Can You Be Fat and Fit — or Thin and Unhealthy?

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Turns out, being obese isn’t necessarily a bad thing. In a new study by U.S. and European researchers, published [PDF] in the European Heart Journal, overweight and obese people were found to be at no greater risk of developing or dying from heart disease or cancer, compared with normal weight people, as long as they were metabolically fit despite their excess weight.

The researchers examined data on 43,265 participants enrolled in the Aerobics Center Longitudinal Study between 1979 and 2003, who filled out questionnaires about their lifestyle and medical history and also underwent physical exams, blood tests and a treadmill test to gauge their cardiovascular fitness. The researchers categorized obese participants as “metabolically healthy” if, aside from their weight, they didn’t suffer from insulin resistance, diabetes, low levels of good cholesterol, high triglycerides and high blood pressure. Nearly half of the obese participants in the study qualified as metabolically fit.

Compared with obese people who had at least two of the above markers of poor health, those who were obese but metabolically healthy had a 38% lower risk of early death from any cause. In fact, those who were fat but fit had no higher death risk than metabolically healthy normal weight participants.

(MORE: Can Love Handles Kill? Why Having a Paunch May Be Worse than Being Obese)

The finding runs counter to the prevailing wisdom that weight is in and of itself a marker of health; rather, it suggests that a person’s level of physical fitness, in addition to his or her weight, matters too. “Weight is a major issue when it’s combined with a metabolic abnormality,” says study co-author Dr. Timothy Church, director of the Laboratory of Preventive Medicine at Pennington Biomedical Research Center in Baton Rouge. “When you have weight plus insulin resistance, weight plus hypertension, weight plus abnormal cholesterol — then you have an issue. Obviously the more overweight and the more obese you are, the more likely you are to have a metabolic abnormality.”

The new paper falls in line with other recently released research, including a study presented last week at the European Society of Cardiology meeting that was based on 14 years of data from a Centers for Disease Control and Prevention survey. That study found that, when it comes to your risk of early death, being obese overall may not be as important as where on the body your fat is distributed. In the study, people who were of normal weight but had a paunch — that is, a lot of visceral or belly fat, which, unlike run-of-the-mill subcutaneous fat, is known to be metabolically dangerous and to promote insulin resistance and inflammation — were twice as likely to die early as people of normal weight with no gut. People with lots of concentrated belly fat also had a higher risk of death than people who were simply obese all over.

Another study published in the Journal of the American Medical Association in early August added evidence for the so-called obesity paradox, finding that among people already diagnosed with Type 2 diabetes, those who were obese lived longer than their thinner peers. Similarly, in a second study published in the current issue of the European Heart Journal, researchers looked at nearly 65,000 patients with heart disease and found that overweight and obese people had the lowest risk of early death, compared with normal-weight or underweight patients; those who were underweight had the highest death risk.

(MORE: ‘Obesity Paradox’: Why Being Thin with Diabetes Is a Dangerous Combo)

So what exactly is going on? Being metabolically fit may be the game changer, says Church, and physical fitness — irrespective of weight — is a strong predictor of whether or not you’re going to be metabolically fit. “Think about insulin resistance. The biggest consumer of sugar in the human body is muscle. Muscle doesn’t just move us from point A to point B; it is also extremely important for many metabolic variables like blood sugar,” says Church. “So it makes sense that someone who is fit is metabolically going to be far better off than someone who is unfit.”

That’s why some heavy people can be fit on the inside — healthier even than some of their thinner peers. Many people who diet but don’t exercise to lose weight, for example, may technically reach a “healthy” weight, but their fitness level doesn’t match. They may appear trim on the outside, but still carry too much visceral fat and not enough muscle on the inside. “They’re not physically active. They have horrible and restrictive diets. They might not be overweight, but metabolically they’re a mess,” says Church.

The key is what doctors and public health experts have been saying all along: get more exercise — whether you’re thin or fat. “Based on the data that our group and others have collected…we believe that getting more exercise broadly and positively influences major body systems and organs and consequently contributes to make someone metabolically healthier, including obese people,” said Francisco Ortega, lead author of the first European Heart Journal paper and a research associate at the University of Granada in Spain, in a statement.

(MORE: Why Being Thin Doesn’t Always Mean Being Healthy)

“You have to remember it doesn’t take that much to be fit,” says Church. “To qualify as fit, it takes about 30 minutes of walking five days a week on average. That’s not a ton of caloric expenditure. It is actually quite easy physiologically to be overweight or obese, but also qualify as physically fit.” Federal guidelines recommend at least 2.5 hours of moderate-intensity aerobic exercise a week.

The bottom line is that the new findings aren’t an excuse to remain overweight or obese: although research increasingly suggests that excess weight alone may not necessarily lead to disease or early death, you’re still more likely to develop other metabolic risk factors that contribute to chronic disease if you’re overweight.

MORE: Being Big Around the Middle Poses Big Risks

17 comments
erinharrop
erinharrop

I want to thank the author of this article for giving an important counter-cultural perspective to our generally thin-obsessed society and medical profession. Having worked with adolescents with eating disorders in a hospital setting, I have witnessed first hand the harm that these overgeneralizations can cause. While two prior commenters make efforts to assert their expertise and debunk the findings that overweight and obese people can be as healthy (or healthier) than thier thinner peers, they ignore several important findings in the literature. 

First, many studies connecting "being overweight" with "being unhealthy" are actually confounded by weight yo-yoing. Essentially, it is more damaging to a person's health to frequently change sizes than it is to remain at a larger BMI. Thus, dieting that causes weight loss that is not congruent with your body's set point may harm health instead of improving it. (See references below)

Second, BMI (or Body Mass Index) has received extensive criticism in the literature. Though it is still used as an indicator of INDIVIDUAL health, it was initially developed by a Belgian mathematician named Lambert Adolphe Jacques Queteletin in the 1800's as a way to broadly categorize and comparing different populations living in various geographical areas. It was not intended to be a measure for individuals or their health. It fails to take into account many relevant factors including: bone density, muscle mass, proportion of fat/muscle, metabolic fitness, and genetic history. It is a racially and sex biased measure, and also biased against tall persons. Furthermore, the accepted levels of BMI have been changed (to be lower) arbitrarily (by experts funded by diet/pharmaceutical agencies) at different points in history. (see references below)

Finally I want to point out that the article, and much of the comments on this page are steeped in "thin privilege." Thin privilege refers to the unearned privileges given to thin people in our culture that is a direct result of the oppression and stigma of people with larger bodies (looking down on someone because of their weight, thinking that some people should not eat certain foods, not selling athletic clothes in sizes that fit larger people, or assuming a person is unhealthy or unintelligent or unprofessional or lazy because of their weight). I believe this article was written with the intent to debunk myths about obesity and promote a health-focused approach to medical care. However by saying things like "the new findings are not an excuse to remain overweight or obese" or " losing weight is a desirable goal for most people" reinforces weight and size discrimination. Further more, admonitions like these should not be broadly disseminated to all people with a BMI over 18.5, as alluded to by one expert.

It is true that the dominant paradigm in the medical literature on obesity and BMI have focused on weight loss. However, I would like to point out that historical dominant paradigms around bodies have led to many other forms of harmful discrimination on the basis of outward characteristics (valuing men's bodies over women's, valuing lighter skin over darker skin, valuing certain facial characteristics, valuing "able" bodies, valuing heterosexism, etc). Each of these paradigms were supported by "science," and have resulted in many forms of oppression. Let us not let the dominant paradigms of our thin-obsessed culture continue to enhance weigh/size discrimination. 

Below you will find research (both academic-based and accessible to the general public) supporting these assertions. 

Erin Harrop, MSWc

Bacon, L. & Aphramor, L. (2011). Weight Science: Evaluating evidence for a paradigm shift. Nutrition Journal. http://www.biomedcentral.com/content/pdf/1475-2891-10-9.pdf

Bacon, L., Keim, N. L., Van Loan, M. D., Derricote, M., Gale, B., Kazaks, A., & Stern, J. S. (2002). Evaluating a" non-diet'wellness intervention for improvement of metabolic fitness, psychological well-being and eating and activity behaviors. International Journal of Obesity

Bacon, L. (2010). Health at Every Size: The Surprising Truth about Your Weight. BenBella Books, Inc.

Top 10 Reasons Why The BMI Is Bogus by Keith Devlin http://www.npr.org/templates/story/story.php?storyId=106268439

ThomasSamaras
ThomasSamaras

I have researched human body size and longevity for about 35 years and have published over 40 papers and books on the subject in medical, nutritional. and scientific journals and books. Based on this research,  my views on weight reduction are summarized below.


While we can be too thin, most of us are well over an acceptable body mass index. Centenarian research indicates that being thin is an important part of reaching 100 years of age. Chan, Suzuki, and Yamamoto noted this fact a number of years ago. The New England Centenarian study also found that male centenarians were almost always thin. Roth, Ingram and Lane also reported that centenarians were generally small.  Willcox reported that in a 40 year study of elderly people in Hawaii, the men who ate less had a lower mortality rate. However, if calories went below 970 Calories per day, mortality started increasing. 


From a biological viewpoint, increasing one's weight above the minimum healthy body mass index (< 18.5), creates virtually bad results in terms of biological parameters. For example, the following parameters move in an unhealthful direction with increasing body mass, starting from 18.5.


Cholesterol, triglycerides, LDL, HDL, Apo A, Apo B, homocysteine, C-reactive protein, fibrinogen, adiponectine, insulin, insulin-like growth factor-1, and sex hormone binding globulin. Depending on the parameter, increasing values can be bad or good. Details are available from Human Body Size and the Laws of Scaling, Nova Publications.


Other factors that get worse with increasing body mass index include: blood pressure, the heart's left ventricular mass, and shortening of telomeres (longer telomeres mean longer potential longevity).


While losing weight is a desirable goal for most people, a well-balanced diet is essential for good health. Therefore, it's wise to lose weight under the supervision of your medical doctor and a nutrition specialist.



JBR
JBR

It would be nice if the link in this article were to the right study.  The one that comes up is a study of hypertension in Finns, not a study that relates cardiovascular fitness to obese and to all-causes mortality.  It would also be nice if the article pointed out what I assume the linked to study does: that these revolutionary and convincing findings are based on the only credible database available for measuring these factors: the one created by the Cooper Clinic Aerobics Center over a period, now, of some 40 years.  No one else in the field of medical research has taken the theory that cardiovascular fitness was crucial to health seriously enough to devote his live to measuring it as Dr. Cooper has.  The methods he has used from the beginning of this exceptionally long longitudinal study were, and still are, state-of-the-art and of most me-too junk science studies that have sprung up like weeds over the last ten years or so, don't measure up to his standards and can safely be ignored.

 Actually it's been 14 years since the first study based on the Cooper Clinic data was published, in the 27Oct1999 JAMA, by Wei, Kampert, et al. but as far as I can see this study sank like a stone, because it's findings are only now beginning to trickle into medical orthodoxy.  The reason is the usual one: it challenges the longstanding and deeply entrenched paradigm that obesity is deadly to health, and the best way to improve the situation is through diet, rather than exercise.   Needless to say, there are massive vested interests in maintaining the old paradigm, because what the Cooper data are saying is: if you are obese or overweight and want to improve your health and your longevity prospects, forget diet, put on the sneakers and go for a 30 minute run every day.

The 1999 study was based on the mortality statistics for some 27,000 men followed over up to 24 years, but a companion study was published a couple of years ago, covering about 8,000 women followed over about 12 years, and the results were the same for women: obese but fit women lived as long as lean and fit women.

There have been a lot of articles over the last ten years about using golf or housework or the like as your fitness program, but that's not enough. You need to work up to at least 30 minutes a day in which your heart rate is between 115-125, and you are breathing fairly hard.  Or you can log the minutes in fewer but longer sessions.  Don't however, undertake an exercise program without running it by your doctor first, but if he discourages you from going ahead, even if you have a serious medical condition like heart disease or diabetes, you should probably think about getting another doctor, because he probably doesn't get the exercise thing.

The original 1999 study divided people into five fitness categories, and fitness was measured not by just asking people to fill out a questionaire, but exercising them on the treadmill to exhaustion.  The biggest jump in longevity was in going from couch potato status (completely unfit) to minimally fit, but there were additional, smaller improvements, as one moved farther up the fitness ladder, until at the very top, and beyond, mortality began to increase a bit.  Thus, marathoners may be pushing things too far, but short of that, the more fit you are in cardiovascular terms, the longer you live - and also the better you feel, though the study doesn't get into that. 

Joan
Joan

This study completely makes sense.  My grandparents came over on the boat from Italy.  They had a farm and sold the produce.  The farm provided most of the fresh vegetables amp; fruits in their  mediterranean diet.   My grandfather was not overweight and worked the farm until the day he died. 

My grandmother was overweight, but the physicians who examined her over her 94 years ALWAYS said she was in perfect health.  In addition, she was mentally sharp as a tack her entire life.  What you eat makes a huge difference.

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Anthony Quin
Anthony Quin

Hi Alexandra,

Informative post and new for me so thanks for sharing with others. Like to say we must exercise daily to stay active and to lead healthy and active lifestyle. Regular exercise boost our metabolism and prevent from high blood pressure, cholesterol, anxiety, cardiovascular disease, diabetes and certain types of cancer.

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Mike Vallin
Mike Vallin

Than why don't I ever see any fat old people? 

Michealbez
Michealbez

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Trivium
Trivium

@Mike Vallin I dunno.  Where do you hang out?

quietreply
quietreply

There are many old people who are fat. You just need to pay more attention!

Jennien
Jennien

Nicole said I didnt know that people able to make $9155 in four weeks on the network. did you look this(Click on menu Home)