As obesity remains prevalent, it is important for patients and clinicians to understand its impact on cardiovascular health. Discussions about weight management can guide prevention and treatment strategies.
Nisha Kuruvadi, D.O., DipABOM, DipABLM
Triple Board-Certified Internal Medicine, Obesity Medicine, & Lifestyle Medicine Physician; Primary Care Physician and Medical Weight Management Specialist
Obesity is a well-established risk factor for heart disease and stroke. Obesity affects cardiovascular health in numerous ways, including increased blood pressure, cholesterol, and inflammation. Excess weight contributes to insulin resistance, raising the risk of type 2 diabetes, which further elevates cardiovascular risk. Obesity also promotes chronic inflammation and arterial stiffness, both of which make heart attacks and strokes more likely.
Weight loss alone can significantly lower heart risks, especially with a 5-10% reduction in body weight. This improves blood pressure, cholesterol, and blood sugar. Sustainable heart health also requires proper nutrition, physical activity, and, when necessary, medications.
- Nutrition: A diet rich in whole, plant-based foods can lower cholesterol and blood pressure by increasing fiber and healthy fats, reducing sodium, and incorporating potassium-rich foods like leafy greens and beans.
- Physical Activity: Regular exercise, including aerobic activities and strength training, supports weight loss and cardiovascular health, with at least 150 minutes of moderate-intensity exercise and two strength training sessions per week recommended, while even small daily movements offer benefits.
- Other Lifestyle Changes: Good sleep, stress management, and avoiding smoking and excess alcohol support heart health and reduce disease risk.
The role of your primary doctor
Despite the benefits of lifestyle changes, many patients struggle with implementation due to factors such as time constraints, limited access to healthy foods, cultural influences, emotional eating, and lack of support. Breaking habits can be difficult, and frustration over slow progress may lead to a loss of motivation. Clinicians can help by offering practical strategies and connecting patients with resources like dietitians and behavioral therapy.
Patients should feel empowered to discuss weight and heart health concerns with their doctor. A simple way to initiate the conversation is by saying, “I’m concerned about my weight and how it’s affecting my heart. What steps can I take to lower my risk?” Mentioning symptoms, family history, or past weight struggles can lead to a more personalized plan.
Healthcare providers should routinely assess weight, BMI, and metabolic risk factors. They can integrate weight management into cardiovascular care, offer structured programs, and refer patients to obesity specialists when needed.
Patients can work with their doctor to create a sustainable plan that includes realistic goals, regular follow-ups, and a combination of personalized nutrition advice, activity recommendations, behavioral support, and medication when needed. A well-rounded approach increases the chances of long-term success and improved cardiovascular health.
Obesity medications
Obesity medications can be part of a comprehensive treatment plan, especially for individuals with high cardiovascular risk, type 2 diabetes, and/or hypertension. These medications help patients follow a heart-healthy nutrition plan and physical activity routine. The most prescribed obesity medications work through different mechanisms.
- GLP-1 receptor agonists (such as semaglutide, liraglutide, and tirzepatide) mimic a natural hormone that regulates appetite, slows digestion, and improves insulin sensitivity, leading to reduced food intake and weight loss. These medications also lower inflammation and improve metabolic function, which contributes to heart health.
- Phentermine-topiramate suppresses appetite and increases calorie burning.
- Naltrexone-bupropion helps reduce cravings and supports behavioral changes.
Recent advancements in obesity medications offer new options for individuals at cardiovascular risk. FDA-approved medications like semaglutide and tirzepatide promote significant weight loss and improve cardiovascular outcomes, reducing heart attack and stroke risk.
For patients taking weight loss medications, a follow-up schedule is important to monitor progress, assess medication effects, and track cardiovascular risk factors. Follow-ups are generally recommended every 4-12 weeks to adjust treatment plans as necessary. Regular monitoring of blood pressure, cholesterol, and blood sugar ensures that weight management efforts are translating into meaningful cardiovascular benefits.
By combining lifestyle changes with medical interventions when needed, patients can take a proactive approach to reducing their risk of heart disease and stroke.
