My View

‘Obesity Has To Be Treated As a Disease—Not a Lifestyle Issue’

Despite high obesity rates, Kansas City heart surgeon says steps are underway “to reduce heart mortality 20 percent by 2020.”

Dr. Willie E. Lawrence Jr. is a Kansas City-based cardiologist working with the American Heart Association to reduce the behaviors and risk factors that create heart disease.
National Journal
Willie E. Lawrence Jr.
Add to Briefcase
See more stories about...
Willie E. Lawrence Jr.
March 7, 2014, 4:39 a.m.

As a Kan­sas City, Mo., car­di­olo­gist, Wil­lie E. Lawrence Jr., 56, sees a con­nec­tion in many of his pa­tients between obesity and hy­per­ten­sion, con­di­tions that can lead to heart dis­ease.

Dr. Lawrence, an ac­com­plished in­ter­ven­tion­al car­di­olo­gist, now ad­voc­ates for pro­grams and ap­proaches that may be more ef­fect­ive.

Ac­cord­ing to 2011 data re­leased by the Health and Hu­man Ser­vices’ Of­fice of Minor­ity Health, Afric­an-Amer­ic­an wo­men are 80 per­cent more likely to be obese than non-His­pan­ic white wo­men. Forty-four per­cent of Afric­an-Amer­ic­ans have high-blood pres­sure. Afric­an-Amer­ic­an wo­men are nearly twice as likely to suf­fer dia­betes as whites, yet only one in five Afric­an-Amer­ic­an wo­men be­lieves she is per­son­ally at risk for car­di­ovas­cu­lar dis­ease, ac­cord­ing to the Amer­ic­an Heart As­so­ci­ation/Amer­ic­an Stroke As­so­ci­ation.

To ad­dress these dis­par­it­ies, Lawrence has long been in­ter­ested in fig­ur­ing out tools that clin­ic­al pro­viders can use.

This in­ter­view, con­duc­ted by Jody Bran­non, has been ed­ited for length and clar­ity.

Obesity is an im­port­ant prob­lem in our Afric­an-Amer­ic­an com­munit­ies, and it’s get­ting worse. My spe­cif­ic in­terest in obesity ex­tends to hy­per­ten­sion. Obesity is one of the risk factors for hy­per­ten­sion, and both, along with dia­betes, in­ter­mingle to in­crease one’s risk for de­vel­op­ing heart dis­ease and stroke.

It’s hard in a 20-minute of­fice vis­it, for a doc­tor or a car­di­olo­gist to really im­pact obesity. First you need to make the per­son real­ize it’s a prob­lem. Obesity may be more ac­cep­ted in some com­munit­ies than in oth­ers. This may make it more dif­fi­cult to mo­tiv­ate pa­tients to diet, ex­er­cise, and re­cog­nize the health risks as­so­ci­ated with obesity. That’s one po­ten­tial obstacle to cre­at­ing an Afric­an-Amer­ic­an cul­ture of health.

Heart dis­ease de­vel­ops over time, and there’s no lin­ear re­la­tion­ship between weight and heart dis­ease. Non­ethe­less, as you lose weight you can po­ten­tially elim­in­ate some of the risk factors for heart dis­ease and stroke. That in­cludes dia­betes, hy­per­lip­idemia (high levels of fat in the blood), and hy­per­ten­sion (high blood pres­sure). As people lose weight, their risk of de­vel­op­ing dia­betes will go down. Rates of high blood pres­sure de­crease. Weight loss may make it easi­er to treat these dis­eases.

The re­search of Don­ald Lloyd-Jones has demon­strated that if you reach the age of 55 with no more than one risk factor for heart dis­ease, it is un­likely that you will die of heart dis­ease be­fore the age of 80. The goal is to not de­vel­op risk factors. 

We’re deal­ing with odds. That’s what makes it so chal­len­ging. If you’re part of a pop­u­la­tion that leads a healthy life­style or if you’re obese and yet you’re among the group that loses 10, 20, or 30 pounds, you’re go­ing to do bet­ter than the group that doesn’t lose weight.

Obesity is a dis­ease that is typ­ic­ally asymp­tot­ic — same thing with hy­per­ten­sion. You don’t really feel bad when you’re over­weight, but it puts people at in­creased risk of oth­er­wise avoid­able heart dis­ease and stroke in their life­time. While there may be no guar­an­tees, put your­self in the co­hort of people who are more likely to live longer, health­i­er lives than people who don’t con­trol cho­les­ter­ol, don’t ex­er­cise or con­tin­ue to smoke

As a car­di­olo­gist, there are frus­tra­tions. Of­ten I get up in the middle of the night and treat pa­tients who are hav­ing a heart at­tack. I open up blocked ar­ter­ies with bal­loons and stents. I may pre­vent a heart at­tack in a pa­tient with a blocked ves­sel. They thank me, but they don’t al­ways do what they need to do to pre­vent fu­ture events.

That’s one of the reas­ons I be­came a vo­lun­teer for the AHA and its hy­per­ten­sion pro­grams. In­stead of deal­ing with end-stage heart prob­lems, we are cre­at­ing policies and sys­tems of care that can im­pact lar­ger num­bers of people. We want to im­prove the car­di­ovas­cu­lar health of all Amer­ic­ans by 20 per­cent, and re­duce death from heart dis­ease and stroke by 20 per­cent by the year 2020.

We need to treat risk factors and change the mi­lieu in which heart dis­ease evolves. We have to de­crease rates of hy­per­ten­sion and obesity. It’s not just enough to take a pill to lose weight, to stop smoking or even treat hy­per­ten­sion. We need to pro­mote true life­style changes to achieve op­tim­al health. Med­ic­a­tions can only get you so far. We’re try­ing to change the psyche of pop­u­la­tions, of pa­tients so that the ex­pect­a­tion is a healthy life­style. That wasn’t al­ways the case.

It wasn’t long ago when it was ac­cept­able to get on a plane and smoke. People were in­dig­nant in a res­taur­ant when they were told not to smoke. For years it was the right of a ci­gar­ette smoker to smoke. Now it’s not ac­cept­able. We’ve changed the en­vir­on­ment. We’ve changed the ex­pect­a­tion for a healthy en­vir­on­ment. Sim­il­arly, obesity has to be treated as a dis­ease — not a life­style is­sue. Hav­ing a healthy life­style has to be the ex­pect­a­tion. And that’s what we’re try­ing to ef­fect at the Heart As­so­ci­ation, wheth­er through obesity aware­ness or ex­er­cise.

There’s that re­cent Biggest Loser win­ner and the dis­cus­sion that the lady lost weight too fast. You don’t want to go over­board and con­trib­ute to in­creased rates of eat­ing dis­orders. But you clearly need to re­cog­nize that obesity is a dis­ease and an im­port­ant health be­ha­vi­or. We have to change the mind-set and draw a re­la­tion­ship between obesity, dia­betes, and high blood pres­sure; and heart dis­ease and stroke.

That’s one of the battles we’re los­ing. We haven’t for­mu­lated a sys­tem­at­ic ap­proach to obesity. We’re see­ing res­ults in young kids, through the work of the AHA. We’ve been able to fo­cus on sug­ary drinks in school. The Heart As­so­ci­ation has worked to­ward le­gis­la­tion to deal with ban­ning them. That is lead­ing to de­creas­ing rates of obesity. En­cour­aging phys­ic­al activ­ity will help. In some mu­ni­cip­al­it­ies, we’ve en­cour­aged city plan­ning — like build­ing side­walks to en­cour­age walk­ing. We are win­ning many of these battles. But we’re los­ing that battle in oth­er places, re­lated to fin­ances. Schools are drop­ping phys­ic­al-edu­ca­tion re­quire­ments.

In terms of le­gis­la­tion around adult obesity spe­cific­ally, I’m not a big fan of lim­it­ing in­di­vidu­al choice. I lean more to­ward cre­at­ing in­cent­ives. The gov­ern­ment’s job is to pro­tect the in­di­vidu­al, so that may be easi­er with smoking ces­sa­tion. But to man­date policies that pre­vent obesity, that’s trick­i­er. What you don’t want is over­re­li­ance on re­strict­ive policies and man­dates that may not fun­da­ment­ally im­pact be­ha­vi­or. In con­trast, we must pro­tect our kids. More sup­port­ive ac­tion re­quires money. For in­stance, in pro­grams that are fin­anced by the fed­er­al gov­ern­ment that provide food for un­der­priv­ileged kids, the re­quire­ment should be that schools of­fer and pro­mote healthy food choices. That’s something we can do.

Our main goal has to be to pro­mote what the Amer­ic­an Heart As­so­ci­ation has termed a “cul­ture of health.” We are do­ing that. I re­main op­tim­ist­ic that in the next dec­ade, through our ef­forts, we will con­tin­ue to see im­prove­ment in the car­di­ovas­cu­lar health of all Amer­ic­ans.

Jody Brannon contributed to this article.
What We're Following See More »
Doesn’t Express Confidence in Marino
Trump to Declare Opioid Emergency Next Week
2 hours ago

After initially promising it in August, "President Trump said Monday that he will declare a national emergency next week to address the opioid epidemic." When asked, he also "declined to express confidence in Rep. Tom Marino (R-Pa.), his nominee for drug czar, in the wake of revelations that the lawmaker helped steer legislation making it harder to act against giant drug companies."

Trump Still Considering Yellen For Fed
9 hours ago

"President Donald Trump plans to formally interview Janet Yellen this week about potentially staying on as Federal Reserve chair, two people familiar with the matter said...Many Republicans on Capitol Hill want Trump to move on from Yellen, whose first term ends in February, and choose a more traditionally conservative Fed chair."

Trump Noncommittal on Marino
9 hours ago
Manchin Asks Trump to Drop Marino’s Nomination for Drug Czar
11 hours ago
McCaskill Will Introduce Bill in Response to “60 Minutes” Scoop
11 hours ago

In the wake of Sunday's blockbuster 60 Minutes/Washington Post report on opioid regulation and enforcement, Sen. Claire McCaskill (D-MO) has introduced legislation that "would repeal a 2016 law that hampered the Drug Enforcement Administration’s ability to regulate opioid distributors it suspects of misconduct." In a statement, McCaskill said: “Media reports indicate that this law has significantly affected the government’s ability to crack down on opioid distributors that are failing to meet their obligations and endangering our communities."


Welcome to National Journal!

You are currently accessing National Journal from IP access. Please login to access this feature. If you have any questions, please contact your Dedicated Advisor.