April 20th, 2011
Obesity Paradoxes: Fat But Still Fit?
If you’re fat, then you must be sick too, right? After all, countless studies have found associations between higher body mass index (BMI) and risk of disease (death too!) In fact, obesity has been linked to at least 20 diseases including diabetes, hypertension cardiovascular disease and even cancer. But why is it that some people are obese but not unhealthy? How do we explain this seeming paradox? Can you improve your health while you’re still overweight? And if you’re fat but healthy, should you bother losing weight at all? Hmmm… interesting questions… and I have answers!
There’s a popular belief that if you’re carrying enough excess weight to put you in the Obese category, as classified by BMI, you’re guaranteed to become the victim of one or more insidious diseases.
But the exact causal relationship between high body weight or high body fat and health problems isn’t as simple as saying, “get fat, get this disease, period.”
Research actually says there are confounding factors.
A new paper published in the Journal of Sports Science takes a close look at several fascinating obesity paradoxes. In today’s post, we are going to pick apart the most well-known of them all – how can you be “fat but fit?”
The authors, from Winston-Salem State University in North Carolina, not only confirmed the existence of this paradox, they took a closer look at the exact reasons why some people are clinically obese, but don’t get obesity-related diseases. I think that’s worth knowing, don’t you?
They reported that 25-30% of obese people are “metabolically healthy.” That means they have normal blood glucose and normal blood lipids.
More importantly, they dug deeper into the reasons why. Some of these findings are new, and it’s important stuff that has many implications.
Here are some of the explanations for how someone could be obese but metabolically healthy (aka “fat but fit”):
- Genetics: Some people may be more genetically protected from various diseases than others.
- Exercise: Some people may be getting benefits from sports and exercise. Many sumo wrestlers and football lineman who are technically obese as rated by BMI are metabolically healthy (not all have been spared from orthopedic problems, however).
- Lifestyle: Lifestyle habits such as drinking, smoking, drug use, sleep habits, stress levels and diet quality may predispose some people to obesity-related diseases more than others.
- Age: Many studies on this subject showed that the metabolically healthy obese were younger. Who doesn’t agree that we can usually “get away with” a lot more indiscretions when we are younger than when we are older?
- Body Fat (adiposity): Most studies so far have used BMI as the classification system for obesity. But body fat percentage and lean body mass (which is what we measure in the Burn the Fat program instead of BMI), can influence health more than total body weight, as is probably the case with the heavy athletes (however, this new study debates that someone can have a high level of body fat and still be metabolically healthy).
- Duration of obesity: If someone has been obese a long time, their risk of health problems is higher.
- Fat cell size: recent research has looked more closely at the biology of the adipocyte. Small but numerous fat cells have been shown to carry lower risk than fewer adipocytes that are much larger.
- Where you store your fat: It has become well known that abdominal and visceral fat accumulation is the most dangerous body fat of all. Fat in the extremities appears to be fairly harmless from a health perspective.
These researchers have made a pretty strong case for saying there’s more to health (and mortality rates) than just what the scale says. We now know this is not only true when you’re very muscular and heavy, but also when you’re very overfat as well.
The story doesn’t end here though. It’s shocking how much of a controversy the “fit but fat” subject stirs up every time it hits the web or the media … on a variety of different levels.
Some people say, if you’re obese – or overweight – but you’re not at high risk for disease, is it such a big deal to be carrying the extra weight?
If you’re healthy should you be encouraged to lose the weight at all? Should you be nagged and pushed to lose the weight? Maybe you should just accept yourself the way you are? Or at least, take your time to lose the weight.
(See the direction this discussion often goes?)
Ok, I’ve now presented the facts. Let me now chime in with my opinion…
These researchers are right about one thing: Being obese is not a 100% guarantee that you’ll get health problems. At least 25% of the obese seem to be spared and they stay metabolically healthy. Thanks to the ongoing research, we have a better idea why and heavier people could use this information to start improving their health – at any body weight.
However, it’s my belief that EVERYONE who is heavy can gain some health benefits or take their health to a higher level by losing weight and improving their body composition. While “obese and unhealthy” certainly puts a fire under your butt, I don’t think “obese and healthy” should mean that you rest on your laurels.
This may be a cliche of the alternative-natural health community, but isn’t it really true that there IS a difference between absence of disease and optimal health?
Imagine a spectrum of health running from left to right with sickness and disease on the far left (0). In the middle is absence of disease (5). On the far right is optimal health, vitality, energy, strength, exuberance, greater longevity, passion – all the manifestations of the HIGHEST level of health (10!)
Most people who appear healthy are only right in the middle of that spectrum. Literally only half of what they could be. A five. Meh. I think this scenario applies to a LOT of the “obese but healthy.”
What’s more, weight loss and better body composition come with other benefits – tangible and intangible – including a higher quality of life, more self confidence, greater mobility and many times, a better social life (and all that comes with it).
And don’t forget the health benefits of weight loss that don’t show up in the metabolic profile: How about getting rid of that sleep apnea? What about taking some stress off those knees and hips?
Going back to the research study, here was one of the primary conclusions:
“Low cardiorespiratory fitness and inactivity are a greater health threat than obesity.”
Out of all those confounding factors, the researchers highlighted exercise… Yep… BURN MORE!
Losing weight alone improves health dramatically for most people, but so does exercise. Exercise and activity play a huge role in staying healthy – independent of how much you weigh.
So here we have even more reasons to be training and not just dieting… and to improve your body composition, not just lose weight…
It’s what I’ve been saying for years – it’s the Burn the Fat Feed the Muscle lifestyle!
– Tom Venuto
PS. We’ve grown accustomed to seeing before and after photos to display a person’s fitness success. We proudly post our fitness champion’s photos quite often. But it always thrills me to hear about what weight loss and body fat loss has done for someone’s health. Blood pressure, triglycerides, cholesterol, seeing them all drop, watching the good stuff go up, hearing your doctor say that you can ditch the meds. There’s more to fitness than just the six pack abs. If you have a before and after HEALTH success story, I’d love to hear from you – just post a comment below.
Obesity paradoxes. McAuley PA, at al. Sports Sci. 2011 Mar, 11:1-10. [Epub ahead of print], Dept of Human Performance and Sport Sciences, Winston-Salem State University, Winston-Salem, North Carolina, USA.
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