Forget that clothes don’t fit well or that you just aren’t happy with the image reflected in the mirror. If you have several pounds to lose, the issue of greatest concern should be how those pounds are weighing on your heart.

Obesity appears to act as the starting block for metabolic syndrome, a constellation of risk factors including obesity (particularly abdominal obesity), insulin resistance (diabetes mellitus), hypertension and dyslipidemia (an abnormal fat profile of lipids in the blood).

When these four factors are presented together, a person has a very high risk of cardiovascular difficulties, specifically stroke and heart attack. Each factor feeds off the other, resulting in a destructive cycle that is incredibly difficult to free oneself from.

“Obesity is a strain on the heart function. The heart has to work harder than usual or more than usual to pump more blood to a person who is larger size and this puts a stress on the heart and it causes the heart to become enlarged,” said Dr. John Ware, a cardiologist at Cardiology Associates of Anderson, S.C.

“The heart wall thickens because it’s a muscle. Anytime you work a muscle harder than usual it will get thicker, as with a bicep. This is good in your arm but not your heart because the heart is hollow and this allows less blood to pump each time the heart beats or strokes. It has to work harder to pump harder to pump blood to a larger area.”

Obesity is associated with lack of exercise and activity, which is a risk for heart disease, said cardiac rehab dietitian Crystal Robinson of Anderson.

“Just carrying all that extra weight around is putting a lot of stress on the heart,” Robinson said. “The hypertension and blood sugar get better when weight is lost — not a huge amount, but just a little can help. But the more weight lost, the better.”

Oddly, where the excess weight is distributed on the body seems to make a difference, according to Michael Gibson, a registered nurse and director of the LifeChoice program in Anderson.

“There have been a lot of studies that have shown that people, especially men, with visceral fat (fat around their midsection) have an increased risk of heart disease,” he said.

Think of this particular body shape resembling more of an apple (fat around the middle) than a pear (fat mainly on the buttocks and thighs).

“Diabetes is a factor in heart disease because it wreaks havoc on the heart and kidneys, lower extremities and the circulation system,” Gibson said. “High blood pressure and diabetes by themselves risk factors for heart disease.”

“If exercise was a pill, it would sell for about $20 per pill because it just does so much for you,” Gibson said. “Obesity puts strain on the joints which leads to inactivity. Not being able to ride the bike and walk creates a sedentary lifestyle, which puts you at risk for heart disease. The heart is a muscle and the old adage that says ‘use it or lose it,’ it really holds true.”

Anyone having a number of risk factors needs to be sure to exercise under medical supervision, Ware said. Start out slowly with something light, such as walking, and avoid taking weight loss supplements while exercising.

“The treatment of heart disease is trying to reduce all the risk factors. You can decrease your chances of having a heart attack by reversing obesity,” Ware said. “By losing weight, you can lower blood sugar, diabetes, blood pressure and cholesterol and it doesn’t cost anything.

“How do you reduce your weight? It’s dietary restriction and exercise. It’s easy to say but hard to do, but I have seen people do it. You have to love life.”