Women with bigger waists relative to their hips face a higher risk of heart attacks than men with a similar body shape, according to a new study.

The study, published in the Journal of the American Heart Association, suggests that a waist-to-hip ratio measurement may be a better indicator of heart attack risk than body mass index for both men and women.

Previous studies have shown that it’s not just general obesity, but also where fat is stored on the body, that contributes to an increased risk of heart disease. However, past research was unclear on what role gender played in the equation, despite clear differences between men and women in body fat distribution.

For this study, researchers looked for sex-specific links between excess weight, fat distribution, and heart disease risk in nearly half a million men and women ages 40 to 69 in the United Kingdom who had no previous history of heart disease. During seven years of follow-up, 5,710 heart attacks were recorded among participants, with women experiencing a 15 percent higher risk of heart attacks than men with a similar waist-to-hip fat distribution.

“We found that women with bigger waists and waist-to-hip ratios face a greater excess risk of experiencing a heart attack than men who have a similar ‘apple shape,’” said the study’s lead author Sanne Peters, a researcher at the George Institute for Global Health at the University of Oxford in the United Kingdom.

On average, waist circumference among all participants was about 33½ inches in women and about 38¼ inches in men. Women with a waist size greater than 35 inches and men with a waist larger than 40 inches are at higher risk for heart disease and Type 2 diabetes, according to the National Heart, Lung, and Blood Institute.

“More intensive screening for the risk and development of cardiovascular disease and diabetes in individuals with an apple shape might help prevent the onset of disease, especially in women,” Peters said.

Goutham Rao, M.D., chair of family medicine and community health at the University Hospitals Cleveland Medical Center, said the study provided a new context for how patients and doctors can battle heart disease.

“We know now that women have to be especially careful,” said Rao, lead author of a 2015 scientific statement from the American Heart Association, which recommends that adults have both their waist circumference and BMI measured each year. “We already knew to have a big waist was a risk factor for the general population, but what’s interesting about the study is that women were especially affected by that specific risk.”

“I think this study points to BMI as a flawed measure and offers evidence that we ought to be measuring waist circumference systematically…”

The study also suggests that measuring waistline size and comparing it to hip size might be a better way to predict heart disease risk than the widely used body mass index, which calculates body fat based on height and weight.

“BMI is a measure of general obesity, and it does not discriminate between fat around the hips or the waist,” Peters said. “Yet, compared to fat around the hips, fat around the waist is more metabolically active, is closely related to insulin resistance and may be more strongly associated with the risk of heart disease, stroke, and diabetes.

“Measures of body fat distribution, including waist circumference, waist-to-hip ratio, and waist-to-height ratio, may be more suitable as indicators for cardiovascular disease risk,” she said.

Rao — who was not involved in the study — agreed, and called for doctors to aggressively seek out “respectful ways to overcome the sensitivity” of measuring patients’ waistlines. Those methods, he said, include doing the measurements in private rooms or letting patients measure their own waistlines with inexpensive digital measuring tapes.

Rao said, “I think this study points to BMI as a flawed measure and offers evidence that we ought to be measuring waist circumference systematically in all of our adult patients at least once a year — not just because it shows certain people they are at high risk, but it might also identify folks that are not at high risk.”

Peters said more research is now needed into the different ways women and men store body fat and how that affects overall health. Rao called for additional research into how waist circumference affects stroke risk, and how it impacts various racial and ethnic groups.

In the meantime, Rao said, the study reinforces the need for both men and women to decrease excess belly fat with a two-pronged approach of proper nutrition and regular exercise.



By: A. Pawlowski 

Lifestyle changes are the first approach doctors try in patients with hypertension and they can be very effective.

If just reading about blood pressure is raising your blood pressure, a doctor may have mentioned you need to keep your numbers in check.

Chronic high blood pressure — higher than 130/80 — takes a toll on your arteries, heart, kidneys, and brain. Lower it, and you reduce your risk of heart attack and stroke.

Cardiologists say it can absolutely be done without the help of medication. In fact, lifestyle changes are the first approach they often try in patients with hypertension. So what are the best ways to lower your blood pressure without pills? We asked two experts:

  • Dr. Ron Blankstein, a preventive cardiologist at Brigham and Women’s Hospital in Boston, associate professor at Harvard Medical School and a member of the American College of Cardiology’s Prevention of Cardiovascular Disease Section Leadership Council.
  • Dr. Jennifer Haythe, an assistant professor of medicine and co-director of the Women’s Center for Cardiovascular Health at the Columbia University Medical Center.

Here are their six tips:


It’s imperative to shed any extra pounds, both doctors said. The rising rate of obesity in the U.S. means doctors are seeing more young people with high blood pressure because it rises as body weight increases. Being overweight puts extra strain on your heart, the American Heart Association noted, but losing just five to 10 pounds may help.

“There are many advantages of weight loss, but certainly that’s one of the most important ones — lowering blood pressure,” Blankstein said.

There is good evidence plant-based diets high in fruits, vegetables, whole grains, and legumes will lead to lower blood pressure and weight loss, Blankstein noted. You’ll also naturally get more potassium, which is associated with lower blood pressure.

At the same time, banish processed foods.

“You have to stick to real foods, which are foods that haven’t been taken by a company and processed and put in a box or plastic bag,” Haythe said.

Bottom line: Your weight and eating style should be at the core of your strategy.

“The combination of weight loss and diet together is incredibly powerful for lowering blood pressure. I have patients who have had enormous success doing that,” Blankstein said.


We need sodium to live, but too much salt leads the body to hold on to more fluids and that causes volume changes inside blood vessels. Over time, blood pressure rises.

“The problem is, salt is everywhere,” Haythe noted.

“It’s not just the salt that you add with the shaker,” Blankstein added. “Most of the sodium we get in our diet is found in various processed foods — things like canned soups, chips, cold cuts, pickles and even bread.”

He recommended consuming less than 2 grams (2,000 mg) of salt — or less than one teaspoon — a day for people who are trying to lower their blood pressure. That can be very effective, he said.


Exercise improves circulation and cardiac output, and has a dilating effect on your blood vessels, Haythe said. It raises blood pressure at the moment, but in an appropriate way, both doctors noted. Long-term, exercise actually lowers your resting blood pressure.

“Our blood vessels learn to relax when we’re not exercising. So the benefits with exercise are not necessarily at the time of exercise, but in general afterward,” Blankstein said.

He advised cardio over weightlifting and considered the general recommendation of 30 minutes of aerobic exercise, five times a week, to be “the absolute minimum.” An hour of exercise a day on most days of the week is better.

Squeezing in a workout, but then just sitting the rest of the day is still not enough activity: Regularly get up and move, Blankstein said. He recommended aiming for 10,000 steps a day.


Drinking too much alcohol can raise blood pressure, so have no more than two drinks a day if you’re a man, and no more than one drink a day if you’re a woman, the American Heart Association advises.

Eliminating alcohol altogether might be useful for someone who already has high blood pressure, Blankstein said.


You can feel your heart working hard if you get angry at work or frustrated in traffic. If you feel that way all the time, the damage accumulates.

“It’s very important for people to try to find ways to reduce their chronic stress, whether they need to go to a therapist, be on medication for that or exercise, do yoga, meditation,” Haythe said.

Stress management can be very helpful, Blankstein agreed. Still, he would never tell patients that managing stress would single-handedly do the job of lowering blood pressure if they’re also overweight or have a poor diet.


If you’re not able to lower your blood pressure with lifestyle changes, having to take a medication is not a failure, Blankstein said. Sometimes, the combination of both is the best approach.

If you have high blood pressure, both doctors recommended buying a monitor for home use.

Whether at home or the doctor’s office, blood pressure should be measured the right way: You need to be in a quiet room. Don’t smoke, drink caffeinated beverages or exercise within 30 minutes before taking the measurement. Also, empty your bladder and be still for at least five minutes before, the American Heart Association recommends.

Measure your blood pressure at different times of day and keep a log so you and your doctor can identify any patterns. If the result is high, also include what you were doing just before the measurement.

It’s common to have “white coat hypertension” — or higher blood pressure when you’re nervous at the doctor’s office. “You don’t want to make any decisions based on that high number,” Blankstein said. Ask the staff to measure your blood pressure again at the end of the visit when you’ve had a chance to relax.



Written by Amanda Menard, LPN

A Guide to Understanding Your Coverage, Costs, and Quality of Care

The health insurance landscape has changed considerably in the past few years, and now, many people are confused as to how to choose the best plan for their needs. The centralized government insurance exchange helps people to be able to see a variety of providers in one place, but it can be difficult for people to choose the plan that is right for them. There are several factors that go into determining which healthcare provider is the best for your needs, and you will have to do some homework if you want to get your selection right. It is important to remember that there is a limited window each year when you can choose your healthcare plan, so be prepared and make your choice before the deadline passes.

Understand the Coverage

  • Be sure to find out which coverage in each planis standard and which coverage is optional.
  • If you have special healthcare needs, then try to find a plan that will pay for as much of your care as possible without taking too much out of your pocket.
  • Check to see if the plan you are considering has coverage for each member of your family.
  • Always look for preventative care coverage such as immunizations and annual check-ups.

Costs of Coverage

  • Understand the out-of-pocket costs you would have with each plan you are considering, and choose the plan that keeps the costs to you down.
  • Utilize online healthcare cost calculators to find out what your healthcare costs would be for your situation. Every situation is different, so be sure to get as many details as you can.
  • The government has set up the opportunity for people to get premium tax creditsthat will help to offset healthcare costs. Check to see if you qualify for a tax credit, and use that when calculating your costs.
  • Your deductibles will determine how much you pay out of your pocket and how much your insurance plan will cover. Take the time to understand your deductibles before making a decision on which plan you want.

Consider Medicare

  • Medicarecould be a cost-effective way for you to get the healthcare you need. Medicare is generally offered to the elderly, but you should check your eligibility to see if you qualify.
  • Medicare offers several different optionsthat can enhance your coverage. You should check out the different options available such as advantage plans, dental plans, and supplemental plans and see if you can put together an overall plan that fits your needs.

Understanding the ACA

  • The most significant change to occur in the healthcare industry in recent years has been the Affordable Care Act. There are laws regarding who must have insurance coverage and consequences for those who do not get insurance. Before you choose an insurance plan, make sure it qualifies under the ACA and you will satisfy your federal obligation to avoid any tax penalties.
  • The ACA has a strict set of guidelineswhen it comes to availability of tax subsidies and who qualifies as being covered by health insurance in a household. When you understand these guidelines, you can make a better decision on which healthcare program is right for you.

What Is Medicaid?

  • Medicaidis a federally outlined medical program for low-income families that is administered by each state. While there are federal guidelines for Medicaid, each state establishes its own eligibility requirements.
  • When the ACA was passed, many states opted to not expand Medicaid. This means that health insurance for low-income families may not be as readily available in those states as it is in others. If your state did not expand Medicaid, then you should contact the state’s health department to determine your available options.
  • Most states have a Medicaid component that is specifically set up to provide for the healthcare of children. Even states that did not expand Medicaid offer access to these programs, which makes this a healthcare option for the children of low-income families.

General Tips

  • To assist with the requirements of the ACA, many states have healthcare cooperatives and other options available for people who cannot afford health insurance. It is important to remember that there are always options to explore when it comes to getting health insurance.
  • The fines for not having health insurance can be very stiff, so it is imperative that every family investigate their healthcare coverage options to avoid having to pay these fines.
  • Healthcare coverage is definitely a buyer’s market, so use your ability to choose to your option. When you investigate the healthcare plans available, compare them side-by-side to make sure that you get the best possible plan for your situation



Written By: Amanda Menar

When a parent is diagnosed with a terminal illness, this new situation will affect the entire family, including the children. In these cases, one of the main concerns is how, when and if this news should be shared with the children. It is normal for parents to want to protect their child, but hiding the terminal illness can oftentimes make matters worse. Namely, withholding information can cause children to feel confused, angry and, many times, guilty.

How to Have the Conversation with Your Children

According to the American Society of Cancer, it is a good thing to tell your children about the terminal illness, but this news should be shared in stages and in a language that a child will be able to understand. Never give a child more information than they will be able to absorb and understand.

If you have a partner, it is best to share this news together; but if you are a single parent then you should tell them alone. A single parent’s greatest concern is to find a reliable person who will take care of their children after they are gone.

But when is the best time to tell your children about your terminal illness? You should talk to your child as soon as the diagnosis is definite. Children know more than parents may think, and they do understand when something is happening in their family, even if you think that you are good at hiding it. Be honest with your children and try to prepare them as much as you can for the future. Keeping your child away from the truth will just make them feel lonely, afraid and guilty.

Preparing Your Child for Loss

In many cases, families have been dealing with the disease for months or even years before it is known that the condition is terminal. In just a few cases, the disease is diagnosed in an advanced stage. This period will help you and your children prepare for the worst. No matter how long you have been dealing with the illness, when it comes to its terminal stage, it won’t be easy for anyone in your family to deal with.

Children have an abstract understanding of life. Young children especially will have difficulties understanding what death is, and the fact that their parent will be gone forever. Usually, after the age of 10, children do understand the meaning of death. Using the right words is very important. Be sure to explain to your child what death really means and that once you are gone, you will not be back. Don’t give hope to your child. Instead, explain to them that once someone has died, they will be physically gone and that the child will no longer see the loved person. In some cases, this conversation might need to be repeated a couple of times because children will usually have questions. Try to answer these as much as you can. For most children, it is very hard to cope throughout the process of losing a parent, especially if they are very young. But in time, the child will accept the reality.

In one way, telling your child the truth can help distract parents from dwelling on the illness. The more they know about the situation, the less afraid they will feel. If you are hospitalized, try to get in touch with your children as much as you can. Reassure your children that you love them and that the illness has no effect on your love for them. Let your child visit you while hospitalized only after you, your partner, a friend or a family member prepares them for this situation. It is not easy for children to see their parent in a terminal condition.

Remember, when a parent suffers from an illness, children will notice that something is going on. Being overprotective of them will just make the situation worse, so be honest. It is normal for you as a parent to not know all the answers, as well as to be unsure of what to say and how to explain the illness to your children. Seek help when necessary from a family member, friend or a professional.

Additional Helpful Resources



Written by Sarah Gehrke, MSN, RN

According to the Center for Disease Control and Prevention (CDC), more than a third of US adults have obesity—this dietary driven disease kills more than twice as many people as infectious disease.

Obesity is a growing problem among people from all walks of life—this is especially true with children since the convenience of technology usage has limited their physical activity, and the availability of overly processed foods, such as pizza, sugary snacks, other fast food, have made children overweight.

Physicians have correlated, through recent studies, that obesity can be attributed to some diseases including diabetes, heart problems, and even some forms of cancer. These non-communicable chronic diseases will cost our global economy $47 trillion over the next 20 years.

Fortunately, preventative measures can be taken to help combat obesity, and with a few lifestyle changes, people of all ages can lose weight, be healthier, and live a longer and fuller life.

WHO: Obesity and Overweight – CDC provides key facts and global estimates about the obese and overweight population

The Global Economic Burden of Non-communicable Diseases – a snapshot of the five major non-communicable diseases and summary of the global economic impact

Provide Healthy Eating Experiences

Offering a healthy eating experience is an excellent way to help prevent obesity. Replacing white flour with whole grains and wheat bread to increase fiber intake is an improvement; however, keep in mind that two slices of whole wheat bread are shown to raise a person’s blood sugar, or blood glucose, more than two tablespoons of table sugar. Bread and packaged food, in general, may have added sugar.

Vegetable and fruit snacks provide a stable energy source. Fresh fruits instead of cake or candy bars are great alternatives for both kids and adults.

The National Institutes of Health (NIH) recommend low-fat dairy in a healthy eating plan. A 2016 study published in Circulation may have a strong influence on policymakers, in the future, to re-evaluate their position against full-fat dairy. Researchers found that out of 3,300 people, the individuals with the highest intake of full-fat dairy products had a 46% decrease in the risk of developing type 2 diabetes compared to people with low-fat dairy.

Science debunked the idea that a diet with high-fat foods is not good for you, in fact, saturated fat is liberated from the do not consume category. Even eggs are back in. Even though the new USDA Dietary Guidelines Committee said that cholesterol is no longer restricted, the guidelines continue to propose a person consume an eating pattern low in added sugars, saturated fats, and sodium. This includes:

A variety of vegetables from all of the subgroups—dark green, red and orange, legumes (beans and peas), starchy, and other

Fruits, especially whole fruits

Grains, at least half of which are whole grains

Fat-free or low-fat dairy, including milk, yogurt, cheese, and/or fortified soy beverages

A variety of protein foods, including seafood, lean meats and poultry, eggs, legumes (beans and peas), and nuts, seeds, and soy products


A healthy eating pattern limits:

Saturated fats and trans fats, added sugars, and sodium

Water or a sparkling mineral water without added sugar instead of soda can make a positive impact on weight and overall health.

With a few simple, healthy eating alternatives, people can lose weight and feel better about themselves. Diets rich in fiber and vitamins can also reduce the risk of heart disease.

Glycaemic Index Tables – compilation of reliable tables of the glycaemic load associated with the consumption of different foods

Dairy Fat and Risk of Diabetes Mellitus – an interesting perspective on dairy consumption and the potential health effects of dairy fat

The Guidelines – an executive summary of the dietary guidelines from the Office of Disease Prevention and Health Promotion

Obesity Basics – definition and overview of obesity risk factors and complications

Choose My Plate – answers to your questions about the 2015–2020 dietary guidelines

Choose My Plate (Multiple Languages) – answers to your questions about the 2015–2020 dietary guidelines in multiple languages

Teach Healthy Eating Habits

Most people who are at their proper weight have a lower risk for diabetes and numerous other health problems. Teaching children healthy habits increases the likelihood that they will be an appropriate weight when they get older.

Acquiring a healthy diet can include encouraging kids to eat fruits instead of candy, limiting sodas, and ingesting whole foods. Teaching people healthy eating habits can be fun! Promoting new things like seafood or different vegetables can send someone on a food adventure that will keep them on the right track for their whole life.

Opportunities to teach and improve food choices exist throughout the day and in varied settings. If small shifts made over time, it can add up to real improvements in long-term eating patterns.

Fast Food Alternatives – how to make careful menu choices

Tips for Healthy Eating On the Go or at Home – tip sheets for eating healthy when dining out and shopping

Nutritional Songs – songs for healthy eating habits

Win Over Picky Eaters – tips to keep in mind when your child or other picky eater only wants to eat French fries or pizza for all meals

Healthy Eating Lesson Plan – an empowering lesson plan for teaching students healthy eating choices (adaptable for grades K–5)

Teaching Veterans Healthy Food Choices – this Healthy Teaching Kitchen YouTube channel aims to improve the health of veterans and their families

Living the Total Body Diet Lifestyle – a total body diet designed from the Academy of Nutrition and Dietetics to get people into a wellness state of mind

Fight Belly Fat Foods – a general overview of obesity in American and tips on foods that help with fighting belly fat

Promote Physical Activity

Getting kids or even sedentary adults to become active can be a challenge. However, some things can be done to help promote physical activity.

Walking groups with friends or co-workers are a great way to encourage each other, hold each other accountable, and get people to stay active. Nature walks are also a wonderful way to get outdoors, be active and enjoy the weather.

Taking the stairs at work instead of the elevator and parking your car further away from shopping centres can add up to your health and wellness over time.

You can create fun, loving connections by adding movement into your daily routine—the whole family will benefit. Most early childhood interactions involve movement. Let’s face it; our world is based on movement.

Boosting activity needs taught and encouraged, in the same way awareness does. Keep in mind children learn their behaviours from adults.

Here are some ideas to choose from that inspire activity:

Limit screen time, such as video games, TV, and other electronic devices.

Make activity cards and use them as a game—paste a picture of physical activity on one side of the card. Then, the child, or adult, chooses the card and demonstrates the movement.

Teach posture alignment and silly stretches using helium balloons. Clip the balloon on the back of everyone’s shirt as a gentle reminder to sit up straight during dinner. Or, encourage a fun activity of arm stretching by tying balloons to each wrist.

Read or write a short story that promotes activity as a part of the story.

You do not have to be a full-time athlete to take part in physical activity. Just a few simple changes can make a difference in one’s overall health, and you might even lose a few unflattering pounds in the process.

Physical Activity for Everyone – the CDC explains the benefits of boosting physical activity

Helping Kids be Physically Active – eleven ways to encourage your child to be physically active

Active Resources – the US Department of Health and Human Services provide different ways to be physically active

Staying Active – Harvard School of Public Health reviews why physical activity is just as important as eating nutritious foods

Adults Aged 50+ Staying Active – the CDC explains why adults older than 50 need more physical activity

Exercise Aspects of Obesity Treatment – a review of the negative impact of obesity, heart disease risk factors, and the treatment of obesity

Provide Emotional Support

Often, people who are overweight have a low sense of self-esteem. Exercising might be a little bit embarrassing or awkward.

Commonly, this is why people who are overweight stay overweight, particularly those without the help and support of family and friends. Providing some emotional support and positive reinforcement can do wonders for those trying to lose weight and live a healthier life.

A study in the Journal of Developmental and Behavioural Paediatrics examined the relationship between social support and health-related quality of life in obese youth. Overall, the study found that obese youth perceive varying levels of support. Their greatest level of social support comes from parents and close friends. Interestingly, a classmate’s support has the strongest influence on health-related quality of life, yet obese youth perceive the least amount of support from classmates.

Both children and adults can benefit from support groups—just lending an ear to those who need it are useful ways to give people who are obese some encouragement and steer them in the right direction.

Psychological Effects of Being Obese – the American Psychological Foundation examine whether people’s internalized societal attitudes about being overweight

How to be a Good Support Team – the article explains ways to help a loved one lose weight without hurting their feelings

Perceived Social Support and Quality of Life – an in-depth review of the association between social support and perceived quality of life in obese youth

Self Esteem, Insecurity, and Obesity – the Obesity Action Coalition discusses the role of self-esteem from birth and the awareness of the continuous stream of negative feedback that can shape self-confidence

Support, Wellbeing, and Energy Balance – key resources from the CDC to promote an energy balance in schools

Community Strategies – the CDC explains community efforts to reverse the obesity epidemic

The Health Effects of Obesity

People who are obese, compared to individuals with a healthy weight, are at risk for many serious health conditions, which include the following:

All-causes of death (mortality)

High blood pressure (Hypertension)

High LDL cholesterol, low HDL cholesterol, or high levels of triglycerides (Dyslipidemia)

Type 2 diabetes

Coronary heart disease


Gallbladder disease

Osteoarthritis (a breakdown of cartilage and bone within a joint)

Sleep apnea and breathing problems

Some cancers (endometrial, breast, colon, kidney, gallbladder, and liver)

Low quality of life

Mental illness such as clinical depression, anxiety, and other mental disorders

Body pain and difficulty with physical functioning

Note. List of diseases and health conditions are retrieved from the Centers for Disease Control and Prevention.



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