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Dr. Roach: Obesity is a contributing factor in a host of medical issues

Dr. Roach
To Your Health

Dear Dr. Roach: We have been hearing for quite a while about the health risks of obesity, and these have become of even greater concern given the pandemic. The discussion usually involves connecting the higher risk to various medical problems obese people frequently have — for instance, high blood pressure, diabetes and heart disease.

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, which I know is very high, and make no mistake, 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 being relatively healthy, I wonder about the question of being at higher risk.

B.W.

Dear 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.

As you suggest, much of the risk comes from the conditions associated with obesity. 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 of obesity. 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, but waist size is seldom measured. 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.

Dear Dr. Roach: I am a man in his late 50s. Doctors told me for years I had mitral valve prolapse but recently, some doctors say I don’t have it. I have had several EKGs and echocardiograms, which all seem to be normal. Who should I believe?

K.S.

Dear K.S.: The mitral valve separates the left atrium from the left ventricle and prevents blood from flowing backward into the left atrium when the ventricle contracts. Mitral valve prolapse is when the valve leaflets billow backward excessively into the ventricle. Often, there is associated backward flow of blood into the ventricle. This is called regurgitation.

I suspect you were given the diagnosis of MVP in the 1980s or 1990s, before echocardiography for this condition was well standardized. As many as 10% to even 20% of people were diagnosed with MVP back then. With current standards, about 2%-3% of the population will have MVP.

MVP can cause rhythm disturbances. It is associated with several different symptoms and, as mentioned, can cause mitral regurgitation. Mitral regurgitation severe enough to cause symptoms that do not respond to medication is the most common indication for surgical treatment.

Readers may email questions to ToYourGoodHealth@med.cornell.edu.