Hearts

Will a Bad Trend in Heart Deaths Make People Think?

JAMA has a new paper describing in detail how the progress in reducing deaths from heart disease is grinding to a halt. Researchers from Northwestern University and the University of Liverpool found disturbing trends in heart deaths. The decline in overall deaths from heart disease is slowing. Deaths from stroke and diabetes are no longer declining. And finally, death rates for high blood pressure are going up.

The Cleveland Clinic’s Steven Nissen sums it up:

At best, progress has slowed to a halt, and, at worst, our rates of cardiovascular disease are going up. And the cause, pretty much everybody agrees, is the obesity epidemic and all of its downstream consequences.

And this is not a problem confined to the U.S. As we’ve reported recently, slowing of progress against heart disease deaths is a global problem.

Hanging On to Outdated Obesity Ideas?

But the real question is whether this will spark better systematic approaches to obesity. Nissen seems to think that treating obesity is too hard. “Once people have developed severe obesity, reversing that is very difficult,” he says. We can almost hear choruses of angels singing the virtues of prevention.

Likewise, the American Heart Association seems to think that obesity is a behavior. Having a BMI under 25 is one of “Life’s Simple 7” ideal health behaviors. Just shed those pesky pounds. In that scheme, body weight is a “modifiable behavior.”

Strangers to the Truth

They are strangers to the truth of obesity. We have reached the point where 72 percent of the population has excess weight and obesity. Prevention might help, but it won’t solve the problem at this point. Obesity is a complex, chronic disease and for the majority of people affected, simply changing behaviors does not reverse it.

We do have other tools that can help manage it and reduce the impact on health and well-being. But we’re not using them. Health systems and payers have systematic barriers in place to prevent people from getting access to evidence-based care for obesity.

The real reason is bias – both about the disease and against the people who have it. The rationalization is that it’s just too hard – as Nissen said.

Well, the truth is this. Until we all confront the reality of obesity as a problem of physiology, not choice, this untreated disease will continue to eat away at our health. Both public health and individual health will decline.

This bad trend in heart deaths is a warning sign we should not ignore.

Click here for the study in JAMA, here and here for further reporting.

Hearts, photograph © emdot / flickr

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August 28, 2019

5 Responses to “Will a Bad Trend in Heart Deaths Make People Think?”

  1. August 28, 2019 at 4:11 pm, mike said:

    Ted, is there one place that you would direct someone for your (or the industry’s ) leading suggested policy list. I get that you can easily need 100’s of pages for a detailed list of policy proposals and plans, but sort of a 5-10 step list of top actions: I read your blog often, but am not aware of it linked to here, but it very well may exist! having something very easy to demonstrate 5-10 concrete actions I think is very important to raising awareness to actual solutions, and love your site, so hoping you have something.

    Along these lines: (again, experts may be totally different recommendations than the following…but hopefully something concrete / discrete like this)

    1. Changing obesiogenic environment by recommending a soft drink tax equialvent to 1.5c per ounce

    2. Encouraging transparency and pricing and recommendation in bariatric surgery to move from <200k cases per year to 500k by 2025 in united states

    3. Moving to equal matching air time for "healthy foods" on a 1 to 1 basis for each soda/candy/fast food advertisement (robert lustig's idea based upon advertising restrictions put on the smoking industry in the 1960's)

    Hope there is something that you have produced or some other source produced that you can reference which is updated every 3-6 months etc. thanks!

  2. August 28, 2019 at 4:54 pm, John DiTraglia said:

    It often seems we are saying there is a treatment for obesity. Short of surgery people are not going to lose weight. We can treat co-morbidities, commiserate with societal misunderstanding and discrimination and recommend good diet and exercise. But the first thing we should tell our patients is that there is no treatment or cure of obesity per se.

  3. August 29, 2019 at 4:12 am, Ted said:

    Mike, yours is an excellent question. I don’t have any quick fixes, just three broad changes we need.
    1. More objectivity about obesity.
    2. More curiosity about what will work to treat and prevent it.
    3. Better care for the people affected.

    For a more detailed policy agenda, I’ll refer you to this from the OAC: https://www.obesityaction.org/action-through-advocacy/overview-of-advocacy-in-obesity/health-policy-agenda/

  4. August 29, 2019 at 4:15 am, Ted said:

    Thanks John, for sharing your thoughts. While I can agree that we don’t have cures for obesity, I can’t agree that there’s no treatment. A skilled obesity medicine physician, surgeons, and allied health professionals can help people manage this chronic disease. Just like cancer, diabetes, or heart disease, good care can improve health and extend life. But we need better treatments. Very true.

  5. August 29, 2019 at 9:17 pm, mike said:

    Thanks for the reply ted.