Overweight and healthy - so there

Is it really necessary to tell someone you know who is overweight that they are in fact overweight? Do you think it's brand new information and if you had not shared it they might have gone on thinking they were just fine. Maybe your 'overweight' buddy or relative is healthier than you, who claims to have a low BMI and be on a strict vegan diet.

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Here's a hypothetical.

Your just went through preventative screenings at your yearly exam. You started with your mammogram, walked down stairs and got all your blood work drawn. You love it when nothing happens to interrupt your tests, as you have imagined on more than one occasion. You shiver thinking of keeling over all you hear is dial 911. Part of that fear is because a friend of yours went in for a simple stress test, and woke up in CCU after emergency open heart surgery, wondering if she had breast surgery? Reduction of course.

You rip open the envelope and all your blood tests—cholesterol and blood sugar levels, ECG, blood pressure—are all within normal limits. High five that air, and do a little jig that you knew you were healthy, though possible 20 or so pounds overweight. Okay a bit more, you're super strong.

Sometimes all you will hear back after 'normal' tests results is that letter in the mail. But, do you really believe in your heart that you're out of the woods. Your current results read normal, they will not typically remain normal and there are changes happening at the cellular level that cannot always be gauged by standard tests. And we know through anecdotal experience that carrying extra weight typically leads to health issues, sleep issues, back and knee problems, and arthritis.

A new analysis suggests that “obese people” who appear otherwise healthy, are at risk of heart disease (and possibly other health issues) down the road. Can we really then say they are healthy just because a moment in time showcases normal results? Many overweight individuals believe they are fit and fat, despite the fact that a waist size over 35 inches for women, and 40 inches for men, or a BMI greater than 30, is associated with strong risk factors for diseases like diabetes, heart disease and certain cancers. These individuals will tell you that they “feel well, function well, and even exercise,” and certainly believe that because screening tests currently show no frank disease, they are indeed fat and healthy.

In The Obesity Paradox: When Thinner Means Sicker and Heavier Means Healthier, US cardiologist Carl Lavie says our modern culture has been duped into thinking excess body fat is bad.

He says the key to optimal health for millions of overweight and obese people may be staying the size they are. ''Fat has been demonised by our society, and our research shows fat is not always the devil,'' he told Fairfax Media from his home in Louisiana - the fattest state in the US. ''You can be heavy and amazingly healthy. Fitness is a lot more important than fatness.''

Lavie, who works at the John Ochsner Heart and Vascular Institute in New Orleans, said a growing body of evidence, including his own research over a decade, shows that while excess fat can lead to risk factors for chronic illness such as cardiovascular disease and type two diabetes, once these diseases develop heavier people have better outcomes.

''This is the obesity paradox,'' he says. ''Among the patients who have heart disease, the overweight and moderately obese are actually doing considerably better, sometimes 30 to 50 per cent lower mortality rates, than the lean people who have the same diseases.

''In no way am I promoting obesity, but for the people who have been losing the battle of the weight, if they can at least become fit, then they can have a very good prognosis and good overall health.''

Lavie says it is unclear how the paradox works, but it may be that heavier people might never have developed chronic disease without weight gain, whereas thinner people may be genetically likely to become sick and have a poorer prognosis.Canadian researchers who recently reviewed a number of past studies found that heavy people who do not have high blood pressure or diabetes DID HAVE more heart attacks and strokes, compared to healthy “normal weight” individuals. That finding alone ran counter to short term studies that suggested that some people could be overweight but heart-healthy.

The conclusion of a leading expert, James Hill, Ph.D., who reviewed this new meta-analysis, which looked at eight different past studies, believed it was reasonable to think that there could be a group of patients who carried excess fat, but were not necessarily at higher risk of health issues. After reviewing all the data he concluded that based on the assessment, health complications are largely inevitable if you carry persistent excess weight. You cannot be overweight and healthy.

So heavy but healthy means that you will inevitably become heavy with risk for disease and finally, as more time passes, heavy with frank disease present, over time. And it's clear that obesity, newly classified as a disease, puts stress on one’s cardiovascular system, though the stress levels may be higher in some, compared to others.

So metabolically unhealthy but normal weight, or overweight, or obese individuals are all three times more likely to develop heart-related conditions, compared to normal weight healthy individuals.

A key message is that whether you are overweight or not, lifestyle habits impact disease risk. And if you have genetic predisposition to heart disease, weight and lifestyle management can delay or limit heart disease in many individuals. If you carry a genetic predisposition and you carry excess weight, you will encourage early expression of disease….add in poor lifestyle and you further increase that probability.