Dr Tiffany Powell-Wiley on Social Factors of Obesity and Cardiovascular Disease

Tiffany Powell-Wiley, MD, MPH, a Stadtman investigator and chief of the Social Determinants of Obesity and Cardiovascular Risk Laboratory at the National Heart, Lung, and Blood Institute, with a joint appointment at the National Institute on Minority Health and Health Disparities, discusses ongoing trials and the American Heart Association (AHA) Scientific Statement on social determinants of obesity and cardiovascular disease. Dr Powell-Wiley will receive the AHA's 2021 Population Research Prize on Sunday during the annual Scientific Sessions.

Transcript

You are receiving the AHA’s 2021 Population Research Prize for your leadership of studies on the social determinants of obesity and cardiovascular disease. Can you tell us about the ongoing trials your team is conducting in this area?

My lab is focused on really understanding how social factors—particularly neighborhood factors—lead to the development of cardiovascular disease. We've approached it in several different ways. The first way that we look at it is using large data sets—what we call epidemiologic data sets—to really understand this connection between neighborhood factors and the development of risk factors for cardiovascular disease, but also cardiovascular disease outcomes. A big part of what we do is more community-engaged approaches where we work directly with community members—primarily in the Washington, DC, area—to really understand what are barriers to heart health for the population and how we can develop interventions that improve their heart health. And then finally, we look at how to better understand really how these neighborhood factors really get under the skin, and affect more biological mechanisms that lead to cardiovascular disease.

The 3 main studies that we're working on right now is an ongoing health and needs assessment within the Washington, DC, area. Thus far, that's really allowed us to really assess what cardiovascular health looks like, but also, it allowed us to really understand what tools we could use in changing health behaviors within the DC population. It also allowed us to really establish our community-engaged approaches. We started working with the community advisory board as a part of that initial study called the Washington, DC, Cardiovascular Health and Obesity Collaborative. And that initial study, that health and needs assessment, which we continue to really use to stay on top of what's happening with heart health in the area, that's led to our next studies, which are our physical activity intervention, which is called Step It Up. Step It Up is designed as a digital health–enabled physical activity intervention. It's looking at how we can improve physical activity and increase physical activity, particularly for at-risk African American women in the Washington, DC, area. With that study, we're looking at whether providing information about or using technology to provide information about physical activity, whether if we tailor that information to where people live, if that improves their physical activity over and above more standard messaging around physical activity. That study is currently enrolling women right now.

And then finally, because we really want to understand how neighborhood factors, again, get under the skin, we have a study that's just starting that is looking at how where you live and where you spend your time, how that can affect more biologic factors—things like your vascular health or immune cells that we know are involved in cardiovascular disease.

Earlier this year, you were the lead author on the AHA’s Scientific Statement on obesity and cardiovascular disease. What were the most important take-home points of that statement?

We were very excited to get that statement out. For AHA, it had been almost 15 years since the last statement around obesity had come out. A lot of data had emerged around potential treatments for obesity, but also there's a lot more data on how—particularly the visceral adipose, your more central obesity—that could affect heart health.

The main takeaways for that is that obesity in and of itself is a very complex disease and we want to acknowledge the complexity of it as a disease in that there are multiple types of factors that lead to the development of obesity, whether it be biologic factors, but also social and environmental factors, and even psychological factors that can contribute to the development of obesity. We also wanted to highlight the importance of thinking about where fat is carried in the body and how that can affect heart health. So we wanted to emphasize that thinking about waist circumference as a measure of adiposity is an important factor to consider. There's more and more data to suggest that visceral adiposity—or central obesity, really fat around the belly—can promote inflammation and affect heart health over and above things like fat in other parts of the body. So we want clinicians to really think about incorporating waist circumference as a part of their measures that they do for patients and think about that in relation to not just measuring body mass index as a marker of obesity, but also bringing in waist circumference as well.

Other big takeaways from the study is that we've gotten more and more data about how lifestyle changes can improve risk factors. In particular, we know that physical activity can improve visceral adiposity, but we haven't seen trials that have shown that lifestyle changes by themselves can improve cardiovascular outcomes. There's more data that needs to come out, more studies that need to be done to really make those connections. We also know that bariatric surgery can definitely affect cardiovascular outcomes and reduce the risk of adverse cardiovascular events, but also improve mortality over time. Definitely an important consideration in thinking about the treatment of obesity is when and for what patients do you think about bariatric surgery.