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Can you Be Healthy AND Overweight?

Five or six years ago, the idea that people could be overweight yet healthy began to gain credence. Some research studies showed that men and women who were physically active yet a few pounds overweight had a lower risk of heart disease than people who were of normal weight but who did not exercise. In fact, in 2004, one researcher even said that as long as a fat or obese person had normal cholesterol, blood pressure, and glucose levels, they didn't necessarily need to lose weight.

However, new research is casting doubt about this soothing idea. Just after we have finished the over-indulging season of the year, we are seeing new evidence that people who are overweight are indeed at greater risk of heart disease than those of normal weight, regardless of biochemical and physiological markers. The most recent study, published in the journal Circulation on December 28, was a large retrospective study of more than 1700 middle-aged men over a period of 30 years. The men were originally examined and tested at age 50, and then again periodically for the next 30 years. They were placed into groups according to body mass index and metabolic profiles. Some were afflicted with metabolic syndrome, a collection of conditions including high blood pressure, impaired blood glucose use, elevated blood fats, low HDL (the "good" cholesterol) and large waist circumference.

Not surprisingly, those in the worst boat were overweight or obese and with metabolic syndrome. Overweight men with metabolic syndrome had a 74% higher risk of developing heart disease by the time they were 80 years old, and obese men in this group were at 155% higher risk of heart disease. Metabolic syndrome is bad news for everyone, however, since the results showed that even men of normal weight with the syndrome had a 63 percent higher risk of heart disease.

The most interesting finding of the study was that being overweight and yet having none of the conditions related to metabolic syndrome leaves you at higher risk of heart disease than if you were of normal weight. Overweight men with normal blood pressure, cholesterol, and blood glucose still had a 52% higher risk of cardiovascular disease than men of normal weight with similar metabolic characteristics. Obese men with normal metabolic profiles had a 95% higher risk.

Johan Arnlov, Ph.D., an associate professor at Uppsala University and the study's lead author, said in a statement, "Previous studies have put forward the existence of a -metabolically healthy' subgroup" of overweight people "who are at no increased cardiovascular risk." But, he said, if you follow them long enough, you would see that there is no such thing as healthy extra weight.

Supporting this new finding is a study done on women that examined physical activity levels instead of metabolic profiles. The report was published in 2008 and examined nearly 40,000 women who had participated in the Women's Health Study. The results of this study showed that women with a higher body mass index had a higher risk of heart disease, even if they were physically active, than women who were active and of normal weight. Being physically fit reduced the level of risk but did not eliminate the health problems associated with being overweight.

Finally, a study presented in October at the Annual Scientific Meeting of the American College of Gastroenterology, showed that generally large National Football League players had significantly higher rates of metabolic syndrome than a group of smaller athletes: baseball players.

In speculating on why excess body fat, even in otherwise healthy people, affects someone's risk for heart disease, some researchers believe that fat tissue itself has unhealthy characteristics. The authors of the Women's Health Study note that fat releases inflammatory molecules, and inflammation is associated with diabetes and heart disease. A new article in the Journal of Physiology reviewing several new studies also reports that fat can interfere with muscle function.

All the researchers agree that the fit or fat issue is highly complex. Being physically active may affect how fat cells operate in overweight people. Age is a factor, as are genetics. To say "being overweight is unhealthy" may be true but it is a massive simplification of a complicated issue. However, accumulating evidence shows that whether or not being overweight is the reason behind an increased risk of heart disease, being physically active and of normal weight are among the best ways to reduce that risk significantly.

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