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Resting Metabolic Rate: A Critical, Primary Care Screening Test

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untitled Copyright 2013 American Medical Association. All rights reserved. JAMAPATIENT PAGE | Cardiovascular Disease Obesity and the Heart The definition of obesity is based on bodymass index (BMI), a number calculated from a person’s height and weight. AnormalBMI isbetween 18and25, andaBMIhigher than30 is con- sideredobese.Obesityhasbeen increasingasaproblemintheUnited States, and currently more than 30% of US adults are obese. Obe- sity has been linked to many different health concerns, including heart disease, diabetes, sleep apnea, cancer, and arthritis. Heart Problems Related to Obesity Several different types of heart problems are related to obesity. Coronary artery disease: Obesity is a risk factor for coronary ar- tery disease (CAD), which results from cholesterol plaque buildup in thearteries of theheart. Althoughobesity is linked tomanyother risk factors for CAD, such as diabetes, high cholesterol, high blood pressure, and metabolic syndrome, obesity is also a risk factor for CAD. The risk for CAD is higher in peoplewith “central” or “visceral” obesity that is concentrated in the abdomen. Heart failure:Obesity is a risk factor for heart failure even inpeople withoutCAD.Theexactway inwhichobesitymight causeheart fail- ure in the absence of CAD is not known, but there are 2main expla- nations. First, obese individuals tend to have greater amounts of blood, which makes the heart pump harder and can lead to heart failureover time.Because theheartworksharder, itsmuscle size in- creases, aconditioncalledventricularhypertrophy (seeFigure). Sec- ond, obesity is linked to sleep apnea, which causes lung problems aswell as high bloodpressure, both ofwhich can eventually lead to heart failure. Atrial fibrillation:Manystudieshaveshownthatobesity is a risk fac- tor for atrial fibrillation, a type of abnormal heart rhythm. In many cases, atrial fibrillation is seen in heart failure. Therefore, the path- waysamongobesity,heart failure, andatrial fibrillationareall closely related. This

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