Obesity and Young Adults: Starting a Meaningful Conversation About Lifestyle Modification
Author:
Sarika Desai, DO
Arizona Heart 360, Phoenix, Arizona
Citation:
Desai S. Obesity and young adults: Starting a meaningful conversation about lifestyle modification [published online September 17, 2018]. Cardiology Consultant.
As a cardiologist, I am more likely to see a 65-year-old patient with heart disease versus a patient in his or her 20s. But on the occasion when I do see younger patients with metabolic syndrome, I realize that they are not properly educated regarding lifestyle modification. Having this conversation with patients at a younger age can potentially save them years of medication use and hospitalization costs, and can lead to a better quality of life overall.
Most patients who leave the office having just heard “lifestyle modification” typically will feel lost by the time they get home. I recently saw a 32-year-old man whose father had had a heart attack at age 38. He was rightfully concerned about his own heart health.
The patient was obese and, unfortunately like a domino effect, had developed obstructive sleep apnea, type 2 diabetes mellitus, and hypertension. The prevalence of obesity roughly doubles between pre-adolescence (17% among 6- to 11-year-olds) and young adulthood (34% among 20- to 39-year-olds).1 He initially felt helpless and asked me about weight loss medications.
After asking him about his fears, his ups and downs of trying different fad diets, and his experience with lifestyle modification, it became clear that he did not have a basic understanding of eating a heart healthy diet. To bridge the gap, I educated him about the value of fruits, vegetables, nuts, and legumes. We then talked about a regimen of cardiovascular exercise for 30 to 45 mins at least 4 days per week.
Life can get hectic, and there is always an excuse for any of us to avoid the gym or engage in a heart-healthy diet—whether it is cost, accessibility, stressors, or time. However, obesity is serious business, especially from a cardiovascular perspective. Obesity is linked with heart disease, stroke, type 2 diabetes, and certain types of cancer. Here is where cardiologists really have the ability to influence behavioral change.
For years, we have been successful at detecting cardiovascular disease and treating it, but there is a paradigm shift where younger patients who are more cognizant about family history and their own healthy or unhealthy habits want to discuss their cardiovascular risk. We need to better prepare ourselves for these discussions. During visits, encourage patients to see a registered dietician who can help them plan their meals. It is one thing to prescribe a low-fat low-carb diet, but it is another for that to translate into actual meals throughout the day. Most insurances cover these types of visits as part of their preventive efforts.
As a cardiologist, I have also been keen on screening for sleep apnea, because if untreated, it can lead to serious cardiac arrhythmias such as atrial fibrillation. Both obstructive and central sleep apnea have been associated with atrial fibrillation in multiple studies, with the risk of atrial fibrillation increasing 2- to 4-fold compared with those without sleep breathing disorder.2 Therefore, treating the obesity before patients develop comorbidities is the key to a better quality of life.
Sarika Desai, DO, is a cardiologist at Arizona Heart 360 in Phoenix, Arizona, and is a clinical assistant professor of medicine at the University of Arizona.
References:
- Dietz WH. Obesity and excessive weight gain in young adults: new targets for prevention. JAMA. 2017;318(3):241-242. doi:10.1001/jama.2017.6119.
- Tung P, Anter E. Atrial fibrillation and sleep apnea: considerations for a dual epidemic. J Atr Fibrillation. 2016;8(6):1283. doi:10.4022/jafib.1283.