Fat but Fit Debate Revisited

Fat but Fit Debate

Fat but fit may seem like an oxymoron, but two studies published in the European Heart Journal suggest that it’s possible to be physically healthy and obese. One study showed that physically active yet obese people are at no greater risk of heart disease or cancer as people of normal weight. A separate study showed no greater risk of dying prematurely in physically fit but obese people.

“The prevailing wisdom holds that being slim must be generally good for you,” Stephan von Haehling, Oliver Hartmann and Stefan Anker wrote in the editorial in European Heart Journal. “Obesity may carry a benefit up to a certain degree, and it should be recognized that obesity is not necessarily associated with abnormal metabolic function.”

The “Aerobics Center Longitudinal Study” ran from 1979 to 2003 and followed more than 43,000 participants. Each subject answered lifestyle and health history questions, underwent a physical examinations, and had there vitals tested. The participants were followed until 2003. The lion’s share of the studies participants were white and only about a fourth were women. The study was partially funded by the U.S. National Institutes of Health and by Coca-Cola Co.

Of the participants that were obese, 46 percent were deemed “metabolically healthy” by the researchers. These individuals had a higher level of fitness and exercised more than most obese people. When the study concluded, it was found that 38 percent of the metabolically healthy obese subjects had a lower risk of death compared to the less fit obese participants. The metabolically healthy obese participants had no significant increase in risk of death compared to metabolically fit people of ordinary weight.

“There are two major findings derived from our study,” said Dr Francisco Ortega, a research associate affiliated to the Department of Physical Activity and Sport, University of Granada in Spain and at the Department of Biosciences and Nutrition, Karolinska Institutet in Stockholm, Sweden, in a press release. “Firstly, a better cardio-respiratory fitness level should be considered from now on as a characteristic of this subset of metabolically healthy obese people. Secondly, once fitness is accounted for, our study shows for the first time that metabolically healthy but obese individuals have similar prognosis as metabolically healthy normal-weight individuals, and a better prognosis than their obese peers with an abnormal metabolic profile.”

The results of the study may have an effect on the public discourse on health and on the treatment options that doctors recommend for patients.

“Physicians could assess fitness, fatness and metabolic markers to do a better estimation of the risk of cardiovascular disease and cancer of obese patients,” Ortega explained. “Our data support the idea that interventions might be more urgently needed in metabolically unhealthy and unfit obese people, since they are at a higher risk,” he said.

A second study was conducted in Sweden and collected data from more than 64,000 people who had heart disease issues from 2005 to 2008. The study found that the highest risk of dying after acute coronary syndrome was greatest with the morbidly obese and underweight individuals. The overweight and moderately obese people were at the lowest risk of dying following the cardiac episode. The results fly in the face of the conventional wisdom that losing weight automatically means better health.

“It is possible to be fat and fit — but relatively few people are,” said Dr. David Katz, director of the Prevention Research Center at Yale University School of Medicine, in an interview with U.S. News Weekly. Dr. Katz was not a part of either study.

“For the most part, the behaviors that promote fitness most effectively defend against fatness into the bargain. It is certainly possible to be thin and unhealthy, which is why health, not a particular weight, is what we should be aiming for as both individuals and a society,” he said.

However, not all doctors are ready to jump on board with the findings. Dr. Gregg Fonarow, a spokesmen for the American Heat Associate and a cardiology professor at the UCLA, says the follow-up period was too short to draw conclusions from.

“This study followed individuals for 15 years — further studies are needed to determine the long-term health consequences of obesity in these individuals,” he said in an interview with U.S. News Weekly.


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