Obesity is a contributing factor

Dear Dr. Roach: We have been hearing for quite a while about the health risks of obesity. The discussion usually involves connecting the higher risk to various medical problems obese people frequently have.

I have been obese all my life and generally not had those problems, so I always find myself asking if I have the same increased risks. I see my physician regularly and until age 60 had no medical problems. At 60, I developed high blood pressure that is now under good control with irbesartan and HCTZ. My blood sugar is good, my triglycerides are excellent and my cholesterol levels are both within normal limits. My BMI is 48, and I know it would be better for me to lose weight. I have done this to the tune of 500+ pounds over my lifetime, but I wonder about the question of being at higher risk. — B.W.

Obesity puts a person at risk for many conditions, but from the standpoint of the biggest risk — overall mortality rate — the relationship is complex.

Much of the risk comes from the conditions associated. Diabetes, high cholesterol and high blood pressure are the most important. Most people who are obese have a poor diet and do not exercise much, but there are exceptions to both of these. Obese people who have no diabetes or high blood pressure, have good cholesterol levels, eat well and exercise regularly are at higher risk for heart disease and stroke than they would if they were not obese.

The magnitude of the risk depends on a person’s weight. BMI by itself is not a great indicator. There are very muscular people who have a high BMI but very little body fat. The combination of waist size and BMI is a much better predictor of cardiovascular risk. A very high BMI, such as 48, is a significant risk, not only for vascular disease, but also for COVID-19, based on the data we have so far.