QUEBEC, Oct. 21 /CNW Telbec/ - "We need to change how we look at obesity,
stop obsessing on weight and BMI and, above all, redefine the proper clinical
use of weight loss drugs," says noted obesity expert Dr. Jean-Pierre Després,
delivering the Heart and Stroke Foundation of Canada Lecture at the Canadian
Cardiovascular Congress 2007.
"Some obese people are healthy yet others, with the same amount of body
fat, will have heart disease or diabetes. There are simple ways to tell the
difference but health professionals are not yet using basic tools to identify
who is at greatest risk."
"Research, health programs and information to help tackle obesity are a
strategic priority of the Heart and Stroke Foundation," said Stephen Samis,
director of health policy for the Heart and Stroke Foundation of Canada.
"That's why we're thrilled to have an international leader in this field of
Dr. Després' calibre as our lecturer this year."
The Foundation is funding targeted obesity research and has created a
national obesity action plan to provide practical ways to take on obesity in
communities across the country.
Dr. Després, who is director of research in cardiology at the Hôpital
Laval Research Center and scientific director of the International Chair on
Cardiometabolic Risk at Université Laval in Quebec City, advocates for two
simple measures to identify those at greatest risk of metabolic syndrome, a
cluster of risk factors related to heart disease, stroke and diabetes. "A
large waistline combined with high levels of fasting triglycerides in the
blood means that there is about an 80 per cent chance that the person has
According to Després, an investigation of middle-aged men living in
Quebec City - the well-known Quebec Cardiovascular Study - indicated that
showing some features of metabolic syndrome was associated with a 20-fold
increase in the risk of ischemic heart disease.
A waist circumference above 90 cm could be unhealthy if accompanied by
blood triglyceride levels greater than 2 mmol/L. Dr. Després believes that
these measures should be standard for any physical exam by a medical
"Obesity is the cholesterol of the 21st century. Despite being a
recognized risk factor for heart disease and other conditions, obesity is
still not well understood or well defined."
The tale of the tape
According to Dr. Després, the issue of obesity goes beyond weight and
body fat, which is why body mass index (BMI) can fail to identify those at
risk, or falsely identify those whose weight may not be putting them at
increased risk of heart disease. He notes that waist circumference determines
whether the person is carrying abdominal fat, and triglycerides indicate how
the body is storing the fat.
Visceral fat is the far more dangerous kind, packed in among the organs
in the abdomen. Subcutaneous fat is fat that is just under the skin. High
triglycerides indicate the presence of potentially dangerous visceral fat.
The skinny on weight loss drugs
Dr. Després urges caution in prescribing weight loss drugs to 'treat'
obesity. "I completely disagree with using weight loss drugs only to lose
weight," he says. "In some cases drugs are medically necessary, but we need to
be much more targeted about who gets them, and focused on their overall
health, not just their weight."
Dr. Després has seen the importance of this global health focus in his
own clinical studies. "We had a man who lost only one pound in a year long
program, but dropped his waist size by 6 cm - a substantial loss of visceral
fat that was much better for his health than if he had dropped more pounds."
A simple prescription to stop obesity
Dr. Després believes that there are two simple steps that would go a long
way to slowing and hopefully reversing the alarming rise in obesity we see
The first is to do a much better job in clinical practice of identifying
and managing individuals whose weight is a risk to their health, and provide
much more support to people who are trying to change their lifestyles for
better heart health.
"From the results of our ongoing lifestyle modification study, we know
that patients who have the support of a health care team, with regular and
ongoing access to a dietitian and an exercise physiologist/kinesiologist, will
be much more successful at making permanent lifestyle changes." Dr. Després
estimates the cost of these services to be about $1,000 per patient per year -
a bargain compared to the hospitalization and ongoing health care costs for
those who develop heart disease or diabetes.
The second is to rethink the environment we live in. "There's no debate -
our kids should have physical activity and healthy foods in school every day,"
says Dr. Després. "But they also need to learn by example, so we all need to
increase physical activity and healthy eating in our day-to-day lives."
"Above all, we need to ban the word 'dieting' and focus on physical
activity/fitness and healthy eating rather than weight."
Statements and conclusions of study authors are solely those of the study
authors and do not necessarily reflect Foundation policy or position. The
Heart and Stroke Foundation of Canada makes no representation or warranty as
to their accuracy or reliability.
The Heart and Stroke Foundation (www.heartandstroke.ca), a
volunteer-based health charity, leads in eliminating heart disease and stroke
and reducing their impact through the advancement of research and its
application, the promotion of healthy living, and advocacy.
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