Just because you’re fat doesn’t mean you can’t be healthy. Recent research suggests that people who are obese but metabolically healthy are in no more danger of dying from heart disease or cancer than healthy, normal weight people.
The study, released this week in the European Heart Journal, is sure to add fuel to the fit-and-fat debate that’s been raging for years: can someone be overweight and in good shape? Can people carry around extra weight but not have a higher risk of death from certain disease?
The answer from this study is yes, and may change the way some look at obesity. Researchers focused on a group of 43,265 people who were part of the Aerobics Center Longitudinal Study. To determine fitness levels, participants were given a treadmill test to measure their cardio-respiratory fitness, and had their body fat percentages calculated as well. They also filled out detailed questionnaires on medical and lifestyle history and had their blood pressure, fasting glucose and cholesterol levels tested.
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Almost half—46 percent—of the obese study subjects were deemed metabolically healthy. This group had a 38 percent lower risk of death from any cause compared to their obese peers who were considered metabolically unhealthy. Researchers also saw no major differences between the obese/healthy group and those who were healthy and normal weight.
The chances of developing or dying from cardiovascular disease or cancer dropped 30 percent to 50 percent among the healthy obese.
“It is well known that obesity is linked to a large number of chronic disease such as cardiovascular problems and cancer. However, there appears to be a sub-set of obese people who seem to be protected from obesity-related metabolic complications,” lead author Francisco Ortega said in a news release. “They may have greater cardio-respiratory fitness than other obese individuals, but, until now, it was not known the extent to which these metabolically healthy but obese people are at lower risk of diseases or premature death.”
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The fitness component, Ortega added, seems to be key: “Based on the data that our group and others have collected over years,” he said, “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.”
That could mean that doctors might have to rethink how they treat obese patients, perhaps throwing out the one-diagnosis-fits-all approach, Ortega said.
“Physicians should take into consideration that not all obese people have the same prognosis. Physicians could assess fitness, fatness and metabolic markers to do a better estimation of the risk of cardiovascular disease and cancer of obese patients.”
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It should be noted that the population wasn’t that diverse—98 percent of people were white, and most were well educated and worked as executives or professionals.
Another study in the journal explored the obesity paradox: Why people who are overweight or moderately obese and have heart disease are less likely to die, while those who are underweight or normal weight have a greater risk of dying.
That study looked at data on more than 64,000 Swedish patients who had acute coronary syndromes, or conditions such as heart attacks that are triggered by decreased blood flow to the heart.
Those who were underweight, as determined by their body mass index, had double the risk of dying compared to normal weight people. Underweight people had triple the risk of dying compared to the lowest risk group—those who had a BMI between 26.5 to about 35, in the overweight to obese range.
Lead author Oskar Angeras told U.S. News and World Report, “In acute coronary syndrome, the obesity paradox suggests that there could be protective mechanisms in either fat tissue or in obese patients' [individual makeup] that reduce the risk of mortality. This is of course speculative and needs further investigations.”
Angeras added, “We believe that it is important to focus on secondary prevention like treating [high blood pressure] and [high fat levels in the blood], stop smoking, exercise and eat a healthy diet, which has solid evidence in literature. Weight reduction is, however, perhaps not that important in itself, more a cause of anxiety among patients.”
Do you think it's possible to be fit and fat, or is being overweight a health risk in itself? Let us know in the comments.
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Jeannine Stein, a California native, wrote about health for the Los Angeles Times. In her pursuit of a healthy lifestyle she has taken countless fitness classes, hiked in Nepal, and has gotten in a boxing ring. Email Jeannine | TakePart.com