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Tackling the dual challenges of AFib and weight wellness

UTSW
By Jaime Almandoz, M.D., Internal Medicine – Endocrinology and Jose Joglar, M.D. Program Director, Clinical Cardiac Electrophysiology Fellowship Program Internal

Obesity and atrial fibrillation
Obesity and atrial fibrillation tend to cross over in symptoms and risk factors. At UT Southwestern, our unique dual management program addresses both diseases to improve cardiovascular health.

Obesity and atrial fibrillation (AFib) are public health crises that are growing at an alarming rate. More than 40% of U.S. adults have obesity, speeding toward 50% or more by 2030. Between 3 and 6 million have AFib, an irregular heartbeat, with that number expected to more than double by 2030.

Research over the last decade has shown a strong association between AFib and obesity, which is defined as body mass index (BMI) of 30 or higher. One study found that a 10% weight loss, along with managing associated risk factors such as sleep apnea and alcohol consumption, can reverse AFib progression.

Weight management also can reduce the risk of recurrent AFib after having a cardiac ablation procedure to correct the abnormal heart rhythm.

Managing the complex conditions of obesity and AFib requires an evidence-based, personalized treatment strategy. Simply telling patients to “eat less and move more” isn’t effective.

That’s why specialists from UT Southwestern’s Heart Rhythm Management team and Weight Wellness Program have joined forces to start a first-of-its-kind Atrial Fibrillation Wellness Program that addresses the dual risk factors for patients with AFib and obesity.

Led by board-certified cardiologists and obesity medicine specialists, our comprehensive care team will offer patients treatments that will include the latest and most effective anti-obesity medications, nutritional counseling, mental health care, exercise, and much more – all with the purpose of addressing both diseases to improve your cardiovascular health and quality of life.

Crossover between weight and AFib

AFib is a type of arrhythmia that interferes with the electric signals that tell the heart when to contract and relax, causing an irregular and often rapid heartbeat.

During an atrial fibrillation episode, the heart may feel fluttery – like it has skipped a beat or as if it’s racing or pounding. Patients also may feel dizzy or short of breath. AFib creates poor blood flow and can lead to blood clots in the heart. It also increases the risk of stroke, heart failure and other heart-related complications.

AFib episodes may come and go, but anxiety about them often keeps people from exercising. Or patients are unable to exercise if the arrhythmia is ongoing, increasing their risk of carrying excess weight. And many AFib symptoms – such as shortness of breath and irregular heartbeat – are also symptoms of obesity.

Obesity can have a direct effect on the heart that induces remodeling of the upper atrial chambers due to inflammation, stress, fat infiltration, and changes in blood flow. Obesity can promote increases in the size of the left atrium, making it more difficult for the heart to pump blood efficiently – increasing the risk of an irregular heartbeat.

People with obesity are at increased risk of other cardiometabolic issues, such as high blood pressurecoronary artery diseasesleep apnea, and Type 2 diabetes. These conditions are also linked to increased risk of AFib.

Treating AFib and obesity can be challenging. In our Atrial Fibrillation Wellness Program, cardiovascular and metabolic specialists partner with patients to approach these diseases and associated conditions with a coordinated effort.

What to expect in the Atrial Fibrillation Wellness Program

This innovative program is open to people with a BMI greater than 30 who have AFib. Patients must be referred by a cardiologist to the program, and we will use leading-edge research to design a treatment strategy that simultaneously addresses AFib and obesity.

Each patient’s plan is focused on attainable goals and sets patients on the path to lifelong cardiovascular health. All new patients start with an initial assessment conducted by several experts:

  • A dietitian who discusses nutrition and weight management history, along with lifestyle factors such as alcohol consumption. They will provide information about nutrition and work with patients to find practical solutions for dietary challenges.
  • A weight management specialist – either an endocrinologist or internal medicine doctor who is board-certified in obesity medicine – who will discuss the patient’s health history and review or order lab tests for conditions such as fatty liver disease or sleep apnea. We’ll work with the patient’s cardiologist to make sure exercise recommendations are safe and effective.
  • A psychologist who will conduct a mental health screening. Obesity and AFib are strongly associated with anxiety, depression, and social isolation, which can significantly affect outcomes and quality of life.

If patients are eligible for anti-obesity medication or bariatric surgery, we will discuss those options. As an academic medical center, UT Southwestern offers the latest, most innovative treatments for AFib and obesity, including clinical studies and advanced medications that may not be available at other centers.

For example, incretin anti-obesity medications were approved by the U.S. Food and Drug Administration in 2021. In clinical studies, patients who took these medications experienced five times the average weight loss of a traditional diet and exercise plan, with over half of participants losing more than 15% of their starting weight. UT Southwestern patients often exceed these results, due in part to our supportive, holistic Weight Wellness Program.

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