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September 2008 Mayo Clinic Women's HealthSource Highlights Normal Weight Obesity, Regular Exercise and Cholesterol

Normal Weight Obesity: A Real Health Risk

ROCHESTER, Minn., Sept. 2 /PRNewswire-USNewswire/ -- Here are highlights from the September issue of Mayo Clinic Women's HealthSource. You may cite this publication as often as you wish. Mayo Clinic Women's HealthSource attribution is required. Reprinting is allowed for a fee. Include the following subscription information as your editorial policies permit: Visit or call toll-free for subscription information, 800-876-8633, extension 9751.

Normal weight obesity isn't an oxymoron.

"The definition of obesity is having excess fat, not excess weight," says Francisco Lopez-Jimenez, M.D., Mayo Clinic cardiologist, in the September issue of Mayo Clinic Women's HealthSource.

Dr. Lopez-Jimenez was the lead researcher in a Mayo Clinic study that found more than half of Americans who are considered normal weight have high levels of body fat. Women with more than 30 percent body fat and men with more than 20 percent are considered obese, even if they have a normal body mass index.

Typically, obesity is determined by calculating body mass index (BMI) using height and weight. "This makes a lot of sense on the surface because people with excess weight for their height often are at high risk of health problems, but it doesn't tell the whole story," says Dr. Lopez-Jimenez.

The calculation of body fat determines how many pounds of body weight correspond to fat. The most common technique to measure body fat is bioimpedance, a method that uses an electrical current to look at body composition. These measurement devices are available at many fitness centers and some clinics.

The Mayo Clinic study, which looked at 2,127 people with normal BMI levels, found that those who had the highest body fat were at increased risk of high blood pressure, high levels of triglycerides (a type of blood fat) and abnormal cholesterol levels and insulin resistance. These metabolic abnormalities significantly increase the risk of type 2 diabetes and cardiovascular disease.

Another way to determine an unhealthy level of body fat is by measuring your waist. In women, a waist measurement of 35 inches or more indicates an increased risk of developing obesity-related health problems.

The solution to excess body fat, even for those of normal weight, is to exercise more and eat a healthier diet.

No More Excuses: Ways to Overcome Barriers to Regular Exercise

ROCHESTER, Minn. -- Finding excuses not to exercise is easy. The September issue of Mayo Clinic Women's HealthSource offers ways to overcome common barriers with some creativity, flexibility and a different mindset. Here's a sample:

Excuse: I don't have time to exercise.

-- Schedule exercise in your day as you would an appointment. If you wait to find time, it probably won't happen.

-- Turn off the TV. Free up time by watching one less program.

-- Think activity rather than exercise. Mow the lawn; climb the stairs; park farther from your destination.

Excuse: I'm too old.

-- It's never too late to start. Even moderate physical activity, such as walking or raking leaves, can help prevent or delay age-associated conditions such as heart disease, diabetes and high blood pressure.

Excuse: I'm too tired to exercise.

-- Realize that exercising increases energy. You may be tired because you're not exercising, or not getting enough sleep. Go to bed earlier.

-- Be prepared. Have workout clothes ready on top of the dresser. Keep a bottle of water in the refrigerator. Simple shortcuts may make it easier to see plans through.

-- Make lunchtime count. Keep a pair of walking shoes at your desk and take a brisk walk during your lunch break.

Excuse: I'm self-conscious about how I look when I exercise.

-- Others probably feel the same way. Remind yourself what a great favor you are doing for your health.

-- Go solo at first. As you become healthier and more at ease, you may feel confident enough to exercise with others.

Excuse: I'm not overweight, so I don't need to exercise.

-- Being thin doesn't necessarily mean you're fit. Although a healthy weight is important, it's also important to get regular exercise.

Excuse: I can't exercise because I have a chronic health condition.

-- This is valid only if your doctor has told you not to exercise. Physical exercise can help manage symptoms of many chronic conditions.

Cholesterol in the News: Answers and More Questions

ROCHESTER, Minn. -- Understanding cholesterol is more than figuring out what's good and bad.

Although much is known about this waxy substance that's in all body cells and its relationship with heart disease, much is still uncertain. Doctors suspect that the relationship may be more complicated than previously believed.

The September issue of Mayo Clinic Women's HealthSource provides an overview of cholesterol and recent news about cholesterol medications.

The general consensus has been that lowering low-density lipoprotein (LDL) or "bad" cholesterol helps reduce the risk of plaque accumulation on blood vessel walls. This accumulation, called atherosclerosis, can lead to heart attack or stroke.

Regular exercise and a healthy diet are known to reduce LDL levels and increase high-density lipoprotein (HDL), the "good" cholesterol that removes excess cholesterol from the body. When diet and exercise aren't enough to control cholesterol levels, medications can help lower LDL levels. Statins are some of the most popular and effective drugs for this task. They prevent the formation of cholesterol in the liver and reduce the risk of dying from cardiovascular disease.

Earlier this year, statins were involved in a study called ENHANCE. Researchers compared the drug ezetimibe-simvastatin (Vytorin), which combines a statin with a cholesterol-absorption inhibitor, with the stand-alone statin simvastatin (Zocor). Researchers hoped that the combination drug would lower LDL cholesterol even more than the statin alone. However, they found the combination drug didn't reduce thickness of plaque in the blood vessel walls any more than the statin did.

The study garnered considerable attention because it seemed to question the long-held belief that lowering LDL cholesterol is an effective way of preventing heart attack and stroke. But many doctors have misgivings about that interpretation, the accuracy of the results and how the findings have been generalized.

Because of the many environmental and genetic factors involved in heart disease, some drugs may be more effective than others in preventing atherosclerosis. There's no evidence that ezetimibe is unsafe and, in fact, taking this drug may allow for a lower statin dose and reduce the statin side effects such as muscle pain. Results from additional studies on ezetimibe are expected in a few years.

When diet and exercise aren't enough, evidence still supports that any therapy that lowers LDL cholesterol appears to provide benefits, and there are many options. Consult a doctor about the best ways to manage cholesterol.

Mayo Clinic Women's HealthSource is published monthly to help women enjoy healthier, more productive lives. Revenue from subscriptions is used to support medical research at Mayo Clinic. To subscribe, please call 800-876-8633, extension 9751, or visit

SOURCE Mayo Clinic
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