Fit and Not Fat

We can’t be truly healthy if we are fat. That’s the bottom line of study reported online December 28 before it’s printed in Circulation, the journal of the American Heart Association.

Previous studies seemed to show that something called “healthy obesity” might exist. They indicated that obese people who didn’t have the metabolic syndrome — a pre-diabetic condition — weren’t at increased risk of heart disease.

But the new research indicates that those studies didn’t follow those people long enough. Only after about 15 years did their heart problems show up in an exceptionally long-term study of 1,758 Swedish men starting when they were 50. The study, “Impact of Body Mass Index and the Metabolic Syndrome on the Risk of Cardiovascular Disease and Death in Middle-Aged Men,” followed them for 30 years.

The study recorded who died or had cardiovascular problems like a heart attack or a stroke. Dividing them into groups on the basis of the body mass index, the differences were striking.

The study found that over the 30-year period, the risk of cardiovascular disease was 63 percent higher in men of normal weight who had the metabolic syndrome, compared to normal-weight men who did not have the metabolic syndrome. It was 52 percent higher in overweight men without the metabolic syndrome, 74 percent higher in overweight men with the metabolic syndrome, 95 percent higher in obese men without the metabolic syndrome, and 155 percent higher in obese men with the metabolic syndrome.

Of course, the new study doesn’t answer all of our questions. It didn’t study women, who as I have noticed are a little different from us men.

While it included people with the metabolic syndrome, it excluded people with full-blown diabetes. It seems awfully likely to me that if they had included people with diabetes in the study the effects of weight would be even greater, but we don’t know for sure.

They also didn’t look at different levels of exercise. Perhaps we can be fit and fat, as I wrote four years when those labels fitted my body. But I’m beginning to doubt it.

In any case, this means that, “if you are overweight or obese, it is all the more important to emphasize your fitness,” as Barry Franklin, PhD, says. He is director of cardiovascular rehabilitation and exercise laboratories at the William Beaumont Hospital in Royal Oak, Michigan, and chairman of the American Heart Association council on nutrition, physical activity, and metabolism.

Even fat people without the metabolic syndrome aren’t healthy, the lead author of the new study says. Johan Ärnlöv MD, PhD, an associate professor of cardiovascular epidemiology at Uppsala University, says, “There appears to be no such thing as metabolically healthy obesity.”
Like 85 percent of people with diabetes I was fat. I know how hard sustained weight loss is. It’s essential, but it was the hardest thing I ever did. Even starting to exercise regularly — one of the hardest things for people with diabetes to do — is easier. But we all have to do both in order to control our diabetes. That’s truly the bottom line.

This article is based on an earlier version of my article published by HealthCentral.