Fat and healthy – not an oxymoron.

Click image to embiggen and read how you, too, can become Plump and Rosy with Honest Fleshiness of Form.

I’m just going to leave this here (along with a small reminder that America’s current conversation surrounding weight and health is shaped, in no small part, by money from the diet industry):

Heavy but healthy? New formula slims down definition of dangerously obese

New Canadian research suggests being obese doesn’t necessarily doom people to an early grave.

Two research teams using a new tool called the Edmonton Obesity Staging System, which ranks overweight and obese people on a five-point scale according to their underlying health, have found that not only can the scale predict who is at greater risk of dying, but that otherwise healthy obese people live as long as those of “normal” weight, and are less likely to die of cardiovascular causes.

The back-to-back studies come as more evidence emerges that a significant proportion of overweight people are metabolically healthy and that the risks associated with obesity do not make for a one-size-fits-all formula.

The Edmonton staging system grades obesity on a scale of zero to four. It uses physical measures such as body mass index, as well as waist-to-hip ratios. But it goes farther by taking into account the presence — or absence — of a spectrum of disease.

Under Stage 0, the person is obese, but has no apparent obesity-related health risks, meaning their blood pressure, blood fats and other risks are all within the normal range. Stage 1 obesity describes people with “sub-clinical” signs of trouble, such as borderline high blood pressure, elevated liver enzymes and occasional aches and pains. Stage 4 is the most severe. At Stage 4, patients have serious, “potentially end-stage” disabilities and illnesses from obesity-related diseases.

In one study published Monday in the Canadian Medical Association Journal, University of Alberta researchers tested the system using data from a survey of 8,143 people in two U.S. national health and nutrition surveys.

They found that although 77 per cent of overweight or obese people in one survey, and 90 per cent of those in another, were classified as Stage 1 or Stage 2, their risk of dying over 20 years of followup was substantially lower than people classified as Stage 3 obesity.

After adjusting for age, history of smoking and metabolic syndrome — a cluster of conditions such as high blood pressure and diabetes —about two per cent of people with scores of O or 1 died during followup, compared to about 40 per cent of Stage 3 patients.

“That’s a huge difference,” said Dr. Arya Sharma, who first proposed the Edmonton classification system.

The findings not only challenge the notion that everyone who is obese needs to lose weight. “Just because you’re normal weight doesn’t necessarily mean that you’re healthy,” Kuk said. “You can still have high blood pressure, you can still have diabetes, you can have a poor lifestyle — and all of these contribute to obviously negative health and early mortality risk.”

“You really need to take the emphasis off trying to attain this normal body weight, because lifestyle practices are equally, if not more important.”

The study was published online in Applied Physiology, Nutrition and Metabolism.

“If someone comes to my office and their BMI is 35, they have obesity, there’s no question,” Sharma said.

“But if I do the tests and I find that they have no other risk factors, then I can confidently tell them that they are at extremely low risk of dying. There shouldn’t be an urgent need to lose weight just because their BMI is high. The focus really should be on trying to maintain that weight and not get heavier.”

The opposite could hold for people with lower BMI’s who don’t meet criteria for surgery but who are at high risk and should be treated. “And we’re missing those patients,” Sharma said.

Sharma said people who have a history of weight cycling — losing large amounts of weight only to put the weight back on, or more — appear to be at higher risk of obesity-related complications.

“If you’re constantly dieting and trying to lose weight, and you put it back and you diet again, you might actually be causing problems.”

(all emphasis mine)

To read the whole article as it appeared in the Canadian press today, click here. To read the actual research papers, click on the links embedded above. To read me ranting about some of these issues and the harm they can and do cause, you can click here, or here, or here (or just crawl inside my head, where the rant is on a constant loop).

3 Comments

  1. Obesity has always been known as a “Secondary Cardiovascular Risk Factor”, in that it can cause many of the primary risk factors but is, of itself, not causative for cardiovascular death.
    Put simply, if your obesity isn’t giving you high blood pressure, diabetes or high cholesterol, it’s effect on your cardiovascular mortality is probably low.

    Obesity certainly is causative of other health problems, which were not directly measured in this most recent study (i.e. Osteoarthritis, breast cancer, more difficulty identifying health problems due to inadequate physical exam on obese people, higher surgical complications, etc…).

    I fully agree with the focus being on healthy living, and not on BMI.

    – Dr Mike

    • The problem is that obesity, or the even less precise condition of being “overweight,” are treated — by far too many doctors as well as the general lay community, from the media to random passers by — as a primary risk factor, regardless of the facts, or the involvement of the diet industry in determining the shared standards for what a healthy weight is.

      And it’s important to remember that one of the reasons that the obese often have inadequate physical exams is because they’re taught to feel enormous shame about themselves, and thus either resist going to the doctor, or to lie to doctors about their health, in order to avoid yet more shaming.

  2. Dr. Sharma is doing some very interesting work. I don’t always agree with him but I read his blog every day. There are times when he comes tantalizingly close to supporting Health at Every Size. If you are looking for topics to blog about, HAES should be one of them!