Obesity and heart disease

September 4, 2002

We know that BMI does not perfectly predict insulin resistance. Patients with BMI greater than 35 are labeled obese. New research suggests that we should disentangle obesity and insulin resistance in determining heart disease risk. Obesity Alone May Not Up Risk of Heart Disease – describes a new article in the cardiology literature.

More than 300 study volunteers free of diabetes and hypertension underwent a regular glucose challenge test to measure insulin sensitivity. The test measures the amount of glucose (sugar) remaining in the blood after a person consumes a sugary drink or is infused with a glucose solution.

The volunteers were categorized as normal weight (BMI less than 25), overweight (BMI between 25 and 30), or obese (BMI over 30). BMI or body mass index is a measure of a person’s weight in relation to their height and is considered a more accurate predictor of heart disease and type 2 diabetes, than weight alone.

As expected, the likelihood of insulin resistance rose in tandem with BMI. Insulin resistance and BMI were also independently related to a person’s age, blood pressure, cholesterol levels, and other heart disease risk factors.

But about 25% of those who were insulin-resistant were normal weight–the same proportion of all insulin resistant individuals that was obese. Some obese volunteers were not insulin-resistant. Overall, BMI alone contributed just 22% to the risk of insulin resistance, report researchers.

“Obesity does not equal insulin resistance,” Reaven told Reuters Health. The researchers estimate that 50% of the variation in insulin resistance is due to genetic factors, 22% to BMI and the remainder due to a sedentary lifestyle.

We also know that exercise benefits all people, regardless of BMI. This article does not address the effect of exercise on insulin resistance. This article does not give obesity a free pass. Note that the probability of insulin resistance increases as weight increases. I suspect that insulin resistance has both genetic and environmental components. One can control the environment with exercise and a healthier diet.

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