The Fat-Fit Debate

Dr. Cindy Haines Health Guide
  • A recent study made headlines with the proclamation that there is no such thing as healthy overweight or obesity. Is this the definitive word? My opinion is that it is not.


    First of all, we are basing conclusions here on an imperfect measurement: the body mass index (BMI). BMI can only give one a general sense of underweight/normal/overweight status. Further, I don't believe that we have enough evidence to conclude that a higher BMI, or even extra adipose tissue (fat), is always detrimental. In fact, we know that having a little extra "padding" in our later years actually can be a good thing for overall health. We also know that some kinds of adipose tissue are more metabolically active (unhealthy) than others. Visceral fat, the kind we store around our internal organs, has been found to be worse than subcutaneous fat (the whole apple versus pear body shape comes into play here).

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    In addition, it is important but not always at top of mind to realize that research such as this may not include all factors that are important in generating far-reaching conclusions. For instance, was the impact of physical fitness addressed? Was active versus sedentary status of all participants included as a variable?


    This recent study was actually a meta-analysis, a review of several existing studies. The researchers reviewed studies that looked at differences between overweight or obese people versus normal weight individuals in terms of their metabolic health and cardiovascular risk. The researchers found that obese people were at increased risk for poor long-term outcomes even without metabolic abnormalities, suggesting that excess weight itself is unhealthy, regardless of metabolic status. They also found that all metabolically unhealthy people, in every weight class, had a similarly elevated risk.


    In other words: obese people with or without metabolic abnormalities were at higher risk of adverse health outcomes, and all people with metabolic disease, regardless of weight, were as well.


    As with any presentation of research by the media, it is important to consider the source and review the data itself to determine if the information is valid and credible. It is also important to consider the fact that research depends on many factors. The conclusions of any one study may or may not be definitive, largely due to this phenomenon of compounding and confounding variables affecting results. We are always learning more, and learning how to vet the independence of potential contributing factors.


    Said another way: If this analysis did not specifically address types of adipose tissue, for example, another forthcoming study may do so…and may come up with a very different conclusion.


    Dr. Cindy Haines is a family doctor, medical journalist, and "70.3 yogi." For even more tips on how to get better health and need the health care system less, check out: The New Prescription: How to Get the Best Health Care in a Broken System by Dr. Cynthia D. Haines, M.D. (Dr. Cindy Haines) and Eric Metcalf, M.P.H. This is a book about getting what you really want: better health on your own terms. More medical care doesn’t mean better health. Dr. Haines and Metcalf reveal some of the most egregious problems with a medical system gone awry, opening readers’ eyes to how to better navigate the changes underway. Using solid research, insiders’ insights, and patient anecdotes, they offer cost-effective and potentially life-saving ways to get more out of health care while using less of it.

Published On: January 05, 2014