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
http://www.BurnTheFat.com

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.

Reference:
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.

Copyright Tom Venuto and Burn the Fat Blog: Do not copy! Unauthorized reproduction of this article is prohibited

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40 Responses to “Obesity Paradoxes: Fat But Still Fit?”

  • Tre

    Three years ago I was 5’4″ and weighed just over 200 lbs. I had almost constant pain in my back and feet. I was out of breath quickly and had trouble even climbing stairs. My blood pressure was getting higher. I was miserable. I had had enough! I took charge of my life, learned how to journal my nutrition and exercise so that things were more balanced, and started reading up on nutrition information. Over the next 15 months I lost 85 lbs, lowered my blood pressure from 150/91 to 120/75, resting heart rate reduced from 89 to 66, no more pain in the back or feet and hardly getting sick any more. I’ve been able to maintain my new healthy weight with ease now that I have the proper tools. It feels great to be healthy!

  • Dorothy S.

    I find these articles fascinating and in some ways confirmation. I’ve lost about 65 lbs. Dramatically increased health once I started following bodybuilding diet and read Burn the Fat. Yet, my docs and nutritionist are envious of my low BP, gold fasting sugar levels, low resting heart rate, my 20 mile bike rides, 12 mile hikes and 6 day a week visits to the gym. According to the numbers and my activity time, I’m fit. But there’s fat there for sure and I’m still obese. We keep digging on what to change to lose the last 40lbs, but I’m grateful right now that I seem to be healthy, despite the weight. Thanks for the good advice and research Tom – keep it coming.

  • stacerella

    My MIL is 83. She had my husband pushing 41. Before that “surprise” pregnancy, she was a normal weight for a woman her age and height. After he was born, she started to pack on weight. A little at first, then as menopause kicked in, more. It wasn’t until her 73rd year when she has some kind of hernia did she start to acquire medical problems and be put on medications. It was about two yrs after the hernia operation that her doctor told her she was a type I diabetic. The following year, she had diverticulitis. Every year from that point on, she seem to rack up a new issue. All the while, she never once changed her lifestyle or diet, just her portions, and never once has any of her blood work came back high in cholesterol. She’s bigger than me, almost by double. She’s lactose intolerant but refuses to give up her 35% table cream shots in her coffee. She doesn’t exercise. In fact, she snoozes a lot during the day. She is, as her doctor states amazingly, in the best physical condition for a woman of her body frame and medical conditions. Her doctor never nags her about losing weight or watching her cholesterol.

    Figure that one out. 🙂

  • In April of 2009 I tried to get full life insurance but they wouldn’t give it to me because there was something wrong with my liver and they couldn’t figure out what it was. After multiple tests, they basically gave up saying that it “obviously wasn’t that bad” even though the life insurance company didn’t agree. Basically I had a fatty liver combined with potentially toxic levels of iron.

    Fast forward to 2 weeks ago. I’m 80lbs lighter and after getting my blood taken again, the tests came back completely normal. Along with that, the doctor hadn’t seen me in 1.5 years and his jaw hit the floor saying it’s no wonder my levels were all normal again.

    All due to the fat being lost through diet and exercise. Simple, but not easy. Vital though.

  • Jim Shelton

    Hi Tom – In 1994, I turned 40 and was in the best shape of my life, mostly from bicycling. At 180 lbs, 5’9″ I could complete a 100-mile ride in under 6hrs, even with asthma and hypothyroidism. I had no idea of the fight ahead of me: 15yrs of chronic illness…

    But starting in 1996, my health gradually declined to the point that by 2004, I was no longer riding the bike at all and tipping the scales at 330+ lbs. It was exhausting just to walk… Each year, doctors would find something to explain my exhaustion: sleep apnea, allergies, a tumor on my neck, chronic sinus infection and in 2001 total pituitary failure. I began full hormone replacement treatment but I still remained on a rollercoaster of sickness and eventually was let go of my systems analyst job/compute career in August 2002…

    All along the way, I made countless comeback attempts, forcing myself back on the bike whenever possible. But the illness ultimately derailed my latest comeback. I had some significant progress along the way – dropping 120lbs in 2004-2005. But I gained most of that back and by 2008 was back up to 325lbs and still too sick to work or even exercise regularly.

    One of my endocrinologists has theorized that my pituitary disorder might be reversible since the MRI showed my pituitary gland was still intact. We tried a withdrawal from Cortef(med for cortisol) but I had to abort because of adverse reactions. In 2007, I tried it again and again had to abort – almost feeling like I needed to be in a psycho ward. Even during this adversity, I hopped on the bike whenever possible – even if it was only once every few weeks. It wasn’t about fitness so much as it was emotional therapy, to feel somehow that I was fighting back…

    In 2008, I tried the withdrawl process and miraculously my pituitary gland restarted that August. After 8 years of lying dormant, my pituitary gland was now working normally… By early 2009, I was no longer taking the steroids/hormones (Cortef, Testosterone, HGH shots) and was in the middle of comeback number 31…

    But then I got sicker than I had been in 10 years and found myself back on the couch – my big comeback once again shot don by illness. No explanation from my docs with the suggestion it was all in my head…

    I eventually suspected I had celiac and by the end of 2009 it had been confirmed by the great improvement from a gluten-free diet. After a rough spring in 2010 – because of autoimmune response to pollens – I began comeback #32… From August through September I rolled up 1600 miles on the bike getting my weight down to 230lbs and my resting heart rate donw to 44bpm. On October 3rd, I completed a hilly 100-mile ride

    I’m still dealing with illness challenges, but I feel I finally understand what was at the heart of it – autoimmune disorder – an overactive immune system that attacks the body in response to triggers such as pollens, dust and gluten. It’s been somewhat of a rough spring in 2011, but I have still managed to get in a lot of workouts in the gym and on the bike. I’m still far from being well, but so much better than I was… Without the exercise I had done along the way, I wonder if I would even still be here…

    I’m determined to get back to my normal weight of 180lbs – I’m currently around 250lbs – but my fitness program is about so much more than fitness. For me, it’s all about empowerment. No matter what has happened in the past, when I’m in the gym or on the bike, I feel empowered – over illness – over life. At least for the moment, I feel like I’m winning the fight and that nothing and no one can ever take away this feeling of victory…

    • Tom Venuto

      Thanks Jim, for sharing. You’re on your way to not just winning the battle, but the whole war. keep after it!

      • Jim Shelton

        Thanks Tom. In reference to the article, I hear all the time “You’re in great shape even with the extra weight.” By their standards I’m “fine,” maybe just lose a few more pounds. But I’ve learned that a sure-fire way to be miserable is to live by someone else’s standards instead of your own.

        I’ve always been an athlete, even during those times when I was far from athletic. But I tell others it’s their call as far as what kind of shape they “should” be in.

        • Tom Venuto

          “I’ve learned that a sure-fire way to be miserable is to live by someone else’s standards instead of your own.”

          No truer words ever spoken!

        • Erin

          That is a GREAT quote!! You’re so right, Jim.

          Keep it up; I know you’ll get there!!

    • I can totally identify with how Jim feels. Four years ago I had salmonella food poisoning so bad I almost died. Before that I was fit, despite being almost 70lbs overweight for my height. After the food poisoning I discovered that I was suddenly seriously allegic to wheat, but I suffered a lot before I realised what was the cause of my problems.

      I went on a wheat free diet, went to the gym and lost all of the 70lbs. I felt amazing, I even went back to competing in bodybuilding.

      Then a year ago I started feeling icy cold all the time , couldn’t sleep and couldn’t digest anything. It was a nightmare! I kept complaining to the doctor, but he would not believe me that my thyroid was playing up as he just saw me slim and fit. He told me I could not be hypothyroid in the shape I was in. In the end I paid to see an endocrinologist who diagnosed a benign tumour on my thyroid of 4cm…a big one. I am now on thyroxine to try to shrink it, or I have to have surgery. I am hypothyroid due to an auto immune response. I have Hashimotos disease.

      However, the endo recommended I go for a test for Celiac disease, but I refused….I cannot go back on gluten and wheat in order to be tested…it would destroy me. I have gone onto a wheat/gluten/ totally grain free diet and I feel wonderful. Throughout all this I have continued on the burn the fat diet, done cardio and heavy weights and continued kickboxing twice a week. I managed to keep my weight gain because of the thyroid problem down to 8kg over the year and now, at last , I am starting to lose it again very slowly. The only way now is forwards and upwards!

  • AlexHK

    I’ve recently joined a hiking and trail running group and met a few of these “fat but still fit” people. I’d even say that some of them are much fitter than many healthy (and exercising) people I know. But it seems to me that they are constantly trying to outrun an unhealthy diet and bad habits. We live in a city with a very sedentary lifestyle (work at office desks, eating in restaurants, use of escalators and lifts just to get up a single floor, etc), but some of these guys hike or trailrun 50+ miles up a week (up and down hills, often in extreme weather conditions) all year long and basically don’t lose any weight. I look healthy and fit, but I am certain I’d not be able to keep up with that week after week (and this is not a self limiting believe talking, that’s my orthopedic issues). Their mistake in particular, in my opinion, is bad nutritional habits, way too much cardio, and not lifting weights. I’d say in this case doing less (1h/day exercise + 1h/day kitchen) is better than doing more (20h+ hiking week).

    I am just glad I was lucky enough to discover the BFFM lifestyle and didn’t first “waste” years of exercise just to find myself stuck with the same old me. And it only took weeks to see results and feel much better. And same as Dan above, my blood test results went from high risk to _optimal_ in no time. And that pretty much reflects how I feel today. I’d not want to go back to fat, no matter how fit I would be.

  • Thanks for posting this Tom. Excellent article. I know that in my personal experience, being 75 lbs overweight/obese, combined with getting older and a life of taking my health for granted was causing me serious health problems. Since I started using BFFM and changing my lifestyle habits, my quite high blood pressure returned to normal, I feel a 100% better and quality of life has improved across the board.
    Thanks again for another great article and balanced perspective.

    Scott

  • Andrea Morrison

    This is a really interesting article. I am most certainly one of the ‘obese and healthy’ group. I have been seriously overweight for a number of years, but still had normal bloods and a very healthy heart. When I started on a diet and exercise plan I used to astound everyone in my classes with how well I kept up – despite my size.

    At least now I can see a good reason for keeping on till I reach my target size – I shouldn’t stay at 5 I should aim for 10. I reckon I am around 8 at the moment, so I will just keep plugging on till I get to the optimum.

  • Well, Tom, I’m another “paradox”. I just turned 63, and your assumption that people my age have more problems than the young doesn’t seem to hold water. Sure, I work out with weights, and that is all that I have had to do to keep my type 2 diabetes under control for the last 6 years, my blood pressure is 114 over 65. I have no sign of heart disease, and i wouldn’t call myself “ripped up”, either ! i weigh 235 pounds, a good part of which is muscle. I smoke like a chimney, and it doesn’t seem to bother me. Am i on some kind of “pristene” diet ? NOPE. My cholesterol is 123 / 40. i spent most of my life on a total crap diet, smoked, and pretty much ate anything I wanted ( you dcn’t wanna know ). All i do for weight control is a little extra exercise, and I seem to succeed whenever I want to. Am i watching what I eat now ? Well, I cut out most of the really bad goodies, but I still eat lots of stuff I’m not supposed to be able to get away with, and I DO get away with it ! My last A1C, yesterday, was 5.4, whcih means my sugar is LOWER than most “normal” people that don’t have diabetes… ( 6 is considered normal ).

    • Tom Venuto

      Hi Louis. thanks for your post. Im really pleased to hear about your health stats. The assumption wasnt mine, it came from the research. Also it was an association, not a causal statement, as you in fact have proven yourself to be an exception. You also may make a good example of the point made about genetics as protective factors (others not so lucky). Your comment makes for an interesting contrast with John’s (below). Thanks for sharing.

  • Tom

    Hi Tom, just wanted to let you know I started the BTF program last May and went from 212 to 163 in about 7 months. Most importantly, I am maintaining that wht. AND GETTING EVEN STRONGER!
    Thanks

    • Tom Venuto

      Hi Tom (hey, great name!) Congrats on the great results for 7 months! Keep up the fine work!

  • John

    Geez, I wish the average American knew at least a TINY bit about statistics.
    Yes – some people smoke 3 packs a day and live to be 90.
    Yes – some people eat until they weigh 400 pounds and live to be 90.
    Yes – some people drink a case of beer a day and live to be 90.
    Does that mean those things are harmless – or even healthy.
    You have to look at the damn statistics!
    Statistically, if you smoke like a chimney, eat like a hog, or drink like a fish, your chances of getting sick and dying early are far higher than a human being who does none of those things.
    Statistics 101. Most Americans can’t even add or subtract without a calculator these days, let alone know the difference between average and median.

  • I destroyed my ankle in a fall on my bicycle 5 or 6 years ago. It took a long time to improve enough to walk, and my weight ballooned to 270lbs. My blood pressure had been slowly rising as I got older (I’m now 62), but when my weight shot up, I had to go on two blood pressure medications. Next up was supposed to be Lipitor, but I made my stand at that point. I tried to lose weight by dieting, especially by cutting out all fat, thinking that would improve my blood chemistry. It took ages to lose 10 lbs. After a year of little success, I found Burn the Fat, wrote down my goals for the week, month, and long term and carried them with me in my wallet, checked my body fat once a week for feedback, and took to rowing 4 or 5 times per week since I couldn’t hike or run. In less than a year I was off the medications, had good blood lipid levels, and lost another 40lbs. Although my weight has fluctuated a bit over the last year or two, my blood pressure and lipids have been very good. Overall, I’m probably at 6 or 7 on the scale described in the article. To go higher I need to find another goal that will motivate me as much as the goal of getting off my meds and preventing metabolic syndrome from wiping me out! Tending toward perfectionism, the most helpful maxim among many useful ones I got from Tom’s book is “I strive for excellence, not perfection”.

  • Reka

    I was just like that, too, carrying lots of extra fat and weight, but pretty strong and with good health status, quite fit, too. Still it is much better now, after losing 55 pounds, I cannot compare the two, I guess when we are accustomed to one condition (being fat since when we can remember) we take the symptoms for granted and don’t realise how much better it can be. Then is we start the change the right way the incredible results keep us on track. I remember when they found out I needed glasses back in high school, I couldn’t see clearly the things in a longer distance but I thought the blurriness was normal. Then when I tried the glasses, it was just like… WOW! Same with this issue, I think if someone is obese and still healthy they are lucky / blessed but better watch out for the future.

  • Jim

    Very interesting article. I’ve known several people who looked like they were anywhere from 20 to 30 pounds overweight, but they biked three or four times a week and the heaviest looking one even completed a 100 mile bike ride. I’ve also seen some pretty heavy looking people running in the Marine Corps. marathon.

  • Chuck S

    The BMI is not a good measure, at least for somebody with a lot of muscle. It uses height, weight, and sex, but doesn’t know if the weight is fat or muscle. Therefore it can wrongly label somebody with a lot of muscle as obese. It may be moderately good for the general population, if not a lot of us have a lot of muscle.

    For yourself, you should look at % bodyfat for a better picture. Just measuring your waist size would be a good first approximation. Measuring neck and other places is better. There are skin calipers that are probably better.

    I believe that having some good fitness – muscles, good cardiovascular condition, etc, makes the fat somewhat less important. Having good vitamin and other nutrient input can also help – probably a lot.

    Also, a lot of harmful things are less that 100% harmful. I would expect that the same amount of obesity would affect different people differently. As an anlogy, cigarette smoking is harmful, but only 8% of smokers get long cancer.

  • I have a friend, Fred, that at one time could not even get covered by insurance because he was unhealthy. When his family got new insurance coverage, he could not, because the insurance company deemed him a poor risk. Ouch! So a couple of years ago he asked me to show him the ropes of cycling. The success story is that now through the help of a nutritionist he doesn’t have to take meds for his diabetes. In fact he’s off all of his meds. He’s healthier and faster than I ever was on the bike. The beautiful thing is to see him pay it forward as well. He now takes on folks that are needing a healthy jolt to their lifestyle and shows them the ropes of cycling.

  • Leanne

    I am one of those (*touch wood*) “fat but fit” people, I am around 320 lbs, and I have a cholesterol level under 4, and don’t have any back/joint issues, or diabetes or anything else for that matter.

    But I am also very conscious that at 32yrs old, that luck might not last forever, and to be safe rather than sorry I need to get myself in shape. But it is nice to see that it is finally being acknowledged that being fat doesn’t automatically mean that you are going to get instantly every obesity related disease going. I think this is more a scare tactic that so many doctors use when their patient doesn’t really warrant the fear factor approach!

    Good article!

  • Nice article Tom! A lot of years ago now, I had to stop playing rugby and pretty much all exercise, due to a prolapsed disc in my spine. My weight ballooned up and I can say that I had never felt worse, being a good bit overweight.

    My general health was okay, but I felt bad about myself. Thankfully I was able to build up my back strength and lose all the excess weight. I have even been able to get back playing rugby. But I will never rest on my laurels, being overweight made me feel terrible.

  • steve swanson

    excellent article

  • Peter

    Tom, you mentioned sleep apnea above. I have it but I am not overweight. I am 5’10” at 182 lbs with ~14% body fat. But then my sleep apnea is central, not obstructive. In your readings, have you seen much about central sleep apnea? Almost everything I see is about the obstructive type. I know this is not your area of expertise, just wondering if you or others have run across the topic. Thanks.

    • Tom Venuto

      peter, thanks for the information. Im most familar with sleep apnea (obstructive) because of how common it is with overweight – extremely common – and when you scroll down and look at my previous post on sleep disorders and major weight gain/ worse body composition, its an important subject. I;ll keep my radar on from this point forward regarding the different types. thanks again for the info

  • Dorothy S.

    It’s been interesting to read comments, but it makes me wonder what ‘fit’ is to many people, as opposed to what (I think) Tom and the article are saying. And I think for some, we’re discussing two different things.

    One is: ‘fat, not fit, but my body’s tolerating it” – e.g. – I’m overweight, minimal exercise but have been blessed with a body that, for whatever reason (genetics, etc.) hasn’t tipped over into the unhealthy side – high blood sugar/pressure, high heart rate, tolerable cholesterol. I eat ‘ok’, can get around, but I can’t perform challenging exercise – certainly not for any extended period (weekend basketball court warrior). That’s NOT ‘fit’, that’s what I think of as ‘psuedo-healthy’. I’m well acquainted with it and lived like that for many years.

    “Fat but fit” is what I’ve always considered: A person that eats properly, performs challenging exercises regularly, has stamina to engage in strenuous activities for a significant amount of time, has good numbers (blood/BPM/BP/cholestrol) but *is still fat – and possibly obese, by the numbers*.

    That latter is what I *thought* the article was talking about – and what the drive is for people like that (like me – now) to continue trying to lose weight when the health has lined up.

    • Tom Venuto

      you could argue that “fit” and “metabolically healthy” are separate and distinct… and as I opined in the article, I think many “fat but metabolically healthy” individuals are – as you suggested – only “psuedo-healthy.” why drop the excess weight, shoot for an ideal body composition and get REALLY healthy? a 10 instead of a 5?

  • Geert Anthonis

    Hi Tom,

    As always you tell it as it is and you back it up with proven research, though I am sure some people will never accept this. Still I have a few remarks.

    If I belief my scales BMI measurement I would be clinically obese. It claims my body fat is 33%. I am 49. I have high blood pressure and they are still looking for the medicine (mix) that can lower it. No medicine so far, western or Chinese, has worked it has been 6 years since I was diagnosed with hypertension. Found out at a regular blood donation. During the last extensive physical all the rest was normal. Now I do quite a bit of exercise: I run marathons, hike (short and long), do triathlons and half iron mans, run, bike and swim. Both the western and the Chinese doctors (I live in Taiwan) told me to stop exercising. But if I do my weight shoots up. Now why do I tell you all this? Because I think that the main factor influencing my blood pressure is my mental state. Even though I realize it I feel pressured and have not found a way to reduce that pressure.

    I have a friend. He is slightly younger than me. He is fat 120 Kg up, he does not want to say how much exactly. He never exercises. Yet he has normal blood pressure and all the other blood work is normal. He is a contented man and rolls with the punches. He is always relaxed. Drinks too much and eats too much but he does not care. And year after year he keeps getting the same examination results. He does not smoke though, nor do I.

    Another friend lost 12 kg a while back, even though he was not fat to begin with. He is 5 years younger than me. He looks gaunt even though he is at his ideal weight. He has problems with high blood pressure and other blood parameters. He has sleep apnea. He is a sport fanatic in a way yet he is not that healthy at all. In my humble opinion that has more to do with the fact that he is often moody and grumpy and smokes like a chimney.

    So I feel I need to change my point of view in order to get better not exercise more. Or better find a way to change my point of view before I start to exercise more.

    One last thing. I like outdoor activities. The thought of working out in an air-conditioned room does not appeal to me at all. Taiwan being hot and humid as it is no longer has any open air fitness, weight rooms. Space being at a premium the option of buying some equipment myself is at the time not feasible either.

    I bought ‘Burn the fat, Feed the muscle’ but never got past chapter one. I got it 3 weeks before my 2nd child was born now 9 months ago. With one toddler and one baby in the home and even a part-time nanny there are still a lot of sleepless nights. So it hard to get the extra energy to put in some training. Or better extra training as I do average 10 to 15 hours a week, running, biking and swimming.

  • Susan Mckell

    I believe that my being over weight can cause me medical problems ..but since my Grandmother lived to be 100 and her weight always was between 200 and 250lbs for all her life ..she was so healthy , she was able to live on her own till she fell when she was 95..it was the first time she had been hospitalized since the birth of her last child over 60 yrs…so i do believe some people are more prone to disease that others ..because my grandmother was living proof ..and so was my auntie who lived till 97 and was always around 200lbs …but they never eat fast food and rarely if ever drank alcohol and neither of them smoked so maybe this also contributed to there good health ..i love your program and thankyou 😉

  • Good to know! It just sucks that society nowadays tend to view fat people as unhealthy. Being comfortable about our own bodies and feeling good about ourselves is better than gradually killing our bodies just to conform to the fitness idealism of today.

  • isabellatiger

    Hi,
    I believe I fall into the obese but fit category. (soemthing I am trying to change) I am 5 2 and 167lbs, have been trying to loose weight most of my life, first did this by extreme dieting, (20-30ys) then by diet and weights but minimum cals (not sustainable too many protein shakes ) and now (at 51yrs) trying your program/sparkpeople/bodybugg
    I do a lot of exercise at least 2 hrs daily of walking swimming planning to ramp up the weights (soon I ruptured my hamstring at work and recently had surgery although I have been doing upper body weights)could you please give some tips for menopausal women ? (At 51 I dont feel old am very active,I do have some muscle under this fat just need to find it) I dont seem to be able to eat enough protein to get this right i dont want to live on protein shaes and tuna have done that its not susstainable. Atm I’m eating about 1500 cals and burning 2500 (bodybugg) and not losing weight what else can I do until I get back to heavy weights. I have tried eating less but that seems to be a dead end. I have an active job on my feet.
    thanks looking forward to finding my abs

  • Zach

    “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).”

    I would be very surprised if that wasn’t a very significant contributor to the “obese but metabolically healthy” paradox. I mean technically you are probably considered “obese” by BMI standards but clearly it’s because you have very large amounts of muscle and thus would be a good example of someone who is “fit but fat” by these studies’ standards, even though you clearly are not fat.

    My understanding was that visceral fat actually produces large amounts of arachadonic acid, and obviously having an overabundance of omega-6’s in your bloodstream will cause major metabolic damage, so the mere act of being fat is extremely detrimental to your health, making “obese” and “metabolically healthy” fairly mutually exclusive.

    Thus I suspect the disparity in some of these studies is the measurements they use to determine who is “obese”

  • People who are fat but fit may not have any disease, but that doesn’t mean they are in the prime of health. All that excess weight is going to take its toll on weight bearing parts of the body. Moreover, considering that body image has a lot to do with self-esteem, it can affect the way you interact with people, and interfere with your relationships, too.

  • I was wondering why after faithfully going to the gym and working out for 2 years and calorie counting I haven’t lost any weight. Is this true? Is exercise really for losing weight or is it just a part of staying healthy.

    • Tom Venuto

      HI Olivia. All you need is a slight shift in perspective and you’ll have a huge “AHA” moment and know what to do. Instead of thinking of “exercise more” to lose weight, think of “calorie deficit to lose weight.” and by extension, exercise more to increase calorie deficit, to lose weight. Exercise CAN help you not only get healthier, fitter, and stronger, yes it can help you get leaner and lose weight, but exercise will never be a crutch for poor nutrition, or simply not paying attention to calorie math. If you exercise more, but you compensate by eating more, then its a wash… and you get the fitness and health benefits but not the weight loss benefits. Thats the only reason there is controversy over This. if you increase exercise and keep your calories EXACTLY the same, you will lose more fat very time. More info: http://www.burnthefatblog.com/archives/2011/01/the-1-fat-loss-tip-for-2011.php

  • Anyone who is fat should be aware that she might be carrying an illness or other health issues, it might be tolerated for now but as the time goes by and you continue gaining weight then the problem there arises. Exercise should be a regular routine whether you are fit most especially if you are fat.

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