Better to Be Fat and Fit Than Skinny and Unfit

“Despite concerns about an obesity epidemic, there is growing evidence that our obsession about weight as a primary measure of health may be misguided. Last week a report in The Archives of Internal Medicine compared weight and cardiovascular risk factors among a representative sample of more than 5,400 adults. The data suggest that half of overweight people and one-third of obese people are ‘metabolically healthy.’ That means that despite their excess pounds, many overweight and obese adults have healthy levels of “good” cholesterol, blood pressure, blood glucose and other risks for heart disease. At the same time, about one out of four slim people — those who fall into the ‘healthy’ weight range — actually have at least two cardiovascular risk factors typically associated with obesity, the study showed. ‘We use ‘overweight’ almost indiscriminately sometimes,’ said MaryFran Sowers, a co-author of the study and professor of epidemiology at the University of Michigan. ‘But there is lots of individual variation within that, and we need to be cognizant of that as we think about what our health messages should be.’ Several studies from researchers at the Cooper Institute in Dallas have shown that fitness — determined by how a person performs on a treadmill — is a far better indicator of health than body mass index. In several studies, the researchers have shown that people who are fat but can still keep up on treadmill tests have much lower heart risk than people who are slim and unfit. In December, a study in The Journal of the American Medical Association looked at death rates among 2,600 adults 60 and older over 12 years. Notably, death rates among the overweight, those with a B.M.I. of 25 to 30, were slightly lower than in normal weight adults. Death rates were highest among those with a B.M.I. of 35 or more. Stephen Blair, a co-author of the study and a professor at the Arnold School of Public Health at the University of South Carolina, said the lesson he took from the study was that instead of focusing only on weight loss, doctors should be talking to all patients about the value of physical activity, regardless of body size. ‘Why is it such a stretch of the imagination,’ he said, ‘to consider that someone overweight or obese might actually be healthy and fit?’”

http://www.nytimes.com/2008/08/19/health/19well.html?_r=1&oref=slogin