Weight a minute! We need to talk about this: The importance of maintaining a healthy weight in People Living with HIV Disease (part of a series of articles)
In 1998, President Bill Clinton appointed Dr. David Satcher, a distinguished physician and military admiral, as the Surgeon General of the United States. He was the second African-American (after Dr. Louis Sullivan) to serve as the highest ranking physician in public health; an esteemed cabinet position. Dr. Satcher tackled America’s urgent health challenges head on. He identified the two major preventable health risks in the country: obesity and smoking.
These conditions are major factors that contribute to the risk of cardiovascular disease (like heart attacks), metabolic diseases (like diabetes), cancers (like lung cancer), pulmonary diseases (like COPD- Chronic Obstructive Pulmonary Disease) and stroke. These diseases were the top killers in the US then, and they continue to be today. But Dr. Satcher was sounding the alarm that the lifestyle factors, especially obesity and smoking, that increase the risk of these diseases are preventable!!!
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While this topic is of supreme importance to all of us, people living with HIV disease need to listen more intently. HIV infection by itself can increase the risk of some of these diseases, particularly cardiovascular disease, metabolic disease and certain cancers, even in people who are controlled on their medication.
To make matters worse, people living with HIV may already be living with diabetes, hypertension, COPD or other diseases which can be a double whammy. These individuals must work extra hard to reduce their risk of death and we want to focus this article (and those that will follow) on weight.
Managing weight is a challenge for many of us, but some people find it particularly difficult. One reason is because the processes in our bodies that regulate and determine our weight are complex. To make matters worse, people who are heavier than their ideal or desirable weight often encounter negative views or stigma from other people.
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Some folks have genuinely tried to reduce their weight using all sorts of diets and exercise programs yet, to no avail. But we first need to define certain terms related to body weight and discuss how medical professionals usually measure weight. Most often, we use an index called the body mass index or BMI. The BMI is essentially the person’s weight based on their height. It is calculated by measuring the person’s weight (in kilograms) divided by their height (in meters), squared or weight/(height X height). BMI is easy to measure and it can be done in any doctor’s office or at home. A person is defined as overweight with a BMI between 25-30 kg/m2 (one-third of the American population) and obese if the BMI is greater than 30 kg/m2 (another one-third of the American population).
But there are some problems with this index. The health risks come from excess adipose tissue or too much fat. But what if I’m a bodybuilder? I may have a high weight and a high BMI, but actually have relatively little fat. In this case, the weight is due to muscle. So researchers tried to develop ways that could specifically measure body fat composition.
The problem here is that all fat is NOT created equal! The health risks of excess fat seem to depend on where in the body the fat is located. The type of fat that is most dangerous to your health is fat that occurs in the belly, or what medical professionals refer to as visceral adipose tissue. Some women may have most of their fat concentrated in the hips or thighs but far less in the belly; and have a high BMI. Is such a person at the same risk of developing diabetes as a person with the same high BMI, but with a lot more belly fat? Probably not.
This is not to say that excess fat outside of the belly doesn’t carry health risks. But it may be less of a risk for cardiovascular and metabolic disease. You really need to discuss this topic with your medical provider and get their advice. There are special tests that can measure belly fat but it requires special equipment and may be expensive.
One simple way could be to just measure the circumference of your waist with a tape measure in your doctor’s office. Recently, some medical societies have favored using waist circumference measurements over BMI (or in addition to BMI) to better predict a person’s risk for life-threatening diseases.
This is a lot, so let’s recap.
At least two-thirds (67%) of the American population is overweight or obese. These conditions increase the risk of deadly diseases. People with HIV are already at risk for cardiovascular disease complications even if their HIV disease is controlled. The fat with the highest health risk is abdominal fat. A better way to understand a person’s risk for disease may be to compare waist and hip circumference instead of body mass index.
So just a couple more points. For people with HIV disease, the medications, especially some of the newer ones, may cause increases in body weight. This is something reminiscent of what we saw with HIV medicines over 25 years ago. We will explore this issue in detail.
There are treatments for people who need to lose weight and most of these can be quite effective. Nevertheless, there are questions you need to ask your medical providers. We will also be discussing this. Stay tuned!
