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Obesity, anorexia

Overweight and obesity are known to increase the risk for cardiovascular diseases that may lead to heart failure. Therefore, avoiding the development of obesity is therefore a widely held recommendation for the prevention of developing heart failure. However, body weight management in patients with established heart failure is more complicated than just recommending weight loss. Here are three reasons why it is not clear if individual patients with heart failure should lose weight or not need to lose weight.

  1. With increasing age, the impact of obesity on the risk of mortality diminishes. Therefore, in most patients with heart failure, higher body weight does not indicate a higher risk of dying.
  2. Robust scientific evidence that among patients with established heart failure the best (longest) survival is seen for patients moderately overweight (BMI 25-30 kg/m2).
  3. Heart failure is understood now as a complex disease that does not only have consequences for the heart but also for the entire body (particularly the muscles) that includes metabolic changes.

These metabolic changes, which are chemical processes within the cells of the body, often lead to a loss of appetite (anorexia) and hence a reduced intake to food. The metabolism of the body changes gradually as part of the heart failure syndrome and some patients in an advanced stage may they slowly but steadily lose weight. If such unintentional weight loss occurs in patients with heart failure it should be a warning sign as it indicates a progressing severity of the heart failure. Continued weight loss of more than 5% of body weight is called ‘cardiac cachexia’ which is associated with a worsening of symptoms, a poorer quality of life and a worse prognosis. When you consider a healthy food intake, a balanced nutrition combined with regular exercise is important.

Weight reduction strategies in patients with heart failure should be carefully monitored and should be considered on an individual basis. Importantly, weight gain may indicate increasing fluid retention in heart failure, and patients, especially those using diuretics, should discuss unexpected weight changes with their doctor or nurse.

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