We only have to look at a Titian painting to recognize that at one point in the history of Western culture, fat was considered beautiful. Before the 20th Century, corpulence was touted as a sign of wealth and luxury, largely because most people were barely surviving on a meager existence.

Ironically, now in our era of affluence and plenty, we have to contend with the health and economic problems of obesity. We have a population in North America that is more than 55% overweight. More than 20% of those overweight are considered obese, a situation which proves to be an economic burden on our Health Care system because of the coronary risk factors associated with obesity. In 2004, total national health expenditure in the USA was $1.9 Trillion or $6,280 per person.

Why is obesity a risk factor for heart disease?

Among obese individuals, triglyceride levels are unusually high, while HDL levels tend to be low; both of these situations are risk factors for heart disease .A recent study involving tissues collected from autopsies of 3000 men (15-34 years old) who had died of external causes (not heart related) identified an association between obesity and coronary atherosclerosis.

Abdominal fat which characterizes obese individuals is also an area of concern. A study of 1300 Finnish men (42-60 years old) suggests that abdominal fat is an independent and major risk factor for coronary events. Several reasons have been suggested for this: a) stomach fat is continually released into the bloodstream in the form of artery-clogging fatty acids; b) abdominal fat also releases compounds that facilitate risk factors such as atherosclerosis, metabolic syndrome and inflammation; c) abdominal fat initiates biochemical events that lead to insulin resistance, a precursor of Type 2 diabetes and heart disease.

Obesity is often a precursor to metabolic syndrome, a dangerous health situation that is manifested through a cluster of symptoms—excess body fat, insulin resistance, low HDL cholesterol, high triglyceride levels and high blood pressure—all risk factors for coronary events. People with metabolic syndrome release immune system messengers called “cytokines” into their bloodstream. Cytokines lead to a communication breakdown between body cells and insulin which leads to excessive insulin production by the pancreas, creating a situation that is a literal “time bomb” for heart disease . In addition, this excessive insulin production can raise fibrinogen concentrations in the bloodstream, thus allowing blood to clot more easily, a situation that is a direct risk factor for heart attacks and strokes.

Because of their size, obese individuals are more often than not sedentary in lifestyle. Inactivity in and of itself is also a coronary risk factor. Data from more than 88,000 women in the Nurses’ Health Study shows that a lean sedentary woman had 1.48 greater risks for coronary heart disease than a slightly heavier but physically active woman.

However, the same study also showed that obesity alone is a risk factor, in fact, an even greater risk factor than inactivity because coronary disease risk was highest for women who exercised the least and had the greatest waist-to–hip ratio. The conclusion that obesity itself is a risk factor is also supported by a study of 5881 overweight and obese individuals which showed that being overweight increased the risk of heart disease by 34%, while being obese increased the risk to 104%.

What can we do to help someone we know who is obese or dangerously overweight?

Acknowledgement of the problem is the first step. Very often, individuals are in a state of denial about the seriousness of their weight situation. A visit to the doctor or a healthcare professional who deals with the morbidly obese is essential. So are visits to a nutritionist, fitness consultant and body work therapist. Only then can the individual be presented with options viable and necessary for his or her situation.

In severe cases of obesity, surgery would be part of the solution. Lifestyle changes that include exercise and healthy eating are more than essential. Just as critical are bodywork therapies that can uncover some of the real issues behind addictive eating. Learning to read body cues of hunger, depression, stress is equally important for re-mapping a new life and a whole new cartography of food and consciousness, body and mind.

In Titian’s day, the corpulent body was an idealized figure on canvass, essentially exiled to the realm of the fantastic or the realm of the unjust in a society where hunger was the norm. In our days, the corpulent body has its own tale to tell: a Quasimodo that is both the scourge and product of a culture addicted to perfection.