It's hard in a 20-minute office visit, for a doctor or a cardiologist to really impact obesity. First you need to make the person realize it's a problem. Obesity may be more accepted in some communities than in others. This may make it more difficult to motivate patients to diet, exercise, and recognize the health risks associated with obesity. That's one potential obstacle to creating an African-American culture of health.
Heart disease develops over time, and there's no linear relationship between weight and heart disease. Nonetheless, as you lose weight you can potentially eliminate some of the risk factors for heart disease and stroke. That includes diabetes, hyperlipidemia (high levels of fat in the blood), and hypertension (high blood pressure). As people lose weight, their risk of developing diabetes will go down. Rates of high blood pressure decrease. Weight loss may make it easier to treat these diseases.
The research of Donald Lloyd-Jones has demonstrated that if you reach the age of 55 with no more than one risk factor for heart disease, it is unlikely that you will die of heart disease before the age of 80. The goal is to not develop risk factors.
We're dealing with odds. That's what makes it so challenging. If you're part of a population that leads a healthy lifestyle or if you're obese and yet you're among the group that loses 10, 20, or 30 pounds, you're going to do better than the group that doesn't lose weight.
Obesity is a disease that is typically asymptotic — same thing with hypertension. You don't really feel bad when you're overweight, but it puts people at increased risk of otherwise avoidable heart disease and stroke in their lifetime. While there may be no guarantees, put yourself in the cohort of people who are more likely to live longer, healthier lives than people who don't control cholesterol, don't exercise or continue to smoke
As a cardiologist, there are frustrations. Often I get up in the middle of the night and treat patients who are having a heart attack. I open up blocked arteries with balloons and stents. I may prevent a heart attack in a patient with a blocked vessel. They thank me, but they don't always do what they need to do to prevent future events.
That's one of the reasons I became a volunteer for the AHA and its hypertension programs. Instead of dealing with end-stage heart problems, we are creating policies and systems of care that can impact larger numbers of people. We want to improve the cardiovascular health of all Americans by 20 percent, and reduce death from heart disease and stroke by 20 percent by the year 2020.
We need to treat risk factors and change the milieu in which heart disease evolves. We have to decrease rates of hypertension and obesity. It's not just enough to take a pill to lose weight, to stop smoking or even treat hypertension. We need to promote true lifestyle changes to achieve optimal health. Medications can only get you so far. We're trying to change the psyche of populations, of patients so that the expectation is a healthy lifestyle. That wasn't always the case.