Obesity: a key factor in stroke prevention
As part of the Stroke Tuesdays series, we spoke with Dr Pascale Chasseur, endocrinologist at Erasme Hospital – H.U.B., about controlling stroke risk factors, particularly obesity. Discover the interview
Pierre, 58, a father of two and a lover of good food, suffered a cerebrovascular accident eight months ago. Since then, his life has changed radically.
“I had never been particularly athletic,” he says with a slightly guilty smile. “But I never thought that my excess weight would one day put my life at risk.”
Following his hospitalisation at Erasme Hospital, Pierre was referred to Dr Pascale Chasseur, an endocrinologist specialising in cardiovascular risk factors related to metabolism. She treats many patients like him, with a clear objective: preventing recurrence.
What factors should be monitored after a cerebrovascular accident?
High blood pressure, diabetes, hypercholesterolaemia, smoking, physical inactivity, sleep apnea and, of course… obesity. This last factor is central. The risk of cerebrovascular accident increases linearly with excess weight.
“For each additional BMI unit (editor’s note: Body Mass Index – BMI), starting from a BMI of 20 kg/m2, the risk of cerebrovascular accident increases by 5%. Obesity is closely linked to the other risk factors: excess adipose tissue, mainly in the abdominal area, promotes insulin resistance, high blood pressure, diabetes, hypercholesterolaemia… leading to atherosclerosis and therefore… cerebrovascular accident. A 5–10% weight loss can significantly reduce the impact of these risk factors,” explains Dr Chasseur.
And concretely, what can a patient do?
For Pierre, the shock of the cerebrovascular accident was the wake-up call. « At first, I was lost. I knew I had to change, but I didn’t know where to start. » This is where the hospital team comes in.
Dr Chasseur: « We first assess obesity and its comorbidities with the patient, provide information, then advise and support them. The aim is not to make them feel guilty, but to build a realistic plan together. This involves a multidisciplinary approach. »
At Erasme Hospital, this includes:
- Personalised dietary follow-up, with advice tailored to the patient’s lifestyle (e.g. Mediterranean diet).
- Support with physical activity to help patients gradually resume exercise.
- Medication support, including GLP-1 treatments (an average weight loss of 13%-20% of body weight2 over 72 weeks, according to studies).
- An assessment for bariatric surgery if the patient has severe obesity (BMI > 35-40) with comorbidities.
Is losing weight really effective in preventing strokes?
Dr Chasseur: “Yes, even a modest weight loss of 5 to 10% can improve blood glucose levels, blood pressure, cholesterol, and sleep apnea, thereby greatly reducing the risk of another cerebrovascular accident. We now know that even within 48 hours of a cerebrovascular accident, good blood glucose control has a positive impact.”
A guided, patient-centred care pathway
“It’s not just ‘eating less and exercising more’. It is a comprehensive challenge that requires time, compassion, and psychological support,” Dr Chasseur points out.
Pierre confirms: “I had to accept that I needed help. It’s hard to look at yourself in the mirror. But I was supported. And above all, I’m not alone.”
And at home, what can be done to control weight?
Pierre involved his partner in his efforts. “We changed our habits together. We cook more healthily, we walk every day. And above all, we motivate each other.”
Close caregivers play a crucial role. They can:
- Encourage physical activity together
- Adapt the family’s diet
- Help keep track of biological assessments (monitoring blood glucose, blood pressure and cholesterol)
- Be a non-judgemental source of support and listening
Dr Chasseur: “Caregivers play a crucial role. They can help motivate loved ones to monitor health indicators (weight, blood pressure and blood glucose), encourage regular follow-up and attend appointments together. Self-image is also an important issue. People need help to overcome feelings of guilt and restore their motivation, with the support of a psychologist.”
Key points:
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“There are no small steps. There are only steps in the right direction.”
Sources:
Kernan W.N. et al., Obesity, a stubbornly obvious target for stroke prevention, Stroke, 2013; 44: 278–286
Aronne L.J. et al., Tirzepatide as compared with semaglutide for the treatment of obesity, NEJM, May 2025, SURMOUNT-5 trial