From Voice of Asia Online: Diabetic and Cardiovascular Risk due to Abdominal Obesity How aware are physicians and patients of waist size?

Increasing obesity is one the most important healthcare problems in United States and has become a major focus of recent government initiatives to improve the health of the country.
The serious effects of obesity are even greater in Indians and other South Asians especially in the case of obesity around the waist. Although, Body Mass index (BMI) is the commonest measure of obesity we now know that a more dangerous type of obesity is “Abdominal Obesity”. “Abdominal”, sometimes called “central”, obesity which is best measured by waist size.
It is now well recognized that abdominal obesity greatly increases the risk of diabetes, heart attacks and strokes. Because of this careful waist size measurements by physicians to evaluate “abdominal obesity” are strongly recommended.
However, as with all new knowledge, a considerable amount of time may pass before both physicians and patients pay careful attention to this very dangerous form of obesity.
To study physician awareness and the understanding of the problem of abdominal obesity (with careful waist size measurements) investigators from the Houston Methodist Research Institute and Baylor College of Medicine performed a detailed survey of physicians. The physicians surveyed were primarily in the Houston and Sugar Land and Sugar Land areas, many of whom had a large number of South Asian patients.
The study investigators were Tamara Shan, Kathleen Wyne, MD, PhD, FACE, FNLA, Samir Desai MD, and Michael Wollner MD. Tamara Shan and Dr Kathleen Wyne presented the results of this study at the National Lipid Association Meeting in Orlando in May 2014. The study has been published in the prestigious “The Journal of Lipidology”.
The alarmingly findings of the study included the fact that only 5% of physicians routinely measured their patients waist sizes. Also, despite seeing an unusually high number of South Asian patients,  66% of physicians were unaware of the smaller waist size recommendations for South Asians required to reduce of the risk of cardiovascular death and diabetes.

National guidelines have now recommended lower thresholds for waist circumference be used for South Asians (90cm for men) than Caucasians (94 cm in men). In fact, the presence of “Abdominal obesity” is likely to be a major reason why heart attacks are more common in South Asians. South Asians living in the US have a 300 to 500 % greater risk of heart attacks compared with Caucasians. Moreover, heart attacks in South Asians are often more “silent” (without symptoms), more severe and occur approximately 10 years earlier, than Caucasians.

Houston Methodist Hospital is helping raise awareness of waist size as an important cardiovascular risk factor, with serious consequences particularily in the South Asian community. In fact , one of the investigators from the above study, Tamara Shan, is actively with Houston Methodist Hospital physicians to help raise community and possibly physician awareness to the dangers of abdominal obesity (measured by waist size), BMI, and diabetes in South Asians.

A recent study from the Mayo Clinic reports that “abdominal obesity” measured by waist size is also a very strong predictor of early death.  Even with a normal BMI and weight, each 5-cm increase in waist size raises the death rate in men by 7% and by 9% in women.  For example, if a woman increased her waist size from 70 to 95cm her mortality would increase by 80%.  Severely increased waist size could lead to the loss 3 to 5 years of lifespan, estimated from the age of 40 yrs.

Tamara Shan will be featured on the Open Forum Radio 1480 AM scheduled for September 27th 2014. Don’t miss!

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