‘Fat but Fit’? The Weight Controversy Continues
Sometimes, questions like if you could be fit and healthy especially if you are overweight, and if working out will minimize the risk of heart attack even with the extra pounds, are difficult to answer to some people. Though the idea that you can be fit also while fat has been controversial for long, many health experts have endorsed physical activity as beneficial; some other doctors have viewed the concept of being “fat but fit” or weight concerns with great suspicion.
Obesity has been described to be related to multiple mental and physical comorbidities, and it is a particular risk factor for CVD and all-cause mortality.
A new study which is believed to be the greatest of its kind puts it that even when obese or overweight people do not have health complications, they still have a high likelihood to develop heart disease than their contemporaries who aren’t overweight.
Whether or not obese people were free from high blood pressure, diabetes, or high cholesterol, there is a condition sometimes regarded as “metabolically healthy obesity.” In as much as they were obese, they had a modestly higher risk for developing a stroke, at about 50 percent increased the risk of coronary heart disease and had almost doubled the risk of developing heart failure over people who were neither overweight nor in similar metabolic health.
Those who were metabolically healthy but are considered as just overweight were at a 30 percent increased risk of coronary heart disease when compared to their peers with healthy weight and are metabolically healthy.
According to Dr. Rishi Caleyachetty, a doctor from the College of Medical and Dental Sciences, University of Birmingham, England, “metabolically-healthy obesity doesn’t exist and is therefore not a benign condition.” Dr. Rishi was the lead author of the paper that was published in the Journal of the American College of Cardiology.
However, critics have criticized the analysis to have left out a lot. This is because it was only based on the electronic health records of about 3.5 million British patients followed from 1995 to 2015. Not only that, but records of doctors don’t also typically depict lifestyle habits; thus, the study fails to account for the varied diet effects. The group weight status through the use of body mass index, a formula which is based on height and weight that doesn’t differentiate fat from muscle. Most important, the analyses have been criticized for not taking into account fitness level or physical activity.
Some other studies have discovered an increased rate of heart failure among individual with obesity. This was revealed by Dr. Carl Lavie, the Medical Director of the Cardiac Rehabilitation and Preventive Cardiology, New Orleans’s John Ochsner Heart and Vascular Institute. However, regarding coronary heart disease outcomes, studies considering both weight and physical fitness have highlighted the importance of fitness ahead of fatness, at least for a moderately obese individual. Dr. Lavie also asserted that he doesn’t think being obese or overweight is doomsday for those experiencing it as they can always maintain a significant level of fitness.
The author of the new paper, Dr. Caleyachetty, subscribed to the opinion that lack of information about exercise and fitness was an important caveat. He also conceded that those individuals that are metabolically obese, healthy, and vigorously active might develop a lower risk of having cardiovascular disease.
Critics see it as an important message to convey, as numerous people will find it easier to undergo an exercise regimen as well as stick with it than to shed some weight and, at the same time, maintain the weight loss.
Though nobody is trying to gain weight or get obese, Dr. Lavie would have a better message for people: ‘You better not gain weight,’” He feels people should be more physically active, improve their prognosis, even while carrying a few extra pounds.
However, Jennifer W. Bea, a University of Arizona Cancer Center Assistant Professor of Medicine and also a co-author of an editorial which accompanied the new study, revealed that they are yet to get hold of the possibility of a person becoming obese while metabolically healthy at the same time. She furthered that obesity is a metabolic disorder in itself and being fat and overweight is usually associated with low-grade inflammation which can contribute to cardiovascular disease, irrespective of metabolic measures.
That, nevertheless, doesn’t imply that weight trumps all. The study indeed discovered that individuals considered to be of average weight but had a single risk factor like high blood pressure, diabetes, or high cholesterol had more significant risk for coronary heart disease than obese people that are healthy.
An epidemiologist, Patrick Bradshaw, at the School of Public Health, University of California, Berkeley says people should “lose weight no matter what.” He furthered that when one is an average weight, one is not given enough lifestyle guidance. Even though your doctor may tell you to ‘exercise and eat right,’ nevertheless, anyone having these metabolic abnormalities is at higher risk of disease, and may even require more intensive lifestyle modifications — to improve health and not to lose weight.
It then implies that metabolic health is essential irrespective of your weight.
Even for people who are also considered underweight, the new study discovered that thin individuals without metabolic problems were at an increased risk for stroke than those with the healthy weight, overweight or obesity without metabolic issues, and the risk further increased for underweight people having metabolic issues.
Interestingly, while the dangers of being obese and overweight call for scrutiny, doctors are usually at a loss to describe the risks of being too thin.
HealthDay News
New British research shows that no quantity of extra weight is beneficial for your heart, irrespective of your fitness level by other measures.
Their findings also suggest that if a patient is obese or overweight, every effort should be made to assist them in getting restored to a healthy weight, irrespective of other factors, as revealed by Camille Lassale, study co-author, Imperial College London’s School of Public Health.
The study also revealed that if their cholesterol, blood sugar, or blood pressure appear within the normal range, overweight is still a risk factor, according to Lassalle in a university news release. Not only that, the increased risk of heart disease development was greater than 25 percent.
The study employed the use of statistics concerning the health of people in about 10 European countries where researchers focused on weight and heart disease symptoms when blood vessels become clogged.
The authors observed more than 7,600 people having cardiovascular events like death from a heart attack, and compared to 10,000 people without heart problems.
When the researchers adjusted their figures so as not to be thrown off by other lifestyle factors, they discovered that people having three or more heart risk factors including large waist sizes (over 37 inches for men and over 31 inches for women) high blood pressure, or high cholesterol were more than twice as probable to have heart disease, irrespective of whether their weight was above average or average.
However, those who were considered overweight but healthy were still 26 percent more probable to have heart disease than their normal-weight counterparts. The study also found out that those regarded as healthy but obese had a 28 percent increased risk.
The findings, without proving the heart risks caused by extra weight, were published on August 14 in the European Heart Journal.
The study also reveals that overweight people who might be regarded as ‘healthy’ are yet to develop an unhealthy metabolic profile which comes afterward in the timeline, and leads to an event like a heart attack.
The study in question as published in the European Heart Journal use data obtained from a study of 520,000 Europeans followed up for up to 12 years on average. The researchers, for the analysis, grouped the participants based on whether they were overweight, obese, or healthy weight, and whether or not they were metabolically. Having a minimum of three of the following risk factors indicates that they were metabolically “unhealthy”:
- Elevated blood pressure
- Low HDL-cholesterol
- High triglycerides (elevated quantities of fat in the blood)
- High blood glucose (Hyperglycaemia)
- Elevated waist circumference
This implied there were six groups being compared; healthy-overweight, healthy-normal weight, healthy-obese, unhealthy-overweight, unhealthy-normal weight, and unhealthy-obese.
Their conclusion
The study revealed that individuals that were obese or overweight had a greater danger of having a cardiovascular event- like a heart attack- as compared to those having normal weight, irrespective of whether or not they have poor metabolic health. The truism could only be ascertained when compared to participants with normal weight who weren’t metabolically unhealthy.
Also, this finding was the focus of the media, using it to dispute the “fat but fit” claim and that every overweight and obese person had a higher risk which is irrelevant of other factors.
What is it with this conclusion?
Though there was a greater danger for overweight and obese participants who were metabolically healthy, the increase wasn’t that great. The danger ratios of 1.26 and 1.28 for participants that are overweight and obese respectively basically imply that the increased risk in each group was 26% and 28%. The fat but fit slogan calls for concern.
The barriers to observational research have been well documented though. Some key issues, including the inability to assess cause and effect and the almost impossibility to control all the potential factors that could influence the outcomes, are yet to be addressed. In respect of these methodological limitations, it could be debated whether or not hazard ratios of this size are significant, as some people suggested a hazard ratio of over two is required to show a positive impact.
The data reveals that even if somebody was metabolically healthy or not, it might not be a much better health or body weight indicator. For the obese and overweight individuals, the hazard ratios pale into insignificance after those of the metabolically unhealthy groups, which include those whose having normal weight.
The bottom line
Although the study did reveal that there is a slightly higher risk that is associated with being obese or overweight, the researchers discovered that the indicators of metabolic health were a greater essential marker of cardiovascular risk. Shedding some weight may as well get your risk of cardiovascular events reduced if you are obese or overweight, but the study didn’t even study “fitness” in the traditional sense.
Importantly, the findings do not debunk the “fat but fit” storyline as precisely as it was suggested in the headlines.
BBC News
Experts have warned that people who are obese or overweight are at a higher risk of heart disease irrespective of whether they appear medically healthy, or not.
The article published in the European Heart Journal further serves as evidence against the idea of whether people can be “fat but fit.” The researchers researched health data on over half a million people in about 10 European countries, including the United Kingdom. Normal blood pressure, blood sugar level, and cholesterol do not assure good heart health among people who are obese.
7,637 of the people in the study had already developed heart disease after a follow-up period of over 12 years as weight seemed to be a risk factor.
In the research, people who were obese or overweight but had healthy blood sugar, blood pressure, and cholesterol readings were up to 28% more probable to have heart disease when compared to individuals with both similar readings and body weight that is healthy.
Being “metabolically unhealthy” and fat – having high blood pressure, blood sugar, and cholesterol – was riskier still.
What is the healthy weight for your height?
The researchers at the University of Cambridge and Imperial College London confirm that the findings are a reminder that too much fat can accumulate health problems for the future.
According to Dr. Ioanna Tzoulaki, from Imperial’s School of Public Health, the study reveals that people that are overweight and might be classed as ‘healthy’ are yet to develop an unhealthy metabolic profile.
The researchers also revealed that excess weight itself might not be directly increasing the danger of heart disease, but rather through mechanisms like glucose and increased blood pressure over time. Prof Metin Avkiran of the British Heart Foundation concluded that to maintain a healthy heart, keeping healthy body weight is a crucial step.
