Fit, Obese and Healthy


We have a frenzy of media reporting on the negative connotations of being overweight. Being obese is a modern stigma. And yet good evidence exists that 30% of those deemed obese suffer no health consequences of their excess weight.

Our changing lifestyles and diets mean that we are more likely to be heavier. But should we be redefining normal weight with the average weight of many populations is increasing and wide range in weight in the general population.

Losing the Weight Battle

It is very hard to reduce weight if you are obese; motivation is difficult. Many overweight and obese people struggle to stick to dietary and exercise regimes that are punitive and rigid.

Setting goals of ideal weight and huge weight losses is unrealistic for most individuals without drastic changes in lifestyle. Negative messages – about weight  – are not achieving change. Health is improved with even small changes in eating habits and exercise –  independent of major weight loss.

Healthy Obese

The notion of the healthy obese is a recent phenomenon. It has dispelled the misconception that being overweight is universally unhealthy. Perhaps the word ‘healthy’ is a misnomer, but some people – overweight in terms of body mass index – do not have the expected health problems:

  • They have good fitness and are healthy.
  • They have no greater risk of CVD and cancer than normal weight people.
  • They may be at much lower risk of disease or premature death than their obese colleagues.
  • They have less hypertension, insulin resistance and dyslipidaemia even than unfit thin individuals.

Better Fat Stores

Body fat distribution is a determiner of the metabolic consequences of obesity and the risks of cardiovascular disease. The main fat stores are visceral fat in the abdomen, subcutaneous fat under the skin and intramuscular fat between the skeletal muscles.

An excess of visceral fat leads to abdominal obesity or central obesity. Genetic factors may predispose to increased use of these stores. Environmental factors – sedentary lifestyle and high energy diets – contribute to increased abdominal obesity.

Big Fat Cells

Size is everything when it comes to obesity, but it may not be body size or BMI that is crucial. The size of the fat cell or adipocyte may be a bigger risk factor for ill health and co-morbidity.

The more abdominally obese individual, the more fat is stored, and the bigger the adipocyte or fat cell. Leaner people have smaller fat cells.

Adipocytes store fat and if you have abnormally large fat cells it may impede cell function. Fat cells secrete the hormones adiponectin and leptins. Adiponectin plays a role in lipid metabolism and insulin sensitivity. If there is an excess of fat stored in the abdomen, adiponectin levels fall and there is a risk of insulin resistance and dyslipidaemia. In obese individuals, how leptins regulate appetite is impeded and leptin resistance may develop.

Visceral fat plays a role an immune function and, perhaps, also fights infection and cancers. Fat cells may recruit macrophages and release immune mediators, such as interleukins and tumor necrosis factor alpha. In those who have excess visceral fat, maybe overactive immunity leads to damage.  Invariant natural killer T-cells accumulate in visceral fat and obese individuals this may increase risk.

Conclusion

In the future, we may distinguish between those obese individuals at high risk for obesity related metabolic diseases from the metabolically healthy but obese individuals.

Setting realistic achievable targets is crucial to success. The days are numbered for treating all obesity with carte blanche enforced extreme diet restriction. Health promotion strategies focus on motivating people to become fit and losing a bit of weight.

Most health gain will be achieved by focusing on patients most likely to become ill because of their excess weight.

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