Fit or Fat, but Not Both?

Let’s face it, Americans have a health problem.  We are not healthy and the problem is getting worse.  It’s not because we don’t have access to good medical care.  It’s not because we are forced to eat thousands of unnecessary calories.  It’s not because we exercise too much.  And, it’s not because we smoke too few cigarettes  No, its generally because we knowingly make bad choices.  Blame McDonald’s, sugary soda manufacturers and super-duper sized convenience store drinks all you want, but we do have free will and we are ultimately responsible for our lifestyle choices when it comes to diet and exercise, even during the holidays.

It’s no wonder then that recent medical literature suggesting there might be such a thing as “healthy obesity” had so much appeal.  No magic bullet necessary – no change in lifestyle needed.  Stay large and in charge and things will work out great.  Well, turns out that may not be entirely true.  The literature on the subject of healthy obesity generally refers to “metabolically healthy obesity,” where blood pressure, cholesterol, blood sugar and other measures of metabolic health are normal.  By examining metabolic health, researchers were really attempting to identify patient populations that were most at risk for obesity related illnesses or most in need of obesity related care.  Obese individuals who were metabolically healthy were thought to be just as “healthy” as those metabolically healthy individuals at a normal weight.  Therefore, the reasoning went, fewer resources needed to be devoted to such individuals.  The attempt to isolate at risk populations, however, was not meant to suggest that obesity is a healthy.  The snapshot of metabolic health in obese individuals, was just that, a snapshot.  It did not hold up over time.

How do we know?  A new meta-analysis of eight studies involving over 60,000 patients, some of whom were followed for over 10 years, concluded that obesity raised the risk of heart attack and stroke by nearly 25%, even in metabolically healthy individuals.  These results confirm what other studies have demonstrated for years – fat, in and of itself, is a risk factor for heart disease and a variety of other health conditions.

Unfortunately, and not surprisingly, there is still no such thing as a “calorie free” lunch and no magic bullet for good health.  Small lifestyle changes, however, can make a big difference.  A healthy diet and exercise are still two of the best friends your body has.  Keep those friendships in good shape and they’re likely to keep you alive and well for a good long time.

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