Fit AND Fat?

On January 7, 2010, in Uncategorized, by Andrea

The usual standard of fitness, the BMI, or Body Mass Index chart, is a crappy indicator.  We all know this.  I mean, anything that puts celebrities like Arnold Schwarzenegger in the “obese category” is not a good indicator of health.  So this is a big “duh” for many of us.

But I always said I had been a “healthy” fat person.  And given my lack of co-morbs prior to surgery, I was.  I had low blood pressure, no signs of heart disease, low cholesterol, no diabetes — even LOW blood sugar rather than trending upward sugar levels, no sleep apnea, no PCOS — but would I have stayed that way?

So again, is there a question of Fit, but Fat?

It’s interesting to me that there were two different things about this — both from two different countries, studying two different genders, that say the complete opposite of each other.  Now given, one is a short-term glimpse of life and one is a long-term study.  I’m more apt to look at the long-term study, but the video does bring in the relevance of waist circumference versus BMI (although I’m not certain it would have made a difference in either case), but it does bring the point home that a different measure should be made.

From Medscape:

Overweight, Obesity up CV Risk Regardless of Metabolic Markers in Long-Term Study

Michael O’Riordan

January 5, 2010 (Uppsala, Sweden) — Middle-aged men with the metabolic syndrome are at an increased risk of cardiovascular disease and death regardless of their body-mass index (BMI), new research shows [1]. On the flip side of that combination, investigators also showed that overweight and obese individuals without the metabolic syndrome are at an increased risk of cardiovascular events and death.

Publishing their results online December 28, 2009 and in the January 19, 2010 issue of Circulation, Dr Johan Ärnlöv (Uppsala University, Stockholm, Sweden) and colleagues say the “data refute the notion that overweight and obesity without the metabolic syndrome are benign conditions.”

As the researchers note in their paper, previous studies have shown that obese individuals without the metabolic syndrome–sometimes referred to metabolically healthy obese, or even healthy fat–were not at an increased risk of cardiovascular disease events. Follow-up in these studies was around 13 years, leaving some question as to the long-term impact of different BMI/metabolic-syndrome combinations.

In this new Swedish examination, cardiovascular risk factors were assessed in 1758 middle-aged individuals without diabetes in the Uppsala Longitudinal Study of Adult Men (ULSAM). During a median follow-up of 30 years, 788 participants died and 681 developed cardiovascular disease. In hazard models that adjusted for age, smoking, and LDL cholesterol, metabolic syndrome was associated with an increased risk in normal, overweight, and obese individuals. As noted, even obese and overweight individuals without metabolic syndrome were at an increased risk for death and cardiovascular events.

ULSAM: Death and Major Cardiovascular Events (HR, 95% CI) in the Different Groups

End point Normal weight without metabolic syndrome Normal weight with metabolic syndrome Overweight without metabolic syndrome Overweight with metabolic syndrome Obese without metabolic syndrome Obese with metabolic syndrome
Total death Referent 1.28 (0.90–1.82) 1.21 (1.03–1.40) 1.53 (1.19–1.96) 1.65 (1.03–2.66) 2.43 (1.81–3.27)
CV death Referent 1.77 (1.11–2.83) 1.44 (1.14–1.83) 2.19 (1.57–3.06) 1.20 (0.49–2.93) 3.20 (2.12–4.82)
Major CV events Referent 1.63 (1.11–2.37) 1.52 (1.28–1.80) 1.74 (1.32–2.30) 1.95 (1.14–3.34) 2.55 (1.82–3.58)

The researchers note that there appeared to be a lag time of approximately 10 years before the Kaplan–Meier curves for overweight and obese individuals without the metabolic syndrome diverged from the curve of normal-weight participants without the syndrome.

“This could be important, because it is possible that the transition from overweight/obesity without metabolic derangements to overt cardiovascular disease is a pathological process that spans several decades,” write Ärnlöv and colleagues.

They note that based on previous studies, weight loss in these so-called metabolically healthy obese and overweight individuals had been questioned, with some researchers even suggesting it might be harmful for them to lose weight. Based on their results, however, the “potential benefits of diagnosing metabolically healthy obese in clinical practice appears limited,” and the data do not support the existence of a healthy obese phenotype based on the absence of metabolic syndrome or insulin resistance.

And conversely, from

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