Fat But Fit? Can You be Obese and Healthy?

Have you ever known someone who was overweight, but when they go to the doctor their health markers are all pretty good?

There's a huge controversy about this "fit but fat" idea. The idea is basically someone who is overweight that does not have diabetes, their blood pressure is good, and their cholesterol is healthy is "fit but fat."

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Does that mean these people are at no risk?

Metabolically Healthy Obesity

There was a new study that was published and it is believed to be the largest of its kind.

It suggests that overweight or obese people, even if they are free of health complications, are still more likely to develop heart disease than their peers who were not overweight.

The study showed that it didn't matter whether you were free of diabetes, high blood pressure, or cholesterol... you still have a modestly higher risk for developing a stroke, and a nearly 50 percent greater risk of coronary heart disease.

Oh, and you have nearly double the risk of developing heart failure if you are overweight.

Those who were metabolically healthy, but considered overweight, were at a 30 percent greater risk of coronary heart disease than those who were at a normal weight and metabolically healthy.

Dr. Rishi Caleyachetty from the College of Medical and Dental Sciences at the University of Birmingham in England was the lead author of a paper published in the Journal of the American College of Cardiology.

He says “The bottom line is that metabolically healthy obesity doesn’t exist." He goes on to say that "obesity is not a benign condition."

What Do the Critics Say?

There's a lot of buzz about this study.

Many critics say that based on the electronic health records of 3.5 million British patients who were followed from 1995 to 2015, it leaves a lot out of the study.

Things like lifestyle habits are overlooked. So this fails to account for a wide range of effects on your diet.

They simply classify weight status by using the body mass index, a formula based on height and weight. This doesn't distinguish muscle from fat.

The study also doesn't take fitness levels or physical activity into account.

Another study found a higher rate of heart failure among obese individuals.

Dr. Carl Lavie is the Medical Director of Cardiac Rehabilitation and Preventative Cardiology at the John Ochsner Heart and Vascular Institute in New Orleans. Carl says when it comes to coronary heart disease outcomes, studies that take both weight and physical fitness into account, "fitness is more important than fatness, at least for the moderately obese."

If You Are Overweight or Mildly Obese, This Isn't Doomsday

“For the very large number of people who are overweight or mildly obese, I don’t think it’s doomsday if they can keep themselves out of the low fitness level,” Dr. Lavie said.

Dr. Caleyachetty, the author of the new paper, agreed that the lack of information about fitness and exercise was “an important caveat.”

“Those people who are metabolically healthy, obese and vigorously active may have a decreased risk of developing cardiovascular disease,” he conceded.

Getting Active Is the Important Part

No matter which side of the table you are on about overweight individuals possibly being healthy, there's one thing we can all agree on.

“I do think that’s a better message than telling people, ‘You better not gain weight,’” Dr. Lavie said. “People aren’t trying to gain weight. They’re not trying to get to be obese. A better message would be to tell people that if they get themselves to be more physically active, they can improve their prognosis, despite carrying a few extra pounds. That’s a better message, and a more obtainable message.”

Getting active and remaining active is the first step to a healthy lifestyle.

There's no getting around that. Whether you are fat, skinny, or in between, getting active is the best thing you can do for your health.

Jennifer W. Bea is an Assistant Professor of Medicine at the University of Arizona Cancer Center. She's also a co-author of an editorial that accompanied the study that says “we haven’t heard the whole story yet” and questioned whether someone can be obese but “metabolically healthy.”

Obesity Is a Metabolic Disorder

Dr. Bea has been quoted saying that "obesity itself is a metabolic disorder.

She mentions that being overweight and obese often is associated with low-grade inflammation. This inflammation in your body is what causes the cardiovascular disease, regardless of your metabolic condition.

Weight Doesn't Trump All

The study also found that those who were considered a normal weight but had just one single risk factor such as diabetes, high blood pressure, or high cholesterol were at a greater risk for coronary heart disease than the healthy obese people.

“The messaging is always, ‘lose weight no matter what,’” said Patrick Bradshaw, an epidemiologist at the School of Public Health at the University of California, Berkeley.

“But when you’re at a normal weight, you’re not given a lot of lifestyle guidance. Your doctor may say ‘exercise and eat right,’ but if you have these metabolic abnormalities you’re at higher risk of disease, and you may need more intensive lifestyle modifications - not to lose weight, but to improve health.”

Being Underweight Is Just as Bad as Overweight

I've always been overweight, so this bit of knowledge is new to me.

The study found that people who were considered underweight with no metabolic problems were at a higher risk for stroke than normal weight, overweight, and obese people with no metabolic problems.

If they were underweight and had metabolic issues, their risk is increased even more.

Overweight people catch a lot of scrutiny, but doctors are often at a loss to explain the risks of being too thin.

Wrapping It Up

Look, metabolic health is still extremely important, regardless of your weight.

The thing about this report that I want you to realize is that it is never "too late" to get your health back up to par.

You can be overweight or obese, start making better dietary choices. Add to your new diet some physical activity and you have started the process of adding years to your life.

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Damon Harrison - January 11, 2019

Great article.

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