The Fit and Fat Debate, Part 2

Big man

Childhood Obesity News has been looking at the confused and tangled matter of fit fatness. Is there such a thing? Can an overweight or obese person ever be said to be truly healthy, no matter how nice the blood test results are? Is all this fat fitness just a way of normalizing the concept of fat acceptance, described by some as a “recipe for world health disaster”?

And of course on one level, fat acceptance is necessary and inevitable — for the health professional. As we have seen, no patient can have a good experience with a doctor who is judgmental and critical. It is an axiom of psychological helpfulness and healing, that no one can change until they are first accepted for who they are.

Meanwhile, regarding the validity of the fat-and-fit proposition, the debate rages on. Alexandra Sifferlin wrote for TIME about a study published by the European Heart Journal, which looked at more than 43,000 subjects and found that “overweight and obese people were found to be at no greater risk of developing or dying from heart disease or cancer, compared with normal weight people, as long as they were metabolically fit despite their excess weight.”

In other words, here is evidence for the theory that it is possible to be both fat and fit. Interestingly, about half of the obese participants were in good enough shape to be deemed metabolically fit. Other research has indicated it’s not so much the fat that matters, but the location of the fat. Sifferlin writes:

… [P]eople who were of normal weight but had a paunch — that is, a lot of visceral or belly fat, which, unlike run-of-the-mill subcutaneous fat, is known to be metabolically dangerous and to promote insulin resistance and inflammation — were twice as likely to die early as people of normal weight with no gut. People with lots of concentrated belly fat also had a higher risk of death than people who were simply obese all over.

Gretchen Reynolds told The New York Times readers of an American study of 40,000 women determining that those with a higher BMI also had a greater risk of heart disease, even if they were physically active, than their normal-weight contemporaries.

In Sweden, Reynolds reports, researchers looked at 30 years worth of medical histories concerning 1,700 men, all in the same city. Metabolic syndrome emerged as a major villain, because even a person of normal weight is far from healthy, if they have it. Having metabolic syndrome, plus being overweight or obese, spells very big trouble indeed. Reynolds says:

Overweight men in that group had a 74 percent higher risk of developing cardiovascular disease by the time they turned 80. Obese men with metabolic syndrome had a 155 percent higher risk.

And even without metabolic syndrome, the overweight man’s risk of heart disease is still a lot worse than it would be at normal weight. This is scary:

Men who were overweight (not obese) with healthy blood pressures, cholesterol readings, blood glucose levels and so on, still had a 52 percent higher risk of developing heart disease within 30 years than men who were normal weight and had similar metabolic profiles. That risk rose to 95 percent among obese men who didn’t suffer from metabolic syndrome.

Reynolds also notes:

Some researchers […] say that fat is itself a tissue with unhealthy properties. Fat can release inflammatory molecules, which increase the risk of diabetes and heart disease. Fat may also interfere with muscle function.

Often it’s hard to see where there is even any ground for debate. Overweight and obesity are problematic, in and of themselves. Metabolic syndrome is bad. A combination is potentially deadly. It’s much better to not have metabolic syndrome, and also better to not be overweight or obese. Here is the bottom line, summed up by the Swedish study’s lead author, Johan Arnloy, Ph.D.:

Some researchers have suggested that a heavy person without other risk factors didn’t need to lose weight. Our data does not support this notion… Previous studies have put forward the existence of a ‘metabolically healthy’ subgroup of obese individuals who are at no increased cardiovascular risk, but if you follow them long enough, you find out there appears to be no such thing as metabolically healthy obesity.

Your responses and feedback are welcome!

Source: “Can You Be Fat and Fit — or Thin and Unhealthy?,” TIME, 09/05/12
Source: “Phys Ed: Can You Be Overweight and Still Be Healthy? ,” The New York Times, 01/06/10
Source: “Overweight men at higher risk of heart attack, stroke, premature death,”, 12/28/09
Image by tombothetominator (Tom Check).

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OVERWEIGHT: What Kids Say explores the obesity problem from the often-overlooked perspective of children struggling with being overweight.

About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:


Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

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