the Cardiovascular Research Trust. Schools participating in the Healthy Heart initiative receive a Healthy Heart Award certificate to recognize their interest in education about how to keep the heart healthy.

Listen to the talk on healthy hearts for schools 

Poet Wendy French described a schools project she undertook with 2015 Hippocrates Prize judge Rebecca Goss as part of a collaboration between the healthy heart charity the Cardiovascular Research Trust and the Hippocrates Initiative. Raphael Shirley read poems by children from the edited anthology Love your Heart which arose from the project.

Rebecca Goss
Rebecca Goss [photo by Rosie Bennett]
Wendy French
Wendy French

The Cardiovascular Research Trust established Healthy Heart Poetry in 2013 in partnership with the Hippocrates Initiative.

There is now an annual Healthy Heart Poetry event at which the children have the opportunity to read their poems from the published Anthology, and Healthy Heart Awards are presented to participating schools. Selected poems are published in an anthology, the first of which, Love your Heart, was published in December 2014.

Order a copy of the Love your Heart Anthology

The Poetry and Medicine Symposium was held to mark the announcement of the winners of the 2015 Hippocrates Prize for Poetry and Medicine. The Hippocrates Prize is an annual award with a closing date of 31st January 2016 for the 2016 Hippocrates Prize.

See more about entering for the 2016 Hippocrates Prize.

Love your heart AnthologyWith a 1st prize of £5000 for the winning poem in the Open International category of  £5,000, £5000 for the 1st Prize in the NHS category, and £500 for the Young Poets Award the Hippocrates Prize is one of the highest value poetry awards in the world for a single poem. In its first 5 years, the Hippocrates Prize has attracted over 6000 entries from over 60 countries, from the Americas to Fiji and Finland to Australasia.

The Cardiovascular Research Trust

The Cardiovascular Research Trust is a healthy heart charity with the aim of informing and educating health professionals, policy makers and the public about advances in understanding effective ways to prevent and treat serious disorders of the heart and the circulation. The Trust has a particular interest in effective healthy heart promotion in the young.

The Trust was founded in 1996.

Activities of our healthy heart charity include:

Healthy Heart Symposia – educational events on how diet, exercise and other aspects of lifestyle can prevent and reduce severity of diseases of the heart and circulation

Healthy Heart Awards for schools

publications aimed at increasing awareness of how to keep the heart healthy

Healthy Heart Poetry in association with the Hippocrates Initiative