‘Fat but fit’ – at increased risk of heart disease

Eat less; move more; live longer has been the mantra of this blog nearly from the beginning. I believe that our actions and health results are all connected. So, I have never had much sympathy with the fat but fit concept. So, I was pleased to run across this research from Imperial College London and the University of Cambridge.

Carrying extra weight could raise your risk of heart attack by more than a quarter, even if you are otherwise healthy.

Tj47GpMT-fCke7VFFVL_0sYa-Zt7-0ZHqTWr4um1KmdFh1SpY_RzDpvc0ckcSR-2

Researchers have found that being overweight or obese increases a person’s risk of coronary heart disease (CHD) by up to 28 per cent compared to those with a healthy bodyweight, even if they have healthy blood pressure, blood sugar and cholesterol levels.

The findings add to a growing body of evidence that suggests being ‘fat but fit’ is a myth, and that people should aim to maintain a body weight within a healthy range.

Storing too much fat in the body is associated with a number of metabolic changes, including increased blood pressure, high blood sugar and altered cholesterol levels, which can lead to disease and poor health. (my emphasis)

However, previous studies have revealed a subset of overweight people who appear to lack the adverse health effects of excess weight, leading to them being classified as ‘metabolically healthy obese’ in the medical literature, and ‘fat but fit’ in the media.

Now, a group led by researchers at Imperial College London and the University of Cambridge has shown that despite an apparent clean bill of health, this overweight group is still at increased risk compared to those with a healthy weight. In the largest study of its kind to date, scientists used data from more than half a million people in 10 European countries – taken from the European Prospective Investigation into Cancer and Nutrition (EPIC) – to show that excess weight is linked with an increased risk of heart disease, even when people  have a healthy metabolic profile.

“Our findings suggest that if a patient is overweight or obese, all efforts should be made to help them get back to a healthy weight, regardless of other factors. Even if their blood pressure, blood sugar and cholesterol appear within the normal range, excess weight is still a risk factor,” said lead author Dr Camille Lassale, from Imperial’s School of Public Health and now based at University College London.

Risk for heart health

In the study, published in the European Heart Journal, researchers looked at the link between excess weight and risk of CHD, a condition where not enough blood gets through to the heart due to clogged arteries, leading to heart attacks.

After a follow-up period of more than 12 years, a total of 7,637 people in the EPIC cohort experienced CHD events, such as death from heart attack. Researchers then selected a representative group of more than 10,000 individuals as controls, for analysis.

Body weight was classified according to definitions from the World Health Organization. Those with a body mass index (BMI) over 30 were classed as obese, while those with a BMI of 25–30 were classed as overweight, and 18.5–25 as normal weight. More than half of the control group (63 per cent) were female, with an average age of 53.6 and an average BMI of 26.1.

Participants were categorized as ‘unhealthy’ if they had three or more of a number of metabolic markers, including high blood pressure, blood glucose, or triglyceride levels, low levels of HDL  cholesterol, or a waist size of more than 37” (94 cm) for men and 31” (80 cm) for women.

After adjusting for lifestyle factors such as smoking, diet, exercise and socioeconomic status, the researchers found that compared to the healthy normal weight group, those classed as unhealthy had more than double the risk of CHD, whether they were normal weight, overweight or obese. (my emphasis)

However, analysis also revealed that within the apparently healthy group there was a significant difference in outcomes for people depending on their weight. The research found that compared to those at normal weight, people who were classified as healthy but were overweight had an increased CHD risk of 1.26 (26 per cent), while those who were healthy but obese had an increased risk of 1.28 (28 per cent).

Population wide prevention

Dr Ioanna Tzoulaki, from Imperial’s School of Public Health, said: “I think there is no longer this concept of healthy obese. If anything, our study shows that people with excess weight who might be classed as ‘healthy’ haven’t yet developed an unhealthy metabolic profile. That comes later in the timeline, then they have an event, such as a heart attack.”

According to the researchers, the excess weight itself may not be increasing the risk of heart disease directly, but rather indirectly through mechanisms such as increased blood pressure and high glucose. They add that as no follow up measurements were taken, they cannot show how the group’s health status changed over time. However, they add that what is clear from the study is that population-wide prevention and treatment of obesity is needed in order to ensure public health.

Dr Lassale added: “Overall, our findings challenge the concept of the ‘healthy obese’. The research shows that those overweight individuals who appear to be otherwise healthy are still at increased risk of heart disease.”

 

Advertisements

6 Comments

Filed under Uncategorized

6 responses to “‘Fat but fit’ – at increased risk of heart disease

  1. When was the last time BMI was updated? In my biology class, the men that were physically fit (sports), were considered fat or obese based on BMI even though they had a well balanced diet.
    And does healthy weight and low blood pressure vs. a highly differing range of cholesterol mean anything significant? At one time I had my cholesterol checked twice in two days. It ranged from the low 200’s to approximately 320 the next day.

    Liked by 1 person

    • I don’t like BMI for individual work. I seems most useful when dealing with big populations. I have written about BMI in the blog. Also, there are good ways to estimate your body fat, again in previous blog posts.

      Like

  2. The Tribe Gym

    I have no idea why fitness professionals still use BMI when there are much better and more accurate ways of testing. Great article by the way. Really important to get this info out in a scientific and factual way.

    Liked by 1 person

  3. Thank you for starting an important conversation about heart health and how our lifestyle choices can greatly impact our risk of heart attack. It is important that we are educated about these simple lifestyle changes that we can make to lower our risk of heart disease. My blog looks to educate Australian women about their number one killer, heart disease, and raise awareness of its largely preventable nature. Isn’t it interesting that even with healthy blood pressure, blood sugar and cholesterol levels, being overweight increases our risk if heart disease by such a large percentage. Thank you for providing some great information about heart disease and for educating people about how they can lower their risk.

    Liked by 1 person

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s