The connection between obesity and health isn’t as straightforward as we might think.
Those of us who puzzle about the connection between obesity and health ask whether it’s possible to be fat and healthy. I’d like to think that it is.
But until recently it didn’t ever occur to me that some people could be healthy because they’re fat and that for them not only is losing weight not necessary it might even be had for their health.
It does seem though that not only can fat people be healthy, in some people it seems losing weight increases a variety of disease risks. Researchers call this the “obesity paradox” though as they come to understand it it might be a misnamed phenomena. What matters, they think, is metabolic health, not obesity after all.
I find this fascinating but it does make me worry about weight loss in my case. I’m a clear case of a metabolically healthy, significantly overweight person.
See the following story from the Vancouver Sun, http://www.vancouversun.com/health/Obesity+some+healthy+others/7607904/story.html.
I’ve italicized the bits that make me nervous!
“According to a recent study funded by the Canadian Institute for Health Research, people who are obese are less likely to die from pneumonia than people of normal or low weight. The study of patients at six Edmonton hospitals found that obese patients were 56-per-cent less likely to die, an example of what the researchers call “reverse epidemiology.”
It is far from the only example. The authors cite studies that reveal paradoxical outcomes for obese patients suffering from coronary artery disease, end-stage kidney disease and heart failure.
Other recent CIHR-funded studies have revealed that some obese people appear to be protected against the very illnesses most associated with obesity, specifically type 2 diabetes and cardiovascular disease.
These seemingly contradictory findings are fuelling research into the so-called Obesity Paradox, according to CIHR researcher Antony Karelis at the University of Quebec.
Karelis has found that about 30 per cent of obese people appear to display metabolic health indistinguishable from those of young lean individuals, including normal blood pressure, low levels of bad fats, high levels of healthy fats, high insulin sensitivity and low inflammation.
Metabolically healthy obese (MHO) adults also have less fat in their livers, muscles and around their vital organs, but more subcutaneous fat under their skin, he said.
“Some [obese] people collect fat under their skin where it is less likely to go into the liver and the heart or the pancreas and cause all kinds of trouble,” said Karelis. “Fat on their thighs is associated with health benefits, but abdominal fat is more associated with [poor health].”
Karelis argues that identifying people by their metabolic health, rather than their weight, is key for doctors making decisions about how to treat their patients.
“We know these people exist and that they have a lower risk of diabetes and cardiovascular disease,” Karelis said. “They have a better inflammation profile, a better hormonal profile and they are physically stronger.”
There are signs that weight loss may be harmful to people who are metabolically healthy but obese.
MHO individuals who participated in a six-month weight-loss study showed deteriorated insulin sensitivity, a risk factor for diabetes and heart disease. Metabolically abnormal obese study participants — those who display inflammation and unhealthy fat profiles usually associated with obesity — showed improved insulin sensitivity, suggesting their health could benefit from weight loss.
A 2009 study in the journal Epidemiology of middle- and older-aged obese adults found an increased risk of death associated with weight loss. Another CIHR study found that weight loss in obese post-menopausal women increased their risk of developing diabetes.”
Since diabetes seems to be the main risk caused by messing with a good thing, i.e. losing weight when you’re metabolically healthy to start, I think I’ll keep on eye on this in my case if I make progress to a leaner me by year 50. We’ve got a type 2 diabetic in the house so monitoring my blood sugar at least is easy.
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