Writing in the Journal of the American College of Cardiology, researchers say that where fat is distributed on the body is far more important than traditional measures, such as BMI.
Investigating data from more than 15,000 people with coronary artery disease, the Mayo Clinic researchers found that those with coronary artery disease and central obesity, measured by waist circumference and waist-to-hip ratio, have up to twice the risk of dying. That's equivalent to the risk of smoking a pack of cigarettes per day or having very high cholesterol, particularly for men.
The new findings refute the obesity paradox, a puzzling finding in many studies that shows that patients with a higher BMI and chronic diseases such as coronary artery disease have better survival odds than normal-weight individuals.
"We suspected that the obesity paradox was happening because BMI is not a good measure of body fatness and gives no insight into the distribution of fat," says Thais Coutinho, the study's lead author. "BMI is just a measure of weight in proportion to height. What seems to be more important is how the fat is distributed on the body."
Why is this type of fat more harmful? "Visceral fat has been found to be more metabolically active. It produces more changes in cholesterol, blood pressure and blood sugar. However, people who have fat mostly in other locations in the body, specifically, the legs and buttocks, don't show this increased risk," explained co-researcher Francisco Lopez-Jimenez.
The researchers say physicians should counsel coronary artery disease patients who have normal BMIs to lose weight if they have a large waist circumference or a high waist-to-hip ratio. The measure is very easy to use, Coutinho says; "All it takes is a tape measure and one minute of a physician's time to measure the perimeter of a patient's waist and hip."
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Source: Journal of the American College of Cardiology