Sunday 22 September 2019

A weighty problem: How Ireland is on course to be the fattest nation in Europe

Ireland remains on course to become the fattest nation in Europe, and that's bad news for our hearts

One in four children in Ireland are now classified as overweight or obese
One in four children in Ireland are now classified as overweight or obese
Irish men have the highest body fat percentage in Europe

Áilín Quinlan

Obesity causes all kinds of problems, but as levels of the condition rise throughout Ireland, one of the greatest concerns is its impact on this nation’s heart health.

That’s because obesity is one of the major risk factors for heart attack and stroke.

With Irish men scoring the highest body mass index (BMI, a key measure of being overweight), in Europe, Irish women ranking third in this category, and one in four children in Ireland now classified as overweight or obese, concern is growing about the inevitable impact on our hearts.

A person who is overweight is defined as having a BMI of between 25 and 29, while a BMI of over 30 defines obesity. The strong link between being overweight and heart disease is underlined by World Heart Federation statistics which show that 21pc of chronic heart disease cases are actually attributable to having a BMI of over 21, which, for many people would come as a shock.

In this context, the fact that so many Irish children are now overweight or obese is of huge concern. Figures show that 75pc of obese children risk remaining obese into adulthood ­— thus bringing with them an increased risk of heart disease and stroke as they age, explains cardiologist and Medical Director of the Irish Heart Foundation, Dr Angie Brown.

She points to the 2014 Cork Children’s Lifestyle Study which showed that 8pc of children aged between eight and 10 years of age already had high blood pressure.

So how does obesity damage your heart?

First, it increases your blood pressure. When we are overweight, the additional fat in the body needs oxygen and nutrients in order to live. This requires the blood vessels to circulate more blood to the fat tissue.

In turn, this forces the heart to work harder in order to pump all that extra blood through additional blood vessels. More circulating blood puts more pressure on the artery walls. Increased pressure on the artery walls increases the blood pressure, and thus, strain on the heart.

Research has found that atherosclerosis — hardening of the arteries ­— is present 10 times more often in obese people compared to those who are not obese. Narrowed arteries and reduced blood flow to the heart can cause chest pain, also known as angina, or a heart attack.

When you carry more weight and increase the strain on the heart, a thickening of the heart muscle can result. And this, explains Dr Brown, can lead to heart failure, which is where the heart’s blood-pumping function does not work properly. 

Obesity also increases the risk of sleep apnoea which in turn heightens the risk of high blood pressure and atrial fibrillation (AF) or an irregular heartbeat (arrhythmia). In turn, AF can lead to heart failure and other heart-related complications.

Furthermore, a condition called abdominal or ‘central’ obesity which occurs when excessive abdominal fat builds up around the stomach and abdomen, can lead to ‘metabolic syndrome’.

This is a cluster of conditions which include increased blood pressure, high blood sugar due to insulin resistance, and abnormal cholesterol or triglyceride levels, all occurring together — and which can increase your risk of heart disease and stroke three-fold.

Research in the US shows that around one-third of overweight or obese persons there have metabolic syndrome.

“The higher your BMI, the higher the risk,” warns Dr Brown, who adds that when a high BMI is combined with a sedentary lifestyle and smoking, it further increases the risk of heart attack and stroke.

Being overweight and obesity are now common in Ireland, she says, adding that the link between obesity and cardiovascular disease must be highlighted: “It is very important that we raise awareness of that. If we’re not careful we will be heading towards increased levels of cardiovascular disease in the future.”

However there is good news ­— obesity is one of the risk factors for heart disease that we can actually do something about, observes Janis Morrissey, head of Health Promotion, Information and Training at the Irish Heart Foundation (IHF), who points out we cannot do anything about some risk factors for heart health, such as age or family history:

“Your weight is something that you can change,” she emphasises.

However, she warns, because heart disease can remain “relatively silent” for a long time, it may not receive the same level of attention from some people as, for example diabetes type 2, for which obesity is also a major risk factor, and which can sometimes be perceived as a more immediate or dramatic condition.

“Diabetes can carry a greater level of worry in the public mind, but it’s very important that the message about how obesity can affect the heart gets out there ­— remember, heart disease and stroke are the number one causes of death in this country,” Morrissey warns.

“Our mobile health check unit reaches people in their communities to assess the risk of heart disease and stroke.

“Highlighting the link between obesity and heart disease is part of having an assessment with one of our nurses,” she explains.

The IHF’s army of health check staff, who visit marts, workplaces, community centres and other venues to carry out heart and blood pressure checks, regularly hold one-to-one sessions with people to explain the risk factors for heart disease and stroke.

“We try to explain that carrying excess weight around the middle can cause problems for your heart,” says Health Check Manager, Marese Damery.

“We’re trying to raise awareness of the fact that if you’re overweight it can affect your blood pressure, and that if you have high blood pressure it is a major risk for heart disease and stroke,” she says, adding that staff explain that losing even 10pc of your excess weight can help lower high blood pressure.

 The feedback from patients is positive, she says. “About half of those we see say they are considering making changes in terms of diet and physical activity.”

New tech brings fresh hope

* Diagnostics and treatment for cardiovascular disease have improved dramatically in recent years, says cardiologist and Medical Director of the Irish Heart Foundation, Dr Angie Brown.

* Better medication is now available to treat heart attack and stroke.

* Improved blood thinning medication for treating atrial fibrillation — which can be associated with an increased risk of stroke — is now on the market.

* New treatments for heart failure reduce mortality rates and improve a patients quality of life, says Dr Brown.

* Improved diagnostic tools can lead to more accurate diagnosis ­— with Echo machines, MRI and CT scanners

* High-tech measurement devices enable people to self-monitor their heart rhythm, she explains.

“People who have experienced heart rhythm disturbance can now have a monitoring device injected under the skin to monitor rhythms and people can avail of telemonitoring at home thanks to these devices,” adds Dr Brown, who explains that special apps are now available which enable patients to self-monitor and measure heart rate accurately using their phone.

* Smaller, more sophisticated pacemakers ­— devices which are placed in the chest or abdomen to help control abnormal heart rhythms —  are now more available.

“There is now a leadless pacemaker which can go directly into the heart and does not require a lead.”

* Increasingly sophisticated artificial hearts, which can serve to keep the heart working until the patient can avail of a heart transplant, are also now available.

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