Is There a Connection Between Weight and Heart Disease?

There’s a connection between excess weight and heart disease. You’re more likely to have heart and blood vessel problems like atherosclerosis, coronary artery disease, and strokes, if you have a body mass index (BMI) that’s considered overweight or obese. In particular, you’re more likely to have heart disease if you have excess abdominal fat or an increased waist size. 

There are a few reasons behind this connection — and they can be hard to untangle. 

Shared risk factors

Part of the reason why excess weight and heart disease can go hand in hand is that they share many of the same risk factors. That means that there are common reasons why you may have both heart disease and excess weight. For example, if you have high blood pressure or diabetes, you’re more likely to have a BMI greater than 30, and you’re also more likely to have heart disease. 

Higher risk of health complications that cause heart disease

Having excess weight also increases the odds of developing health complications that are themselves risk factors for heart disease. Scientists are still learning about the ways that weight can change your body and affect health. 

Each of these weight-related conditions alone increases your risk for heart disease. But together, the effects add up even more. 

Weight and cholesterol levels

Having a larger body size makes you more likely to develop high cholesterol. About 60% to 70% of people with a BMI higher than 30 have increased cholesterol. These changes might happen because excess weight makes it hard for LDL receptors to function properly. This leads low-density lipoprotein (LDL) or “bad” cholesterol to build up. Increased fat cells may also cause inflammation that changes how cholesterol is processed in the body. 

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Weight and blood pressure

Having excess weight can also lead to high blood pressure. This can happen for several reasons. To start, your heart muscle has to pump harder. As it pumps harder, the blood vessels may stiffen in response. The kidneys may not work as well, and fluid may build up in the blood vessels. Also, fat cells can secrete hormones that change the walls of blood vessels. All of this can end up raising your blood pressure.

Weight and obstructive sleep apnea

Obstructive sleep apnea (OSA) is a condition in which the upper airway can narrow and collapse during sleep. This can lead to snoring, pauses in breathing, and even waking at night gasping for air. The greater your weight, the more likely it is that you develop disordered breathing when sleeping. 

There are a couple reasons for this. One reason is that excess fat around the rib cage makes it harder for your lungs to breathe efficiently during sleep. Another reason is that fat deposits around the windpipe (trachea) specifically can make it more likely to collapse on itself during sleep.

Weight and Type 2 diabetes

There’s a strong link between obesity and diabetes. In fact, excess weight is the main risk factor for diabetes. Scientists are still uncovering all the ways in which excess weight can lead to diabetes. But it’s clear that excess fat cells lead to changes in how your body uses insulin — something called insulin resistance. 

Excess weight also causes changes in the cells of your pancreas, and higher levels of inflammation. These changes make it harder for your body to process blood sugar efficiently, which eventually leads to Type 2 diabetes.  

Excess weight independently increases risk for heart disease

Even if you don’t have other conditions like high blood pressure or diabetes, obesity is still considered a risk factor for heart disease. Researchers have been able to factor out the role that other health complications play in the link between weight and heart disease, to show what they call an “independent” link between excess weight and a higher risk of heart disease. 

The reason? It’s thought that an increase in levels of inflammation in people with excess weight causes a buildup of fatty plaque in the body’s arteries (atherosclerosis). Over time, this can cause heart attacks, heart failure, strokes — and more. 

This is especially true if you carry excess weight as belly fat. Having a larger waist size usually means that a person has more “visceral fat,” which is the fat that surrounds your internal organs. This type of fat is even more likely to cause the kind of inflammation that leads to heart disease. 

Can weight loss lower your risk of heart disease?

There’s no doubt about it, weight loss can be hard. But if you’re looking to optimize your heart health, losing just 3% to 5% of your total body weight can have a big impact. To work toward reaching a healthy heart and weight, here are some key areas to focus on. 

Heart-healthy diet

A heart-healthy diet can help with weight loss, high blood pressure, blood sugar regulation, and more. A heart-healthy diet is one that is high in:

• Fruits

• Vegetables — especially leafy greens

• Legumes

• Whole grains

• Healthy fats, like olive oil and oily fish

• Dairy foods

You should avoid or cut back on: 

• Red meat

• Processed meat

• Fried foods

• Trans fats

• Sugary foods with added sugar or high-fructose corn syrup

Exercise for heart health

Moving your body more is an excellent way to improve your heart health. Though exercise has many health benefits, exercise on its own doesn’t lead to significant weight loss for most people. But combined with other behavior changes, moving your body regularly can help you to lose weight, and maintain a steady weight over time. And, regular exercise has other benefits beyond weight control. It helps improve your mood, your sleep, your energy levels — all of which can help you reach your weight-loss goals.

Types of exercise that are especially good for improving heart health include: 

• Aerobic exercise: brisk walking, cycling or running

• Strength training: lifting weights or doing push-ups

• High intensity interval training (HIIT): This is when you alternate between high-intensity exercise and lower-intensity exercise. 

The American Heart Association (AHA) recommends that adults should get at least 150 minutes of moderate-intensity exercise every week, or 70 minutes of vigorous intensity exercise weekly. 

Improve your sleep 

When you think about weight and heart health, getting a good night’s sleep might not be the first thing to come to mind. But getting enough sleep can help your body maintain a weight that’s best for your overall health. People who sleep less tend to gain more weight. This might be because sleeping fewer than 7 hours a night is linked to changes in hormone levels that regulate how full you feel. It’s also linked to an increased risk for heart disease.

And it’s not just the amount of sleep you get that matters. Sleep quality matters, too. So look for ways to create a good sleep schedule and improve your sleep hygiene habits.  

Lower your stress

Stress can affect your weight and heart health in several ways. High levels of stress can increase stress eating or turning to less nutritious foods for comfort. It can also lead to habits  like smoking that increase your risk for heart disease. And being stressed might actually make your body burn fewer calories. Some studies have shown that mindfulness-based stress reduction can lead to lower weight and healthier eating habits. 

There are many ways to bring down your stress levels. For some it’s yoga. For others it might be spending time in nature, meditating, or calling a friend. Look for activities that feel fun or relaxing — chances are, it’ll be easier to create new healthy habits if you enjoy doing it.

Weight-loss medications 

When diet and exercise changes don’t make enough of an impact on your weight or diabetes, it may be time to think about weight-loss medications. These medications work best alongside diet and exercise. 

Some examples of weight-loss medications include oral medications like:

• Orlistat (Xenical)

• Naltrexone ER/bupropion ER (Contrave)

• Phentermine/topiramate ER (Qsymia)

Another category of weight-loss medications include injectable medications like:

• Liraglutide (Saxenda)

• Semaglutide (Wegovy, or Ozempic for Type 2 diabetes)

• Tirzepatide (Zepbound, or Mounjaro for Type2 diabetes)

And many more weight-loss medications are on the way. 

Losing weight may lower your risk of heart disease. Each medication has unique benefits and side effects, so make sure to talk with a trusted healthcare professional about what the best option might be for you.

Wegvovy (semaglutide) for heart disease

In March 2024, the FDA approved the use of Wegovy to help reduce the risk of heart disease in people who are considered overweight or obese. This is the first weight-loss medication approved for this use. The approval came after a large study of more than 17,000 adults who received either Wegovy or a placebo. Both groups also received lifestyle counseling and treatment for other medical conditions. The group that received Wegovy had lower rates of heart attacks, strokes, and death. 

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Written by:

Karen Hovav, MD, FAAP

Karen Hovav, MD, FAAP, has more than 15 years of experience as an attending pediatrician in a variety of clinical settings. She has worked in a large academic center in an urban city, a small community hospital, a private practice, and an urgent care clinic.

Edited by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.

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