Weight loss is given insufficient priority in the management of heart patients despite the benefits, according to a new study published in European Heart Journal.
The research studied more than 10,000 heart patients and found that less than 20% had a healthy body mass index (BMI) at the time of hospitalisation for a heart event.
When the health of the patients was investigated 16 months later, the researchers found that 86% of patients who were obese during hospitalisation were still obese while 14% of overweight patients had become obese. Young women were particularly affected, with nearly half of those under the age of 55 being obese.
Yet, more than a third of obese patients said they had not received advice on physical activity or nutrition and nearly one in five said they had not been informed that they were overweight.
This struck the researchers as surprising considering weight loss is strongly recommended in overweight and obese patients with coronary heart disease as it improves blood pressure and lipids levels and reduces the risk of type 2 diabetes, thereby lowering the likelihood of another heart event.
"It seems that obesity is not considered by physicians as a serious medical problem"
"It seems that obesity is not considered by physicians as a serious medical problem, which requires attention, recommendations and obvious advice on personal weight targets," said the authors.
For patients who lost 5% or more of their body weight, the researchers saw significantly lower levels of hypertension, dyslipidaemia, and previously unrecognised diabetes compared to those who gained 5% or more of their body weight. They also reported higher levels of physical and emotional quality of life.
As for advice, half of all patients were advised to follow a cardiac prevention and rehabilitation programme, with no difference in advice according to their weight status. For obese patients, less than two-thirds were advised to follow dietary recommendations (63.7%) or to do regular physical activity (64.2%).
Positive associations were found between lifestyle improvements and weight loss in obese or overweight patients. Compared to those who gained 5% or more of their body weight, those who lost at least 5% of their body weight had more frequently reduced fat and sugar intake, increased consumption of fruit, vegetables, and fish, done regular physical activity, attended a cardiac rehabilitation and prevention programme and followed dietary advice from a health professional.
The researchers also note that weight gain was significantly associated with smoking cessation. In patients who were overweight or obese at hospitalisation, those who quit smoking gained 1.8 kg on average in contrast to the 0.4 kg average weight gain observed in persistent smokers.
Less than half of patients across Europe report completing cardiac rehabilitation programmes
An author of the study, Professor Catriona Jennings of the National University of Ireland, said cardiac rehabilitation programmes, which typically emphasise exercise, should give equal priority to dietary management. She said: “Weight loss is best achieved by adopting healthy eating patterns and increasing levels of physical activity and exercise. Whilst actively trying to lose weight at the same time as trying to quit smoking is not advised, adopting a cardio-protective diet and becoming more physically active has the potential to mitigate the effects of smoking cessation on weight gain in patients trying to quit. Their aim is to maintain their weight and to avoid gaining even more weight following their quit.
"Uptake and access to cardiac rehabilitation programmes is poor with less than half of patients across Europe reporting that they completed a programme,” added Professor Jennings. “Such programmes would provide a good opportunity to support patients in addressing overweight and obesity, especially for female patients who were found to have the biggest problem with overweight and obesity in the study. Uptake and access could be improved with the use of digital technology, especially for women, who possibly are less likely to attend a programme because they have many other competing priorities, such as caring for others. There are good reasons for people to address their weight after a cardiac event. – but it’s not easy and they do need help."