Can You Be Fat And Healthy?

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It is possible to be metabolically fit even with extra pounds or a high BMI. You can have metabolically healthy obesity if your waist size is under 35 inches (for women) and under 40 (for men). Blood sugar, blood pressure, cholesterol levels and insulin sensitivity must all be normal. Where the extra weight lies also plays a role - around the abdomen may signal a problem. Get yourself tested.

Being overweight brings a fair share of social stigma and self-doubt. With obesity or overweight also implicated in multiple health issues including increased cardiovascular risk and risk of diabetes, the health concerns associated with being fat have been high. Studies in earlier decades were focused on observing overall mortality rates and health problems in obese individuals. They found that mortality from all-causes, cardiovascular disease, cancer, and heart disease were all in “excess” in those in the “overweight” BMI (body mass index) category.1 Obesity was found to cause a 28 percent increase in mortality risk among men and 20 percent among women.2

A growing segment of research is now showing that it is possible to be fat but fit.

The Fat And Fit Paradox

A new movement in research is exploring the phenotype of the obese yet metabolically fit individual. One study found that when metabolically healthy but obese subjects were compared to others who were obese but metabolically abnormal, there was a stark difference. Those who were metabolically healthy and obese were found to be at no additional risk of mortality or cardiovascular disease compared to people with normal fat who were metabolically healthy. On the other hand, they had as much as 30 to 50 percent lower risk of cancer mortality, mortality from all-causes, and cardiovascular illness (fatal as well as non-fatal).3 About 10 to 30 percent of all obese individuals are estimated to be metabolically healthy.4

What Is Metabolic Fitness?

While being fat or having a high BMI may not appeal to our aesthetic or to norms of traditional fitness, metabolic fitness is a different story. For someone to have metabolic syndrome or be metabolically “abnormal,” they measure high on risk factors that make them prone to cardiovascular disease as well as conditions like diabetes. Symptoms like hypertension, insulin resistance, dyslipidemia, and impaired glucose tolerance are signs of metabolic syndrome. If you are metabolically healthy, you will have levels or readings within the “normal” range on all these factors.5

How The World Stacks Up: Metabolic Health Influenced By Culture And Ethnicity

Obesity is on the rise worldwide. A study from 1997 to 2003 found that obesity was more prevalent in Central and Eastern Europe. Countries of Western Europe like Italy and France, and some Scandinavian nations had a lower incidence. In the United States, obesity had gone up to 34 percent as of 2010. The prevalence was also higher in economically developed countries, compared to developing nations. Metabolically healthy obesity is linked to the lifestyle and ethnicity of a person. In other words, geographical and cultural differences in diet and exercise or activity levels could impact metabolic health as well.6

A study of 163,517 men and women from seven countries found that metabolically healthy obesity was highest in Italian obese men, followed by German men and women from the UK. In general, more women were metabolically healthy and obese, compared to obese men.7

How Fat Can You Be While Remaining Healthy?

It may seem counterintuitive, but it is possible to be fat and in good metabolic health. This can be achieved through regular exercise and a healthy diet, and by avoiding risk factors for cardiovascular disease or diabetes, like smoking.

As professors from the Harvard School of Public Health caution, to qualify as “healthy” when you are obese, you must fulfill certain criteria. Your waist size must be under 35 inches if you are a woman and under 40 inches if you are male. Blood sugar, blood pressure, and cholesterol levels must all be normal. You must have normal insulin sensitivity. And lastly, you should be in overall good physical health and demonstrate good fitness levels.8

How Dangerous Is A “One Size Fits All” Approach?

BMI doesn’t tell the complete story. A broader palette of factors including indicators of metabolic syndrome must be checked. Ignoring these criteria and assuming all is well is dangerous. It could put you at risk of serious illness or mortality from not treating or managing a health condition linked to obesity.

Where you carry your extra weight can play as much of a role. If you have a lot of abdominal fat, you could be at increased risk of metabolic syndrome. It could also mean you are more at risk of developing diabetes, atherosclerosis, hypertension, cancer, and dyslipidemia. Oxidative stress on the body increases when you are fat, raising your risk.9 Conversely, those with a “pear shape,” who carry the weight on their hips and legs, have a protective glucose and lipid profile. Metabolic risk as well as cardiovascular risk is lower than those in their “apple shape” counterparts.10

How your body uses the surplus also matters. In some obese individuals, the surplus energy is burnt in the muscle and liver mitochondria or sent to subcutaneous depots. This kind of obesity is metabolically benign and can mean protection from atherosclerosis and insulin resistance.11

All this research might lead you to be more forgiving of the extra weight you carry. While that is great for your self-esteem, it is important to get a thorough health check to see that all your indicators read normal. If your medical reports are similar to that of a normal fat person, then you may be among the lucky lot who are metabolically healthy even though they are overweight. For everyone else though, being fat may still be a warning sign that your body is under stress and needs you to lose those extra pounds.

References   [ + ]

1. McGee, Daniel L., and Diverse Populations Collaboration. “Body mass index and mortality: a meta-analysis based on person-level data from twenty-six observational studies.” Annals of Epidemiology 15, no. 2 (2005): 87-97.
2. Barry, Vaughn W., Meghan Baruth, Michael W. Beets, J. Larry Durstine, Jihong Liu, and Steven N. Blair. “Fitness vs. fatness on all-cause mortality: a meta-analysis.” Progress in Cardiovascular Diseases 56, no. 4 (2014): 382-390.
3. Ortega, Francisco B., Duck-chul Lee, Peter T. Katzmarzyk, Jonatan R. Ruiz, Xuemei Sui, Timothy S. Church, and Steven N. Blair. “The intriguing metabolically healthy but obese phenotype: cardiovascular prognosis and role of fitness.” European Heart Journal 34, no. 5 (2013): 389-397.
4. van Vliet-Ostaptchouk, Jana V., Marja-Liisa Nuotio, Sandra N. Slagter, Dany Doiron, Krista Fischer, Luisa Foco, Amadou Gaye et al. “The prevalence of metabolic syndrome and metabolically healthy obesity in Europe: a collaborative analysis of ten large cohort studies.” BMC Endocrine Disorders 14, no. 1 (2014): 1.
5. van Vliet-Ostaptchouk, Jana V., Marja-Liisa Nuotio, Sandra N. Slagter, Dany Doiron, Krista Fischer, Luisa Foco, Amadou Gaye et al. “The prevalence of metabolic syndrome and metabolically healthy obesity in Europe: a collaborative analysis of ten large cohort studies.” Bmc Endocrine Disorders14, no. 1 (2014): 1.
6, 7. van Vliet-Ostaptchouk, Jana V., Marja-Liisa Nuotio, Sandra N. Slagter, Dany Doiron, Krista Fischer, Luisa Foco, Amadou Gaye et al. “The prevalence of metabolic syndrome and metabolically healthy obesity in Europe: a collaborative analysis of ten large cohort studies.” BMC Endocrine Disorders14, no. 1 (2014): 1.
8. Overweight and healthy: the concept of metabolically healthy obesity, Harvard Health Publications.
9. Matsuda, Morihiro, and Iichiro Shimomura. “Increased oxidative stress in obesity: implications for metabolic syndrome, diabetes, hypertension, dyslipidemia, atherosclerosis, and cancer.” Obesity Research & Clinical Practice 7, no. 5 (2013): e330-e341.
10. Manolopoulos, K. N., F. Karpe, and K. N. Frayn. “Gluteofemoral body fat as a determinant of metabolic health.” International Journal of Obesity 34, no. 6 (2010): 949-959.
11. Stefan, Norbert, Konstantinos Kantartzis, Jürgen Machann, Fritz Schick, Claus Thamer, Kilian Rittig, Bernd Balletshofer, Fausto Machicao, Andreas Fritsche, and Hans-Ulrich Häring. “Identification and characterization of metabolically benign obesity in humans.” Archives of Internal Medicine 168, no. 15 (2008): 1609-1616.