Heart-healthy diet

Lifestyle Changes

Guidelines for Weight Loss

Lifelong changes in eating habits, physical activity, and attitudes about food and weight are essential to weight management. Unfortunately, although many people can lose weight initially, it is very difficult to maintain weight loss. People with type 2 diabetes may have a particularly difficult time. Here are some general suggestions that may be helpful:

• Start with realistic goals. When overweight people achieve even modest weight loss they reduce risk factors in the heart. Ideally, overweight patients should strive for 15% weight loss or better, particularly people with type 2 diabetes.
• A regular exercise program is essential for maintaining weight loss. If there are no health prohibitions, choose one that is enjoyable. Check with a doctor about any health consideration. [For more information, see In-Depth Report #29:Exercise.]
• Do not take hunger pangs as cues to eat. A stomach that has been stretched by large meals will continue to signal hunger for large amounts of food until its size reduces over time with smaller meals.
• Be honest about how much you eat, and track calories carefully. Studies on weight control that depend on self-reporting of food intake frequently reveal that subjects badly misjudge how much they eat (typically underestimating high-calorie foods and overestimating low-calorie foods). In one study, even dietitians underreported their calorie intake by 10%. People who do not carefully note everything they eat tend to take in excessive calories when they believe they are dieting.
• For patients who cannot lose weight with diet alone, weight-loss medications are now available, including sibutramine (Meridia) and orlistat (Xenical in prescription form, alli in non-prescription form). Orlistat may help improve cholesterol levels, regardless of weight loss. Sibutramine is also helpful in weight loss but should not be used by patients with high blood pressure or kidney or liver problems.
• Once a person has lost weight, maintenance is required. To maintain a healthy weight, make careful decisions about how many calories you consume in food and how many calories you expend through physical activity. Such thinking will eventually become automatic.
• For severely obese patients, weight loss through bariatric surgery may be an option.

Even repeated weight loss failure is no reason to give up. [For more information, see In-Depth Report #53: Weight control and diet.]

Exercise

Inactivity is a major risk factor for coronary artery disease, on par with smoking, unhealthy cholesterol, and high blood pressure. In fact, studies suggest that people who change their diet in order to control cholesterol lower their risk for heart disease only when they also follow a regular aerobic exercise program.

Research strongly supports the benefits of exercise on coronary artery disease:

• People who maintain an active lifestyle have a 45% lower risk of developing heart disease than do sedentary people. Even moderate exercise reduces the risk of heart attack.
• People who lose weight and exercise regularly have a significantly better chance of maintaining weight loss compared to those who do not exercise.
• Burning at least 250 calories a day (the equivalent of about 45 minutes of brisk walking or 25 minutes of jogging) seems to confer the greatest protection against coronary artery disease, particularly by raising HDL ("good" cholesterol) levels.
• Aerobic exercise also appears to open up the blood vessels and, in combination with a healthy diet, may improve blood-clotting factors.
• Resistance (weight) training offers a complementary benefit by reducing LDL (the so-called bad cholesterol) levels.
• Exercises that train and strengthen the chest muscles may be very important for patients with angina.

[For more information, see In-Depth Report #29: Exercise.]

Stress Reduction

Stress is always highly associated with negative effects on the heart and other parts of the body. A number of techniques are available to help people relax and reduce tension. [For more information, see In-Depth Report #31: Stress.]

Highlights
Introduction
Nutrition Basics
Diet Plans
Lifestyle Changes
Resources
References

Review Date: 5/5/2009
Reviewed By: Harvey Simon, MD, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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