Teen Obesity and Heart Disease

Written by Dr. Steve Chaney on . Posted in Uncategorized

Author: Dr. Stephen Chaney

teen obesity and heart diseaseI don’t need to tell you that we are in the midst of an obesity epidemic. Sadly, that obesity epidemic has even affected our children. Currently, one third of the adolescent population of the United States and other developed countries is overweight or obese, and those numbers are rapidly increasing.  Teen obesity and heart disease are not uncommon.

You probably also knew already that overweight and obesity in the early years increases the risk of death from cardiovascular disease and other causes among young adults, but a new study suggests that the consequences of overweight during the teen years may be much worse than we thought.

How Was This Study Done?

This study (Twig et al, The New England Journal of Medicine, DOI:10.1056/NEJMoa1503840, Published April 13, 2016) was based on a national database of 2.3 million Israeli adolescents ages 16-19 (average 17.1) for whom height and weight were measure between 1967 and 2010. Israel has such an extraordinarily large database because one year before military service all Israeli adolescents are required to undergo a medical evaluation. This is predominantly a male population because Orthodox women are excluded from service.

military studyIsrael also has a national health service that keeps a comprehensive database of deaths. Therefore, the investigators were able to record all deaths in this group that were attributable to coronary heart disease, stroke, sudden death from an unknown cause, or a combination of all three categories, which they classified as total cardiovascular deaths through June 30, 2011. That means that the median age at the end of the study was around 40.

The investigators divided the subjects into groups based on their BMI (weight (kg)/ height (m)2), a measure of the leanness or obesity of each individual and compared BMI with deaths due to various kinds of heart disease.

What sets this study apart from all previous studies was the size of the database (2.3 million). Because of the very large number of subjects in the study the investigators:

  1.  Were able to accurately measure the effect of BMI on cardiovascular deaths in people aged 30-40, an age at which the incidence of cardiovascular deaths is relatively low.
  2. Were able to divide the subjects into seven BMI groupings, rather than the two or three used in most previous studies.

For example, most previous studies have simply compared individuals who were obese (BMI > 95th percentile) or overweight (BMI in 85th to 94th percentile) with everyone in the normal range (BMI in the 5th to 84th percentile).

This study further separated individuals within the normal BMI range to high-normal (BMI in the 75th to 84th percentile), mid-normal (BMI in the 50th to 74thpercentile), and low normal (BMI in the 25th to 49th percentile) and compared each group to individuals with BMIs in the 5th to 24th percentile.

Teen Obesity and Heart Disease:  Will Your Teen Die Prematurely?

The results of the study were pretty sobering.

teen deaths from heart disease1)     For teens who are obese (210 pounds for a 6’ boy and 175 pounds for a 5’6” girl) at 17, their risk of dying prematurely from:

  • Heart attack increases 4.9 fold
  • Stroke increases 2.6 fold
  • All cardiovascular causes increases 3.5 fold
  • The increased risk of dying from all kinds of cardiovascular disease was 2-fold greater by age 27 and 4-fold greater by the time the subjects had reached age 37-47.

2)     For teens who are overweight (185-209 pounds for a 6’ boy and 155-174 pounds for a 5’6” girl) at 17, their risk of dying prematurely from:

  • Heart attack increases 3.0 fold
  • Stroke increases 1.8 fold
  • All cardiovascular causes increases 2.2 fold

3)     For teens who are at high-normal weight (175-184 pounds for a 6’ boy and 145-154 pounds for a 5’6” girl) at 17, their risk of dying prematurely from:

  • Heart attack increases 2.0 fold
  • Stroke increases 1.4 fold
  • All cardiovascular causes increases 1.8 fold

4)     Perhaps the most surprising finding was that even for teens who are at mid-normal weight (155-174 pounds for a 6’ boy and 130-144 pounds for a 5’6” girl) at 17, their risk of dying prematurely from:

  • Heart attack increase 1.5 fold
  • All cardiovascular causes increases 1.3 fold

5)     The number of teen girls in the study was much less, but they appeared to have similar increased risk of cardiovascular deaths with increased BMI compared to the boys in the study.

The message is clear on teen obesity and heart disease.

  • Obesity and overweight during the teen years are killers. They can lead to a significant increase in deaths due to heart attacks, strokes and all cause cardiovascular mortality long before those teens reach the age of 50.
  • Even teens who are in the higher end of what is considered a normal weight range are at increased risk of cardiovascular mortality long before they reach their golden years.

The Bottom Line

A recent study compared the BMI of 2.3 million Israeli teens (average age 17) with cardiovascular deaths over the next few decades

1)     Teens who were overweight or obese had a 2-fold greater risk of dying from cardiovascular disease by age 27 and 4-fold greater risk by the time they reached age 37-47.

2)     Even teens who were at the upper end of the normal weight range had a 1.8-fold increased risk of dying from cardiovascular disease.

The message is clear.

  • Obesity and overweight during the teen years are killers. They can lead to a significant increase in deaths due to heart attacks, strokes and all cause cardiovascular mortality long before those teens reach the age of 50.
  • Even teens who are in the higher end of what is considered a normal weight range are at increased risk of cardiovascular mortality before they reach their golden years.

     These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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High Protein Diets and Weight Loss

Posted October 16, 2018 by Dr. Steve Chaney

Do High Protein Diets Reduce Fat And Preserve Muscle?

Author: Dr. Stephen Chaney

Healthy Diet food group, proteins, include meat (chicken or turkAre high protein diets your secret to healthy weight loss? There are lots of diets out there – high fat, low fat, Paleolithic, blood type, exotic juices, magic pills and potions. But recently, high protein diets are getting a lot of press. The word is that they preserve muscle mass and preferentially decrease fat mass.

If high protein diets actually did that, it would be huge because:

  • It’s the fat – not the pounds – that causes most of the health problems.
  • Muscle burns more calories than fat, so preserving muscle mass helps keep your metabolic rate high without dangerous herbs or stimulants – and keeping your metabolic rate high helps prevent both the plateau and yo-yo (weight regain) characteristic of so many diets.
  • When you lose fat and retain muscle you are reshaping your body – and that’s why most people are dieting to begin with.

So let’s look more carefully at the recent study that has been generating all the headlines (Pasiakos et al, The FASEB Journal, 27: 3837-3847, 2013).

The Study Design:

This was a randomized control study with 39 young (21), healthy and fit men and women who were only borderline overweight (BMI = 25). These volunteers were put on a 21 day weight loss program in which calories were reduced by 30% and exercise was increased by 10%. They were divided into 3 groups:

  • One group was assigned a diet containing the RDA for protein (about 14% of calories in this study design).
  • The second group’s diet contained 2X the RDA for protein (28% of calories)
  • The third group’s diet contained 3X the RDA for protein (42% of calories)

In the RDA protein group carbohydrate was 56% of calories, and fat was 30% of calories. In the other two groups the carbohydrate and fat content of the diets was decreased proportionally.

Feet_On_ScaleWhat Did The Study Show?

  • Weight loss (7 pounds in 21 days) was the same on all 3 diets.
  • The high protein (28% and 42%) diets caused almost 2X more fat loss (5 pounds versus 2.8 pounds) than the diet supplying the RDA amount of protein.
  • The high protein (28% and 42%) diets caused 2X less muscle loss (2.1 pounds versus 4.2 pounds) than the diet supplying the RDA amount of protein.
  • In case you didn’t notice, there was no difference in overall results between the 28% (2X the RDA) and 42% (3X the RDA) diets.

Pros And Cons Of The Study:

  • The con is fairly obvious. The participants in this study were all young, healthy and were not seriously overweight. If this were the only study of this type one might seriously question whether the results were applicable to middle aged, overweight coach potatoes. However, there have been several other studies with older, more overweight volunteers that have come to the same conclusion – namely that high protein diets preserve muscle mass and enhance fat loss.
  • The value of this study is that it defines for the first time the upper limit for how much protein is required to preserve muscle mass in a weight loss regimen. 28% of calories is sufficient, and there appear to be no benefit from increasing protein further. I would add the caveat that there are studies suggesting that protein requirements for preserving muscle mass may be greater in adults 50 and older.

The Bottom Line:

1)    Forget the high fat diets, low fat diets, pills and potions. High protein diets (~2X the RDA or 28% of calories) do appear to be the safest, most effective way to preserve muscle mass and enhance fat loss in a weight loss regimen.

2)     That’s not a lot of protein, by the way. The average American consumes almost 2X the RDA for protein on a daily basis. However, it is significantly more protein than the average American consumes when they are trying to lose weight. Salads and carrot sticks are great diet foods, but they don’t contain much protein.

3)     Higher protein intake does not appear to offer any additional benefit – at least in young adults.

4)     Not all high protein diets are created equal. What some people call high protein diets are laden with saturated fats or devoid of carbohydrate. The diet in this study, which is what I recommend, had 43% healthy carbohydrates and 30% healthy fats.

5)    These diets were designed to give 7 pounds of weight loss in 21 days – which is what the experts recommend. There are diets out there promising faster weight loss but they severely restrict calories and/or rely heavily on stimulants, they do not preserve muscle mass, and they often are not safe. In addition they are usually temporary.  I do not recommend them.

6)    This level of protein intake is safe for almost everyone. The major exception would be people with kidney disease, who should always check with their doctor before increasing protein intake. The only other caveat is that protein metabolism creates a lot of nitrogenous waste, so you should drink plenty of water to flush that waste out of your system. But, water is always a good idea.

7)     The high protein diets minimized, but did not completely prevent, muscle loss. Other studies suggest that adding the amino acid leucine to a high protein diet can give 100% retention of muscle mass in a weight loss regimen – but that’s another story for another day.

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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