‘Fat But Fit’ Theory Mainly Flops in Long Term: Study
As someone who has struggled with weight control all my life I always thought this smelled like wish fulfillment. The bottom line is if you carry around a pile of lard there will eventually be a price to pay.
If it sounds too good to be true, it probably is.
So I guess no more eating cheeseburgers while I’m trying to pass the time on the treadmill?
Damn!
The actual important results:
I.e., of the 66 individuals labeled as health and obese at the beginning of the study, 34 developed risk factors within 20 years. No word on whether 51% is more or less than the fraction of healthy non-obese people who developed risk factors like high blood pressure or high cholesterol within 20 years. Nor do they report results on actual bad outcomes.
Most ignorant article headline ever as the article (looking in the journal on-line it actually is just a letter, not an actual article) has nothing to do with fitness in any way. Fitness was not measured at any point in the study.
This article merely states what we already know - obesity as a stand alone factor (not looking at fitness) is associated with the development of adverse metabolic markers in the future. No duh. Hence of those who were obese at the start of the study without any adverse metabolic markers (the “healthy obese”) about half developed one or more risk factors over 20 years. Indeed as Dr. Love note - no report of how many “healthy non-obese” did so no way to determine any odds ratio. But no matter, it is already a pretty well established factoid.
The “fat but fit” specifically is the documentation that fitness is an independent predictor of future outcomes whether obesity is present or not, to the degree that a normal BMI individual who is not fit has no better risk than an obese individual who is fit. The best outcomes being held by those who are both normal BMI and fit (and eating a healthy diet and not smoking of course).
I thought the supposedly counter-intuitive “fatter but fitter” thing applied to people who were like 15-20 pounds overweight. Your average schlub, not obese land whales.
Could you (or anyone) explain this a little more, please? I’ve been curious about it for a long time but was too afraid to ask before. (I’m a tiny bit afraid now.) I don’t mean to offend anyone (so apologies if I am).
How is one fit and obese at the same time? I’ve been watching The Biggest Loser for the first time. This is the season with all former athletes. For those people to get to the size they started the show with, they had to eat a lot and not move too much, from what they’re showing on the show. If they were fit, wouldn’t they be not obese?
I can’t see anything about fitness in that article? Am I missing something?
First you get fat. How, I leave as an exercise for the reader. (Or lack of exercise for the reader.) Then you get fit. You’ll probably start losing weight as you get fitter, or maybe not if you simply eat a bit more. You can easily eat in a minute all the calories you burned off in an hour of exercise. But even if you start losing weight, that part takes much more time than the getting fit part.
I can easily walk stairs for 30 minutes without getting out of breath these days, but my BMI is still 35.
Oh, and inactivity is not a prerequisite for getting obese.
Fitness refers to cardiorespiratory fitness. It is often measured by maximal exercise capacity as in a stress test and sometimes proxies for it are used in studies, such as reports of how much time each week is spent in what level of physical activity. The related converse in the predictive value for adverse outcomes with physical inactivity.
Obviously fewer of the fat have high levels of fitness compared to those who are normal weight (defined in these studies by BMI measures) … fatness can be a marker of higher chance to that someone is less active … but some are. One can have high cardiorespiratory fitness and be fat. Minimally one can be not inactive and obese. And obviously one can be of normal weight and have poor cardiorespiratory fitness and/or be very inactive. Some of the latter also have the bad metabolic markers that are generally thought of as consequences of obesity despite being of normal weight.
The data across multiple large scale studies are pretty consistent. A lack of fitness is as important of an indicator for outcomes as obesity is and someone who is both unfit and fat has the highest risk of all (well not counting things like smoking status).
From the actionable POV it translates into making sure that those of normal weight do not think they are “okay” because they are thin whether or not they are active, and that those who are heavy recognize the importance of exercising even if it resulted in no fat loss at all.
What the report of this “article” (and again, it was actually in the letters section) does is confuse a lack of current adverse metabolic markers of obesity (“healthy obese”) for “fitness” - two different concepts even though the fat with high fitness are more likely to be contained within the group without current adverse metabolic markers.
Hm, you’d think those details would be important…not as much fun as proclaiming that “Fat 'n Fit is Wrong!”, but still important.
No one thinks that fat is good (do they?), but I think that part of the “fat and fit” movement is recognizing that getting up and moving has health benefits, even if you don’t immediately lose 100 pounds. That’s kind of important, since it takes a long time to lose that much weight – if you do it in a healthy way.
Major proofreading fail as regards the linked article.
I see multiple references to there being only a “small” or “very small” percentage of the obese people studied that did not accumulate one or more cardiac risk factors over the 20 years of the study. Yet it seems that 49% fell into this category, which is not “small” or “very small”. The study (or what’s reported of it) also did not indicate whether the 51% who showed risk factors actually had worse clinical outcomes. Obviously it is undesirable to (for example) develop hypertension, but showing actual higher incidence of heart attack or stroke in the fat contingent would have been more convincing (as would a contrast to the non-fat group).
And as noted, there’s no reference to exercise/fitness status.
Not that carrying around significant extra weight is a good thing, both for cardiovascular risk and other health measures (like strain on knees and other joints). But it’s hard to see how this study translates into “see, fatties, you’re gonna die much sooner, drop that doughnut and back off”.
Yeah, but anecdotally, I don’t see a lot of fat 70 and 80 year old people around. If they’re not dying I’m forced to assume that their weight gives them mobility problems that keeps them housebound or stuck in mobility chairs. Living just as long as normal weight people but with the last 15 years of my life spent in a chair is less appealing than losing weight.
Right, the choices for fat people are basically the following:
[ol]
[li]Be unconcerned with your weight and health, don’t try to eat healthy or exercise[/li][li]Try your hardest to lose all the extra weight and get down to your normal weight[/li][li]Try to eat healthier and exercise more and not be sedentary, while realizing you might never be non-fat again[/li][/ol]
Obviously choice number 1 is bad for health. Choice number 2 is probably best for health in the ideal world, but that is difficult and the number of people that lose weight and keep it off is extremely small. And losing a lot of weight and then gaining it back definitely doesn’t help your health.
Choice number 3 is obviously the best choice for many obese people. You can start eating more fruits and vegetables and less junk food, and exercise several times a week, and improve your energy levels and cholesterol and arteries but not get down to your ideal weight. This is what the “fat but fit” people are doing.
NFL offensive linemen would be the prototypical Fat but Fit examples. I think the idea is you work out a ton but also eat a ton.
You’d think by now that studies would be designed with the understanding that not all with the same BMI are the same. Consider these three hypothetical guys (similar hypotheticals for females):
The BMI of 33 individual who eats junk and sits on his duff all day.
Someone who has been a stable BMI of 33 while powerlifting with regularity and does some jump rope or stair climbing on off days. Eats a ton and has some fat in addition to muscle.
The person who was a BMI of 38, lost a moderate amount of weight with improved nutrition and consistent exercise and is now a BMI of 33.
Of course they do not all have the same odds for developing the same outcomes.
Some context is gained by comparing the article of the op, with its 66 obese individuals without adverse metabolic markers, with the other larger studies.
(Bolding mine.)
Other larger studies even find different results for the group “metabolically healthy obese” without controlling for fitness depending on how the term is defined. Basically no risk factors and obese had the same long term mortality rates as those of normal weight.
Realistically though the majority of the obese do not fit the standards of having no risk factors and high cardiorespiratory fitness. Fatness continues to be a marker for unfitness risk. But while few who are obese can realistically expect to become and to maintain a normal weight status, they can realistically aspire to moderate weight loss (while still being fat) and to achieving and maintaining moderate levels of fitness. If they do that they will be “fat but fit” and pretty much OK, the bullshit of the linked article notwithstanding.
I’ve never believed it even though I’ve always had a vested interest - too much belly. But I will say this; a couple months back I took a job at a UPS-style package center. Four to seven hours a day, moving boxes up to 70 pounds, building pallets, and all that crap. Thirty-two were in my training class - most younger and a lot more fit looking than I am. Now I’m sure other reasons came into play and not just fitness but only five of us are left. Is fat unhealthy? I’m betting yes. But I’ve also got a few bucks riding on skinny not always amounting to much either.
Thank you for all the interesting information. And thank you to iljitsch also for providing a personal story.
I can understand how someone can become unfit and gain a lot of weight and then start to gain fitness and still be large. And I suppose DSeid’s studies indirectly show that it’s possible, but my curiosity was about whether people could be fit in a cardiorespiratory way and remain obese for decades. My thought was that if someone is fit enough to exercise regularly for decades, then remaining the same weight would require more food to keep the weight on since muscle is also being built at the same time. It seems like one of those two things would shift over time.