Q: I read that researchers are saying if you've got heart disease and you're fat, you'll outlive someone who is normal weight. Is that right?! -- Katie J., Pierre, S.D.
A: Glad you asked, Katie. The so-called Obesity Paradox (people who have heart disease, diabetes or end-stage kidney disease and are overweight live longer than people who are normal weight) is big news, but we think it should be called the Big Fat Mistake.
Let's start with the real story: People who are normal weight according to their BMI (body mass index), but who have excess fat around their waists (for men, a waist 40 inches or larger; for women, it's 35 inches or larger), are 17 percent more likely to die from a heart attack than folks whose BMI says they're overweight (but whose extra pounds are concentrated elsewhere). And new research indicates that BMI may not be an adequate way to assess risks for people with heart disease. So studies that looked only at BMI and not at waist size (all of the ones that assert you live longer if you are fat and diagnosed with heart problems) are missing a big piece of the picture.
What makes a big belly so dangerous? The fat deposited in your torso is very busy metabolically. It churns out hormones and proteins that fuel high LDL cholesterol and triglycerides, high blood pressure, insulin resistance and overall inflammation that's implicated in cancers and dementia.
What we know for sure: Being overweight is always a risk factor for developing heart disease, and excess body fat increases bodywide inflammation that triggers diabetes, dementia and cancer.
Avoiding obesity -- and related health problems -- depends on being fit. Try walking 10,000 steps a day and doing strength-building two to three days a week. Exercise strengthens the immune system and builds good muscles (including the heart muscle) to help you battle disease. And exercise is vital if you do carry extra pounds; overweight people who exercise outlive overweight people who don't.
Once you develop obesity-related health challenges, you need to make a disease-reversal plan. Dr. Mike's Wellness Clinic uses restorative therapies including acupuncture, yoga and meditation, in conjunction with nutritional support, physical activity and medications, to do just that!
Q: I'm thinking about having a vasectomy, but what are my chances of having the procedure reversed if I change my mind later? -- Paul H., Houston
A: Every year more than 500,000 men in the U.S. and 55,000 in Canada have vasectomies. About 5 percent seek reversals later. But at Dr. Mike's Cleveland Clinic, requests for vasectomy reversals have risen 82 percent in three years, to about 10 percent of men who've had the operation.
Now if you change your mind it won't be because of the way a vasectomy makes you feel. Having your vas deferens snipped (that's the tube that carries sperm from your testicles to your urethra) won't reduce your sex drive, your ability to have an erection, orgasm or the amount you ejaculate (sperm only makes up about 5 percent of the ejaculate; the rest comes from the prostate and will continue to flow). And men frequently report that sex is more enjoyable without having to worry about an unwanted pregnancy.
When it comes to reversal, the outcomes are pretty good: If you have a reversal within three years of the vasectomy, your doc is 97 percent likely to be able to rebuild the vas channel. (Choose an experienced urologist with access to the latest microsurgery technology.) Even if it's been more than 15 years, your chances are better than 70 percent.
Most people ask for a reversal because they have a new partner. Men under the age of 30 are not encouraged to have vasectomies, because they're 12 times more likely to ask for a reversal down the road.
(Mehmet Oz, M.D. is host of "The Dr. Oz Show," and Mike Roizen, M.D. is Chief Medical Officer at the Cleveland Clinic Wellness Institute. Submit your health questions at www.doctoroz.com.)