Weight Management

Chloe Steele, our heart health nutritionist, tells us about effective weight management strategies to help prevent and manage heart disease.

It has been estimated that 39-49% of the world’s population are overweight or obese, both of which are recognised risk factors for the development of heart disease 1. However, there are a proportion of individuals who are seemingly normal weight, and still have heart disease. In recent history, these individuals were somewhat of an enigma leading to further scientific research studies showing that where you store your weight, and not the number on the scales is a better predictor of heart health. This means that it is no longer sufficient to simply lose weight or to work towards a better body mass index (BMI). Targeting that tough belly fat and ensuring that you decrease your waist circumference is essential to improve your risk of heart disease.

Why do we get belly fat?

Now to understand how to lose it, we need to know why it is formed. There are many factors which come into play with this. Poor sleep, lack of exercise and environmental factors such as pesticides and hormones in our food can all contribute to the formation of fat around the middle. Improving any of these things can make a difference, but for the most dramatic effect, it may be necessary to change our diet.

How to choose the right diet

There are many diets out there, but most of them work on the adage of eat less. Whilst this may seem logical, recent research has shown that diets which focus on reducing calorie intake often don’t work and are not sustainable ways to lose weight. Other popular diets often heavily focus on cutting down one of the major nutrients such as fat or carbohydrates.  A diet low in fat may seem like a rational way to decrease body fat, however the removal of one nutrient means that others must increase and that usually means an increase in dietary carbohydrates.  Whilst in the short term, this way of eating has been shown to help weight loss, carbohydrates are sugars and increased intake over a long period of time can lead to a condition called insulin resistance, which promotes weight gain 2. Diets high in carbohydrates also usually involve a high amount of processed food, which has been associated with excess body weight 3. Diets high in fat and low in carbohydrates have been shown in the short term to aid weight loss, however this may not be sustained in the long-term 4–6. Furthermore controversy exists over long term effects on blood lipid levels due in part to the type of fat being consumed and how it can differentially effect the body 2. Diets high in saturated fats from animal sources may increase bad LDL cholesterol in the blood, which is linked to heart disease 5. Whereas fats from plant-based sources have been shown to be of benefit, highlighting that not all fat is bad 2,7.

Which foods are recommended to include in your diet for a healthy heart?

Whilst this may seem confusing, ultimately what it highlights is that concentrating on the ratio of nutrients in the diet and calorie counting may not be the best tactics for weight loss. Instead, the aim is to focus on the quality of the food being consumed. Diets that don’t need a degree in mathematics to follow and concentrate on the ingredients rather than cutting things out, like the Mediterranean diet, have been shown to have benefits to both long-term weight loss and heart health 8–10. This diet is based on the traditional way of eating in Greece, Italy and other countries that border the Mediterranean Sea. It has an abundance of whole grains, fruits, vegetables, fish, lean meats, beans, nuts, and seeds, with the main source of fat from olive oil, and with dairy and red meat kept to a minimum. This ensures that a broad spectrum of nutrients are consumed, with plenty of monounsaturated and polyunsaturated fats, fibre, vitamins, and minerals. Olive oil, especially extra virgin, is an important part of this diet due to its association with a reduced risk for heart disease 11. A great by-product of focusing on all of this quality food is long-term weight loss and in particular a reduction in waist circumference, highlighting the benefits of concentrating on superior ingredients to fight the fat that plays a part in the development of heart disease 12.

  1. Powell-Wiley TM, Poirier P, Burke LE, et al. Obesity and Cardiovascular Disease. Vol 143.; 2021. doi:10.1161/01.atv.0000216787.85457.f3
  2. Ge L, Sadeghirad B, Ball GDC, et al. Comparison of dietary macronutrient patterns of 14 popular named dietary programmes for weight and cardiovascular risk factor reduction in adults: Systematic review and network meta-analysis of randomised trials. BMJ. 2020;369. doi:10.1136/bmj.m696
  3. Askari M, Heshmati J, Shahinfar H, Tripathi N, Daneshzad E. Ultra-processed food and the risk of overweight and obesity: a systematic review and meta-analysis of observational studies. Int J Obes. 2020;44(10):2080-2091. doi:10.1038/s41366-020-00650-z
  4. Yang Q, Lang X, Li W, Liang Y. The effects of low-fat, high-carbohydrate diets vs. low-carbohydrate, high-fat diets on weight, blood pressure, serum liquids and blood glucose: a systematic review and meta-analysis. Eur J Clin Nutr. 2022;76(1):16-27. doi:10.1038/s41430-021-00927-0
  5. Choi YJ, Jeon SM, Shin S. Impact of a ketogenic diet on metabolic parameters in patients with obesity or overweight and with or without type 2 diabetes: A meta-analysis of randomized controlled trials. Nutrients. 2020;12(7):1-19. doi:10.3390/nu12072005
  6. Tobias DK, Chen M, Manson JE, Ludwig DS, Willett W, Hu FB. Effect of Low-Fat vs. Other Diet Interventions on Long-Term Weight Change in Adults: A Systematic Review and Meta- Analysis. lancet Diabetes Endocrinol. 2015;3(12):968-979. doi:10.1016/S2213-8587(15)00367-8.Effect
  7. Jenkins DJA, Wong JMW, Kendall CWC, et al. Effect of a 6-month vegan low-carbohydrate (‘Eco-Atkins’) diet on cardiovascular risk factors and body weight in hyperlipidaemic adults: A randomised controlled trial. BMJ Open. 2014;4(2). doi:10.1136/bmjopen-2013-003505
  8. Delgado-Lista J, Alcala-Diaz JF, Torres-Peña JD, et al. Long-term secondary prevention of cardiovascular disease with a Mediterranean diet and a low-fat diet (CORDIOPREV): a randomised controlled trial. Lancet. 2022;399(10338):P1876-1885.
  9. Velázquez-López L, Santiago-Díaz G, Nava-Hernández J, Muñoz-Torres A V., Medina-Bravo P, Torres-Tamayo M. Mediterranean-style diet reduces metabolic syndrome components in obese children and adolescents with obesity. BMC Pediatr. 2014;14(1). doi:10.1186/1471-2431-14-175
  10. Papadaki A, Nolen-Doerr E, Mantzoros CS. The effect of the mediterranean diet on metabolic health: A systematic review and meta-analysis of controlled trials in adults. Nutrients. 2020;12(11):1-21. doi:10.3390/nu12113342
  11. Guasch-Ferré M, Hu FB, Martínez-González MA, et al. Olive oil intake and risk of cardiovascular disease and mortality in the PREDIMED Study. BMC Med. 2014;12(1):1-11. doi:10.1186/1741-7015-12-78
  12. Bendall CL, Mayr HL, Opie RS, Bes-Rastrollo M, Itsiopoulos C, Thomas CJ. Central obesity and the Mediterranean diet: A systematic review of intervention trials. Crit Rev Food Sci Nutr. 2018;58(18):3070-3084. doi:10.1080/10408398.2017.1351917