Obesity, Example Stroke, Dr Chatty discussed on Cardionerds



Southeast asians are a group that we know that even a little bit of excess weight can be linked to a lot more insulin resistance and also cardiovascular consequences and then just put the epidemiology obesity in context. We've seen down trending rates of cardiovascular mortality over several decades. And now we're starting to see while. These rates have plateaued when some subtypes of cardiovascular disease for example stroke. We're seeing an uptick in these rates and the broad consensus that these changes in our cardiovascular mortality trends are likely the early effects of this obesity epidemic. That's emerged over the last several decades so a really important epidemiologic public health and clinical challenge. That i think very much needs to be addressed. Well thank you very much. That was so comprehensive and really highlights obesity especially when it comes to prevention dr chatty as you've mentioned currently the who classifies have be city based. Ibm i and you even kind of alluded to some of the limitations. But i've had so many patients from the short gentleman who just jacked up at the gym or people of other different body types of all shapes and sizes who say. Bmi doesn't work for me. What are the limitations of using bmi to measure obesity. And i their benefits of measuring waist circumference instead for your individual patient get the has global consequences and it's something that we could study on a population level but when it comes down to personalize medicine does it matter and should i change the way i approached risk. Great in very important question so first. Bmi as you salute to is a great population measure for understanding cardiovascular risk population level and for looking at trends in obesity over time but the major limitation of bmi is that it does not reflect. Body composition and body composition is pretty relevant to understanding the risks associated obesity so in terms of body composition. I often use. Example of ray lewis. Who is a famous lamb. Becker for the baltimore ravens and at his peak kind of athletic performance. Bmi was around thirty two and of course lewis had very little body fat at that point and this was all really muscle mass but he would fall into the great one obesity range if you were just using bmi so i completely endorse and think that's very important to think about waist circumference because waist circumference is a a really nice way of getting a better sense of body composition. It's a helpful measure. That's quite underutilized. So why is it important. Abdominal obesity is what is actually most closely linked to insulin. Resistance and the rare metabolic consequences linked to obesity like diabetes hypertension inflammation and that's why abdominal obesity or wasted conferences. A core part of the metabolic syndrome construct unfortunately wasted conferences currently quite under utilized and we notebook from our work from other people's work that adding waist circumference measurements to the bmi measurements particularly those individuals. Who are in the overweight group. So bmi twenty to thirty and those who are in the great one obesity group thirty to thirty five gives quite significant prognostic information both for the likelihood of developing co morbidity and for the likelihood of developing cardiovascular disease so as very strongly encourage measurement of waist circumference in patients almost as another vital sign that we should be tracking to better understand risk particularly when we think about cardiovascular prevention by. That's really great to know in honestly can't remember the last time i saw a patient's waist circumference recorded in my clinics. I'm gonna have to start asking about that from now on but are so re ticket. Obesity is bad. Put doctrine. Do me why is it bad. How does increase at a positive fit into the schema of metabolic risk metabolic. And hey since we're cardi nerds. How does obesity and metabolic syndrome affect the heart..

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