Misconceptions about Obesity and Heart Disease

Some common misconceptions about food and eating should be put to rest. The first has to be about obesity. Fat people are more likely to have a heart attack than thin people - but the relationship is not a straightforward one. And many thin people still have heart attacks. Eating too much, and exercising too little, causes obesity and coronary disease, but you can still have coronary disease if you are thin by eating the wrong things.

What does this prove? It is better to be of normal weight than to be overweight, but obesity of itself may not be a direct cause of coronary disease. The fact is that if you are overweight, your blood levels of cholesterol are usually higher than normal, and it is this, and not simply being too fat, that makes a heart attack more likely.

The consequence of this is that just reducing weight alone, without also reducing your cholesterol levels, may not help" Of course-, losing excess weight will always make you feel and look better, and you will be happier with your own body image. It will also probably reduce your chance of stroke and reduce any high blood pressure you may have - but unless you also reduce your blood cholesterol level, your chances of avoiding a heart attack will not increase.

Here is a typical 45-year-old male factory worker as an example. Three years ago he was developing middle-aged spread. At around 3 stone (20 kg) overweight, he felt he had to do something about his health - so he bought a dog, and started taking it out for a walk every night. The extra exercise, he reasoned, would take off the weight, and he could carry on with his eating habits of a lifetime.

He was right. He started to enjoy the exercise and added to it by joining his wife, twice a week, at the local swimming pool. Now he was just the right weight for his height of 5 feet 10 inches (1.7 m) -just under 12 stones (126 kg).

Yet when he came for his 'well man' visit, his doctor was very concerned. His cholesterol level was 7.1 mmol/1, which put him in the top quarter for heart attack risk. That, along with his ten-a-day cigarette consumption, and a slightly raised blood pressure, gave him a one in three chance of a heart attack in the next five years.

Needless to say, he did not think much of these odds! Asked about his eating habits, he confessed to a 'good fry-up' for breakfast most mornings, cheese or bacon sandwiches for lunch, tea and chocolate biscuits in the afternoon break, and a typical dinner of 'meat and two veg' followed by pudding or tart and custard every evening. He might finish the day with a toasted cheese snack and a milk chocolate drink.

He rarely ate fish, his vegetables were confined to a few cooked 'greens', and he never bothered with fruit. Potatoes were usually eaten as chips, or mashed with cream and butter - a special - favourite.

It took some persuading for him and his wife to change the habits of a lifetime - but it worked. His mornings now start with cereal, such as muesli, or porridge, taken with skimmed milk or yoghurt, plus toasted wholemeal bread, spread with jam or marmalade. His lunchtime sandwiches are now filled with chicken, turkey, sardines or mackerel pate, which he follows with an apple or pear or an orange. This now does him until the evening, except for his afternoon cup of tea (he has abandoned his chocolate biscuit).

His dinner is now much more varied than before, ranging from pastas to grills, stews and even curries, so that his chips and mash have been replaced by rice and pasta or potatoes baked or boiled in their jackets. At least three times a week his main course is a fish -preferably an 'oily' one, such as herring, mackerel, sardines, trout and salmon. Now that salmon prices have slumped below cod prices, he and his wife do not see it as a luxury item. He eats so well that he doesn't find it necessary to take anything just before bedtime, except, perhaps, a cup of tea and some fruit. His weight is steady, but he does not feel he has been put on a diet, or is eating too little.

The effect on his cholesterol has been dramatic. In three months it fell down to around 5 mmol/1 - well within the normal range. He has also stopped smoking. His blood pressure has also swung down into the normal range, possibly because his salt consumption has fallen along with his fat consumption. He feels fitter, too, with more zest for life. It is only now that he feels so much better that he realizes how unfit he still was, even after losing the weight.

This combination of the lower cholesterol, the non-smoking, and the lowered blood pressure has greatly improved his chance of survival. Now the statistics say that he has less than one chance in fifteen of having a heart attack in the next five years. That is a five­fold reduction in risk, about which he, his wife and his doctor are all very happy!

This story could be told a million times or more around Britain and other developed countries, with very little variation. It is never too late for anyone to change - it just means a little initial effort in taking the decision. Once people take the plunge, and start to try all the new ways they can eat, then few return to the old habits. The first step is always the hardest.