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Can You Really Be Fat But Fit?

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Obese people often have unhealthy blood fats, high blood pressure, diabetes, and other health problems, yet a certain percentage of them don't.

This group is categorized by doctors as “metabolically healthy obese”, or “fat but fit”. However, is this really possible when it comes to longevity? Will they have the same life expectancy as their fit but slim counterparts?

A team of researchers tackled this question and here’s what they found...

Typically, obesity leads to metabolic problems reflected in elevated blood sugar and insulin resistance, diabetes, increased blood pressure, unhealthy levels of blood fats, and systemic inflammation.

These effects are not universal, however, with three to 22 percent of obese people having none of these problems.

Research groups looked into whether this cohort were just as healthy as those who were not obese and came up with mixed findings. What’s more, there were limitations in the studies they carried out.

So, scientists at the Institute of Health and Wellbeing, University of Glasgow, Scotland, carried out a comprehensive analysis to see if they could come up with a more definitive answer.

Differences Between Healthy Obese and Others 

For their study the Scottish team looked at data from 361,363 people living in the United Kingdom.

Over half were metabolically healthy and not obese (MHN). Others were metabolically healthy but obese (MHO), metabolically unhealthy but non-obese (MUN), or metabolically unhealthy and obese (MUO).

When the study began, the data showed that compared to metabolically healthy and not obese, metabolically healthy but obese were older, watched more television, exercised less, had a lower education level, less wealth, ate more red meat and processed meat, were more likely to be male and of non-white ethnicity, and were less likely to be smokers.

But compared to metabolically unhealthy and obese, the metabolically healthy and obese were younger, watched less television, exercised more, had a higher education level, were wealthier, and were less likely to be male and of non-white ethnicity. The only factor that was the same when these two groups were compared was a higher red and processed meat intake.

Personally, I find the similar intake of red meat and processed meat interesting. We’ve long pointed to the health dangers of processed foods—meats in particular. This research appears to suggest that a diet high in red and processed meat may be correlated with obesity, but a more specific study would have to home in on this issue to be sure.

After accounting for various elements of the participants’ demographics, lifestyle habits, and socioeconomic factors, the key finding over the study period of 11.2 years is that being metabolically healthy but obese increases risk of death by a whopping 22 percent.

In short, “fat but fit” is not really an option if you want a long life.

More Likely to Suffer Heart and Lung Problems 

In fact, compared with the metabolically healthy and not obese group, the metabolically healthy but obese were also 4.3 times more likely to have type-2 diabetes, had a 76 percent higher risk of heart failure, were 28 percent more likely to suffer respiratory disease, were 19 percent more likely to suffer chronic obstructive pulmonary disease, and 18 percent more likely to suffer heart attack or stroke.

Even when compared to the metabolically unhealthy but non-obese group, the metabolically healthy obese were 28 percent more likely to have heart failure.

The researchers also compared the metabolically healthy but obese category to all the non-obese, whether metabolically healthy or not. They found the metabolically healthy but obese group had double the likelihood of diabetes, a 60 percent higher risk of heart failure and were also 44 percent more likely to die of heart failure, as well as having a 20 percent greater risk for respiratory disease. They were also 12 percent more likely to die from any cause over those non-obese groups.

There’s No Such Thing as ‘Fit But Fat’ 

Following these findings, the researchers summed up their conclusions in their paper, published in the journal Diabetologia in June, saying that people who are metabolically healthy but obese are far from healthy. The researchers wrote...

"The current study demonstrated that people (who) were metabolically healthy but obese were at a substantially higher risk of diabetes, heart attack or stroke, heart failure, respiratory diseases and all-cause mortality compared with people (who were) metabolically healthy and not obese.

"Particularly worth noting is that people (who were) metabolically healthy but obese were at an even higher risk than those (who were) metabolically unhealthy but non-obese of heart failure and respiratory disease.

"The key point therefore is that the risk of many important outcomes...is elevated in people with obesity even if they have a normal metabolic profile.

"People (who are) metabolically healthy but obese are not ‘healthy’...We suggest the term ‘metabolically healthy but obese’ should be avoided in clinical medicine as it is misleading..."

Lead author Frederick Ho said, "This reinforces the adverse consequences of obesity to be multidimensional and go beyond the usual metabolic health markers."

This article landed in my in-box from one of our talented contributors in a timely fashion. I'd just been thinking the day before that obesity has come to be accepted in America as the new normal, and how profoundly sad and dangerous this is. Increasingly it carries no social stigma or employment drawbacks nor does it even seem to be a drag on finding a mate. Everyone’s fat, so what the heck? Even show business is populated with performers who are way overweight.

It’s a different world from the one I grew up in, where obese kids could come in for a rough time, and ads, TV shows and movies celebrated people with a healthy weight. Looking at old newsreels from World War II, it’s amazing how thin the young men were – every single one of them. They were way below what we accept as a healthy weight. They were skinny.

Of course, people were much poorer and food was expensive. Most people spent a big share of their small household income on food, and eating in a restaurant? That was a rare treat. I don’t long for a return to poverty. But our brave new world of gourmet food for all has its own drawbacks.

Because being overweight is now acceptable, you’re not going to get much social support for keeping your weight down. We talk a lot about losing weight, but almost no one does, and for sure no one’s going to stare at you and laugh these days. This means we have to look within ourselves for strength and take control of our own lives. Society is no longer any help.
  1. https://link.springer.com/article/10.1007/s00125-021-05484-6 
  2. https://diabetologia-journal.org/2021/06/11/people-with-healthy-obesity-are-still-at-increased-risk-of-disease/ 

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