National Obesity Forum - 'Don't lose weight after heart attack'

Daily Telegraph 05 September 2007 [David Haslam]

Obese patients who have had a heart attack should not lose try to lose weight, a doctor said yesterday. The idea is set to divide the medical community because heart patients are routinely told to lose weight and lead a healthier lifestyle to prevent further attacks. Prof Stefan Anker, of the Royal Brompton Hospital in London, said ''once the damage is done'' it is better to remain overweight because the extra calories protect the body.

Addressing the European Society of Cardiology annual congress in Vienna, he stressed his findings relate only to patients who have already got heart disease and younger patients should prevent damage by remaining a healthy weight. Prof Anker cited an editorial he had written in the journal Circulation and several large studies showing improved survival in heart patients with a body mass index of between 30 and 35 - classed as clinically obese. "There is no evidence that you prolong life when advising people to lose weight with a BMI of up to 40 “ he said.

''There is no indication from epidemiological data that after the onset of heart disease, in old and ill people, that you improve hospitalisation rates or improve survival when patients lose weight." He said doctors had simply extrapolated the advice from the ''young and the fit'' to relate to the ''old and ill''. He said that a doctor would never ask a cancer patient or an Aids patient to lose weight and ''it should equally never happen in patients with heart failure''.

The editorial in the journal Circulation said: "Among patients with cardiovascular illness, the finding that obese patients fare prognostically better than non-obese patients is not restricted to patients with chronic heart failure. Indeed, in other chronic illnesses like chronic obstructive pulmonary disease, cancer, renal failure, or liver cirrhosis, obese patients show better survival. Obesity must be a marker of something positive if it is not itself of benefit."

The article, co-written by Prof Anker, said obese patients carry more fatty tissue and this contains twice as much energy as muscle making it an energy reserve. He argued that proper randomised clinical trials should be carried out but added: "However we look at the data on hand, there can be no doubt that the presence of obesity in patients with chronic heart failure is associated with longer survival, although not necessarily with better quality of life. ''It seems time to comprehensively revisit our thinking about obesity, especially in the context of chronic illnesses."

Prof Peter Weissberg, the medical director of the British Heart Foundation, said the study showed bigger people did better when diagnosed with heart failure ''but this does not apply across the board to all people with heart problems''. He said it may be more difficult to diagnose heart failure in thin people, meaning they are sicker - and therefore more likely to die - when the disease is detected. David Haslam said: "There is cast iron evidence that obesity causes heart disease, around 20 different cancers and a host of other problems."